By Barbara Forshier on March 30th, 2017 in Diversion, License Defense
For nurses, being accused of drug diversion is not only frightening—it’s potentially career-ending. These allegations can carry serious consequences ranging from felony charges to job loss and license suspension or revocation.
If you’re facing a drug diversion accusation, Forshier Law can help you respond strategically and protect your future. Attorney Barbara Forshier brings a rare combination of legal skill and clinical insight to every case. Before becoming a lawyer, she spent 25 years as a registered nurse at a major Twin Cities hospital. Today, she defends nurses in licensing and misconduct investigations with the goal of preserving their careers and reputations.
What is Drug Diversion in Healthcare?
Drug diversion refers to when a healthcare provider takes—whether for personal use, sale, or distribution—medications that have been prescribed to someone else. This may involve stealing wasted portions of administered drugs or withholding them from patients.
Drug diversion is often driven by personal needs, with between 10% and 15% of healthcare workers struggling with drug dependency at some point in their careers. Opioids like codeine, fentanyl, oxycodone, and hydrocodone combinations are the most commonly diverted drugs, but others like high-cost antipsychotics have also been frequently reported.
As a nurse, being wrongly accused of drug diversion can take a heavy toll on your career, your reputation, and your emotional state. The penalties for drug diversion can include not just suspension or termination but also criminal prosecution and suspension of your license by the Minnesota Board of Nursing. Worse still, defending yourself can be complex and mentally exhausting. You may need to provide detailed explanations of your medication handling, documentation practices, and adherence to facility protocols—sometimes under intense scrutiny.
Signs of Drug Diversion in Nursing
There are certain red flags that may suggest someone is diverting, even when they aren’t. These actions can be innocent, but when they appear as patterns or are coupled with other issues, they may be misunderstood. If you notice any of the following behaviors in your work practice, it is essential that you review your documentation habits, clarify your facility’s policies, and take steps to correct the situation.
- Irregular or suspicious behavior: This might include visiting the facility outside your scheduled hours, coming in early or staying late, or taking longer-than-usual breaks. While these actions often have innocent explanations—like picking up an extra shift or helping a coworker—they may raise concerns if they happen often without clear context.
- Always needing to waste some of the drugs: Regularly needing to waste medications—especially without a clear or consistent reason—can be seen as a red flag. Documenting patient refusals or dropped meds is important, but if it becomes a pattern, make sure your notes clearly reflect why the waste occurred and that you’re following your facility’s witness requirements.
- Pattern of patients not experiencing expected pain relief: A trend of patients reporting unrelieved pain after receiving medication may prompt review. While this could point to a medical issue unrelated to diversion, it’s wise to ensure your documentation fully reflects what was administered and when—and to note any patient feedback or complications.
- Constant presence around narcotics: Nurses who regularly volunteer to count controlled substances, medicate others’ patients, or request extra doses may draw attention—even when acting out of helpfulness. To avoid misunderstanding, make sure your actions are documented and that requests for additional medication are medically justified.
- Deterioration in physical appearance, work habits, and productivity: Fatigue, stress, or personal life challenges can sometimes affect your appearance or behavior at work. While these aren’t inherently signs of drug use, they may be misinterpreted. If you’re noticing changes in your energy, mood, or focus, it may be helpful to talk to a supervisor or seek support.
- Inaccurate records: Errors in medication documentation—such as missing waste witnesses, mismatched administration times, or unaccounted doses—can trigger audits or investigations. These issues are often the result of being busy or understaffed, but it’s important to review your charting habits and align closely with your facility’s medication handling policies.
Best Practices For Preventing Drug Diversion Allegations
If you worry that your actions might be perceived as diverting, tackle the issue before you are wrongfully accused. Adhering to these best practices for substance handling can make the difference in protecting your career.
- Withdraw only what you need: Avoid withdrawing more than the patient is expected to receive. Not only does this reduce waste, but it also limits the chance of miscalculation, mishandling, or misinterpretation by others reviewing your records.
- Don’t have one “waste buddy”: Have more than one person regularly witness you waste. This can avoid miscommunications and ensure that more than one colleague in the practice can vouch for you if issues ever arise.
- Don’t wait to waste: Waste immediately with a witness whenever the dose is known. Wasting at the cabinet right when the medication is removed is best practice and is often facility policy. .
- Don’t hesitate or wander with controlled substances: Administer the drug in close proximity to removing it from the medication dispensing system or waste it. Carrying medications in your pockets throughout the day can raise questions and create unnecessary suspicions. NEVER put medications in your pockets.
- Keep careful records: Account for every drop of IV medication or pills.
- Know and follow your facility’s controlled substance policies: Use the correct containers for disposal every time. A sink, toilet, plant, or regular sharps container will not do the trick.
- No “honor system”: Be known as someone who actually witnesses the waste every time. Don’t get drawn into someone asking you to use the “honor system,” even to save time or help a friend. The risks are not worth it.
- If you pull you push: Except during an emergency, the nurse who is to administer the medication should always be the one to withdraw it. This keeps accurate records of what has been withdrawn as well as who is responsible for it.
- Chart administration as soon as possible: Charting administration helps ensure better and more consistent patient care. It also clearly reflects your habits as a nurse and creates a record for your own protection.
- Chart pre- and post-administration pain scales: Patients who consistently report lack of pain relief are a red flag that someone in the practice may be diverting, or even replacing substances with something else, such as saline.
- Ensure that your orders reflect your practice: Critical thinking in nursing means avoiding one-size-fits-all solutions that can lead to dangerous dependencies and unsafe practices. For instance, consider a prescription of morphine for the pain of 8 or greater—but you and your colleagues consistently medicate for the pain of a 6 or greater. Exercising your clinical judgment here can help avoid errors for patients and identify risks for their safety as well as for your own career.
- Be sure to bar code scan your controlled substances. If you are giving 2 tablets to equal a full dose, scan each dose; do not scan one tablet twice.
If You’ve Been Falsely Accused Of Diverting Drugs, Forshier Law Can Help
A drug diversion accusation can put your license, career, and reputation at risk. With so much at stake, it’s critical to have an advocate who understands both the clinical and legal complexities involved. As a registered nurse and experienced attorney, Barbara Forshier brings 40 years of nursing experience to every case she handles. At Forshier Law, we offer strategic, compassionate representation focused on protecting your professional future. Contact us today to start building your defense.
