Preventing controlled substance diversion in perioperative settings: a narrative review

Area of Science:

• Anesthesiology and Perioperative Medicine
• Pharmacology and Drug Safety
• Healthcare Management and Policy

Background:

• Diversion of controlled substances poses significant risks in perioperative environments, affecting patients, staff, and facilities.
• Perioperative settings, including operating rooms and recovery units, are high-risk areas for drug diversion due to frequent handling of controlled substances.

Purpose of the Study:

• To review and summarize strategies for preventing the diversion of controlled substances within perioperative settings.
• To provide an overview of current approaches to mitigate drug diversion risks in anesthesia and surgical environments.

Main Methods:

• A comprehensive literature search was conducted across major databases (PubMed MEDLINE, Embase, Scopus, Web of Science, Cochrane).
• Searches included terms related to drug diversion, anesthesiology, perioperative staff, and controlled substances.
• Manual reference searching was also performed to supplement the database findings.

Main Results:

• Identified strategies for preventing diversion are broadly categorized into education, distribution controls, auditing, and provider screening.
• Some existing strategies are resource-intensive, and there is limited evidence to guide the selection of optimal methods.
• Awareness of perioperative diversion is increasing, but a definitive optimal approach remains undefined.

Conclusions:

• Anesthesia departments require collaboration with hospital pharmacies to implement effective diversion prevention strategies.
• Selection of strategies should be based on local resources and evidence, acknowledging the current limitations in data.
• Proactive and collaborative selection of reasonable strategies is essential for managing perioperative controlled substance diversion.