Jessica Gerstein

Annotated Bibliography
October 25,2015
ENC1102 Wolcott
The Problem of Drug Diversion in the Nursing Field

Drug Diversion means the transfer of a controlled substance from a lawful to an

unlawful channel of distribution or use. (Berge.) This is a prominent issue that within
hospitals and health-related industries that is unknown to those outside of this field. The
many ways that nurses attempt to steal these drugs for illegal and personal purposes, and
every article written about drug diversion, establishes that this behavior is illegal and
should be treated as such. Nurses lose their licenses and face time in prison because this
is an unauthorized abuse of their power. State programs established to help these nurses
that face these issues are available because mental health, and the addiction that comes
with this problem, is taken very seriously. This bibliography attempts to represent
selected documentation from a wide range of sources, including books and articles from
the web. All publications of this bibliography range from the past three decades and all
publications within are in English. This was written with the intended audience of nursing
students, workers in the medical field, or those interested in the topic of drug diversion.
This bibliography was written to prove an overall understanding of the horrific problem
of drug diversion within the hospitals and clinics in this United States.

Berge, Keith H., Kevin R. Dillon, Karen M. Sikkink, Timothy K. Taylor, and William L.
Lanier. "Diversion of Drugs Within Health Care Facilities, a Multiple-Victim
Crime: Patterns of Diversion, Scope, Consequences, Detection, and Prevention."
Mayo Clinic Proceedings. Mayo Foundation, 12 July 2012. Web. 11 Oct. 2015.

Jessica Gerstein
Annotated Bibliography
October 25,2015
ENC1102 Wolcott
Anesthesiologist Keith H. Berge, doctor at the Mayo Clinic in Minnesota, and
wrote this article in order to raise awareness for the current and ongoing
prevention of drug diversion. In this article, it is brought to the reader's attention
that drug diversion is not an individual criminal act, and drug diversion involves
more than the one health care professional. Berge touches on the consequences
and harm drug diversion puts on a patient's health. In addition to how this would
affect patients, it would also affect the employer and other employees. Unlike
other articles I have read regarding drug diversion, she includes signs of what
encountering an employee using drugs illegally would be like.

Borns, Patricia. "Investigation: Addicted Nurses Steal Patients' Drugs." The News
Leader. News Leader, n.d. Web. 11 Oct. 2015.
Patricia Borns, staff writer for The News Leader and prior Miami Herald and
Boston Globe editor, investigates the state of Virginias way of dealing with drug
diversion. Using actual stories of real nurses and how they started out with this
problem and how Virginia dealt with this problem. Virginia offers a monitoring
program for nurses with an addiction problem. The idea of returning a nurse
struggling with addiction to a workplace filled with drugs seems counterintuitive to some. (Borns) Having examples of specific instances where drug
diversion has hurt someone's career as well as their health, but knowing there is a
state program there to help them is very important to my bibliography.

Jessica Gerstein
Annotated Bibliography
October 25,2015
ENC1102 Wolcott
Burke, John. "Drug Diversion: The Scope of the Problem." Naddi.org. N.p., n.d. Web.
John Burke, president of the nonprofit organization National Association of Drug
Diversion Investigators, writes an article discussing the importance of stopping
drug diversion. He also discusses how addictive prescription drugs are and how
this relates to why drug diversion is a major problem. Burke lists and explains
common pain relievers, tranquilizers, and forged and altered prescriptions. In
addition to these he also goes into detail about those involved such as doctor
shoppers, whose full time job is to visit practitioners and exaggerate symptoms to
see how easy it is for them to obtain prescriptions. Burke makes a final point that
drug abuse is not always revolved around street violence, but that it is a criminal
act and is a leading factor in death. This article is very helpful in adding insight
from someone who focuses on stopping drug diversion.
Carpenter, Holly. "The Painful Problem of Drug Diversion and What You Can Do
American Nurse Today." American Nurse Today. N.p., 02 Dec. 2014. Web. 11
Oct. 2015.
Senior Staff specialist Holly Carpenter wrote the article The Painful Problem of
drug Diversion and What You Can Do, a preventative and informative read.
While informing the reader with facts, she gives insight to readers on the
consequences, actions and resources of drug diversion. In 2010 alone,
hydrocodone with acetaminophen was prescribed 131.2 million times(Carpenter)
A tip of advice that Carpenter wrote about is to require that employees are

Jessica Gerstein
Annotated Bibliography
October 25,2015
ENC1102 Wolcott
educated on drug abuse and how the dangers will not only affect them or their
career, but their family, workplace and coworkers.
Catlin, Bill (2015) Minnesota Company at Center of Alleged $400 Million Fraud.
Retrieved from http://www.mpr.org/
Bill Catlin, a 30-year employee of Minnesota Public Radio now the editor
responsible for directing this companys business and economic news, reports
about the wholesaler Minnesota Independent Cooperative and their indictment
with the federal law. In May 2015, David Miller and his company were allegedly
involved in a fraud scheme of $400 million including purchasing prescriptions
from illegal sources and selling these prescriptions to pharmacies. Miller, the
owner, was one out of 33 other employees who was held at large for the
companys discrepancies that were not arrested. This alleged federal crime is an
example of a different point of view of drug diversion, while we normally hear
about nurses in hospitals committing these felonies.

Chait, Jennifer. "Drug Abuse Among Nurses." LoveToKnow. N.p., n.d. Web. 23 Oct.
2015.
The article Drug Abuse Among Nurses was the most factual article out of this
whole bibliography. Jennifer Chait is a full-time freelance writer.
This informational article gave statistics involving the large-scale study;
Substance use among nurses: differences between specialties. This study reveals

Jessica Gerstein
Annotated Bibliography
October 25,2015
ENC1102 Wolcott
the few rather interesting facts from the study, such as Pediatric and emergency
nurses reported a higher use of cocaine than other specialties. (Chait) These facts
give a different look on drug diversion because this article is simply stating the
facts rather than giving the strong opinion of how bad drug diversion is for nurses.
Though the article does gives preventative tips and how to watch for drug abuse,
these facts are the main focus of this article.
Christianson, Eric. "NurseTogether.com." How Drug Diversion Will Affect Your
Nursing Career. Nursetogether.com, 13 Dec. 2013. Web. 11 Oct. 2015.
Author Eric Christianson, founder of MedEd101.com and writer for Nurse
Together, pieces together how drug diversion can affect ones nursing license. In
this article, he touches on instances where nurses that want to divert drugs, will
divert those drugs whether or not it will affect their job. He also includes that if
there were to be a problem endangering a nurses career that there is help, such as
state-programs. This article is relevant because it touches on how a nursing
license would be affected if such diversion were to occur.

Cole, B. Eliot. "Recognizing and Preventing Medication Diversion." - Family Practice

Management. N.p., 08 Oct. 2001. Web. 23 Oct. 2015.
This articles main point is informing patients how to spot if their caretaker is
abusing their medications. This quote, Pain must be regarded as a disease and
the physicians first duty is action heroic action to fight disease, by Benjamin

Jessica Gerstein
Annotated Bibliography
October 25,2015
ENC1102 Wolcott
Rush is the opening quote and is meant for empowering patients to realize the
problem that could be right in front of their face. While it is normally focused
upon nurses and patients, confidentiality from doctors should be taken seriously
as well. Prescription pads should be kept in a safe, locked place just to be safe
from theft. B. Eliot Cole has his Masters of Public Administration as well as his
MD.

Creighton, Bonnie. "This Is "how" Nurses Divert Drugs for Their Own Use."Answers
Articles and Jobs for Nurses and Nursing Students RSS. Allnurses.com, 07 Jan.
2003. Web. 11 Oct. 2015
Bonnie Creighton, an RN from Minnesota, uses this post to describe her personal
relation to drug diversion and how drug diversion happens. She uses examples
specific to each medicine, such as if a patient is on Morphine the nurse would
simply replace the drip of Morphine with the same amount of saline. The
Nurse often "forgets" to document the narcotics supposedly given, on the
patient's med sheet in the chart. (Creighton) In her closing paragraph, Creighton
talks about how state programs are available to those using drug diversion for
their own addiction, however not available to those selling the narcotics.

"Diversion Central." Drug. N.p., n.d. Web. 23 Oct. 2015.

Jessica Gerstein
Annotated Bibliography
October 25,2015
ENC1102 Wolcott
As a change of topic from the horrors drug diversion, Drug Diversion Central
holds online seminars, Webinars, to inform people on drug diversion and ways to
prevent controlled substance abuse. The next webinar is held on November 10th
of this year. The webinars stress the topic of following DEA regulations.

Eichenwald, Kurt. "When Drug Addicts Work in Hospitals, No One Is

Safe."Http://www.newsweek.com/2015/06/26/traveler-one-junkies-harrowingjourney-across-america-344125.html. NewsWeek, 18 June 2015. Web. 23 Oct.
2015.
Kurt Eichenwald, three time New York's Best Selling Author and previous news
editor for Vanity Fair, tells the story of David Kwiatkowski. Kwiatkowski was
known as a traveling nurse, but had a drug problem with opiates but it became an
even bigger problem when he infected over 45 people with Hepatitis C. As
Eichenwald tells this medical horror story along with a drawn out article of
Kwiatkowskis whole life, it allows the reader to think of how scary it is. Not just
drug diversion and addiction but how this risky action can lead to killing patients
because of their negligence.

Hughes, Patrick. "Prevalence of Substance Use Among US Physicians."JAMA Network.

N.p., n.d. Web. 23 Oct. 2015.

Jessica Gerstein
Annotated Bibliography
October 25,2015
ENC1102 Wolcott
Patrick Hughes presents an article thats purpose was to estimate the prevalence of
substance abuse among physicians. An experiment was done anonymously
through the mail to discover how many physicians had used alcohol and illicit
drugs. 59% of these people asked to respond answered and allowed for the results
to back up the claim that physicians use these substances, but not abuse them.
This was discovered on the Journal of American Medical Association, the JAMA.

Injection Safety." Centers for Disease Control and Prevention. Centers for Disease
Control and Prevention, 08 Sept. 2015. Web. 23 Oct. 2015.
This government verified website from the Center of Disease Control and
Prevention created a web page that includes prevention tips and also resources
for anyone who may be involved with drug diversion. While this web page
focuses on injections, it also shows statistics like in 1992 when 45 cases of a
Hepatitis C outbreak were connected back to a surgical technician in Texas.
Statistics like these help to show how common it is that diversion goes on, but it
also shows how serious it can affect patients during their malpractice. Tampering
with a patients medicine and tools to give the medicine causes a denial of very
essential medications for pain management, standard care and risks their health.

Laferney, Michael C. "Dealing with Drug Diversion.

Jessica Gerstein
Annotated Bibliography
October 25,2015
ENC1102 Wolcott
"Http://www.reflectionsonnursingleadership.org/Pages/Vol36_2_Col_LaFerney.a
spx. N.p., 20 Aug. 2010. Web.
Reflections on Nursing Leadership website gives more than just information of
leadership positions within nursing field but releases books and the website posts
articles regularly. In this article, Laferney goes into detail on what a nurse abuse
on the job. Laferney is a psychiatric clinical nurse specialist in Massachusetts. He
explains shortly some ways that nurse managers do their job but stresses on
signs that nurse managers should be aware of relating to drug abuse.

"Spotlight On... Drug Diversion." Spotlight On... Drug Diversion. U.S Department of
Health and Human Services, 24 June 2013. Web. 20 Oct. 2015.
Government approved website, Office of Inspector General for the U.S
Department of Health and Human Services, released a spotlight shining on the
topic of Drug Diversion. In this article, a real life example was talked about in
short how a physician Dr. Friedlander wrote illegal prescriptions for patients who
were addicted to controlled substances. Friedlander was sentenced to jail for 9
years and was ordered to pay restitution. This article gave other examples of
instances involving prison time, this outlook on drug diversion allows for us to
put into perspective how serious this is.

Tanga, Hazel. (2011) Nurse Drug Diversion and Nursing Leaders Responsibilities.

Jessica Gerstein
Annotated Bibliography
October 25,2015
ENC1102 Wolcott
JONAS Healthcare Law, Ethics, and Regulation. Volume 13, Number 1.
Retrieved from Illiad
In this journal Hazel Y. Tanga, MSN from Gonzaga University and currently
nurse manager at Veteran Affairs San Diego Healthcare System, expands upon
drug diversion within nursing leaders. In this journal, Tanga uses a theoretical
example allowing the reader to imagine he or she is a nurse executive (NE). She
gives plenty of instances where the reader would have to make decisions about
what their strategy would be. What should the nurse manager and the nurse
executives next course of action be?(Tanga 14) She then knows that each
reader isnt a NE and answers the question how it was handled and why. This
journal excerpt is beneficial as it shows the problems that nurse executives come
in contact with in the specific case of drug diversion.

Thomas, Cynthia M. "The Impaired Nurse: Would You Know What to Do If You
Suspected Substance Abuse?" American Nurse Today. N.p., 11 Aug. 2011. Web.
20 Oct. 2015.

This article written by Cynthia Thomas, assistant professor of Nursing at Ball

State University, gives real life instances where coworkers may suspect illegal
behavior seen on the job. This scenario depiction allows for the reader to see and
know how to handle specific situations, it also gives opportunity for readers to

Jessica Gerstein
Annotated Bibliography
October 25,2015
ENC1102 Wolcott
learn how to bring it up to bosses or head of departments around the hospital. This
article suggests to nurses to become aware of the signs of addiction and controlled
substance abuse, do not allow yourself to be manipulated or fear confronting a
nurse if patient safety is in jeopardy.(Thomas) The way this article is written
supports the claim of how serious drug diversion is, especially to those coworking nurses involved and how they can prevent malpractice.

Warner, David O. "Substance Use Disorder Among Anesthesiology Residents."

Http://jama.jamanetwork.com/article.aspx?articleid=1787405&resultClick=1.
JAMA, 04 Dec. 2013. Web. 23 Oct 2015.
The Journal of the American Medical Association released this article, written by
David Warner, an anesthesiologist from the Mayo Clinic in Rochester, Minnesota.
On the American Board of Anesthesiology in North Carolina, Warner goes into
detail of a long-term study done on physicians who had just begun training in
their residencies for anesthesiology testing to see how many of the 44,612
residents would abuse substances. The purpose of this study was to describe the
incidence and outcomes of SUD among anesthesiology residents in the United
States. (Warner)