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Preventing controlled substance diversion in perioperative settings: a narrative review

Prévention du détournement de substances contrôlées en milieu périopératoire : un compte rendu narratif

  • Review Article/Brief Review
  • Published:
Canadian Journal of Anesthesia/Journal canadien d'anesthésie Aims and scope Submit manuscript

Abstract

Purpose

Diversion of controlled substances in the perioperative setting is an ongoing challenge, with consequences for patients, anesthesiologists, perioperative staff, and health care facilities alike. Perioperative environments are at high risk for diversion, since controlled substances are frequently handled in these settings, with varying levels of oversight. In this narrative review, we summarize strategies for preventing diversion of controlled substances in perioperative settings (i.e., operating rooms, endoscopy suites, and postanesthesia recovery units).

Source

We performed a targeted literature search in PubMed MEDLINE, Embase, Scopus, Web of Science, the Cochrane Register of Controlled trials, and the Cochrane Database of Systematic Reviews, as well as a manual search for additional references. We used terminology related to drug diversion, drug abuse, anesthesiologists, pharmacists, physicians, operating room personnel, and controlled substances.

Principal findings

Many strategies have been described for preventing diversion in perioperative settings, and these are broadly categorized into: education, distribution, auditing, or provider screening. Some of these approaches may be time- and resource-intensive. There is limited evidence to inform anesthesia departments’ choice of which strategies to adopt.

Conclusion

Although awareness of perioperative controlled substance diversion has been improving, there are too few data to suggest an optimal approach. Anesthesia departments will need to work collaboratively with hospital pharmacies and actively select strategies that are reasonable given local resources.

Résumé

Objectif

Le détournement des substances contrôlées en milieu périopératoire constitue un défi permanent qui a des conséquences pour la patientèle, les anesthésiologistes, le personnel périopératoire et les établissements de soins de santé. Les environnements périopératoires courent un risque élevé de détournement, car les substances contrôlées sont fréquemment manipulées dans ces milieux, avec divers niveaux de surveillance. Dans ce compte rendu narratif, nous résumons les stratégies de prévention du détournement des substances contrôlées dans les milieux périopératoires (c.-à-d. salles d’opération, salles d’endoscopie et salles de réveil).

Sources

Nous avons réalisé une recherche documentaire ciblée dans les bases de données PubMed, MEDLINE, Embase, Scopus, Web of Science, le registre Cochrane des essais contrôlés et la base de données Cochrane des revues systématiques, ainsi qu’une recherche manuelle de références supplémentaires. Nous avons utilisé une terminologie liée au détournement de médicaments, à l’abus de substances, aux anesthésiologistes, aux pharmacien·nes, aux médecins, au personnel de salle d’opération et aux substances contrôlées.

Constatations principales

De nombreuses stratégies ont été décrites pour prévenir le détournement dans les milieux périopératoires, et celles-ci sont généralement classées en éducation, distribution, audit ou dépistage des fournisseurs et fournisseuses de soin. Certaines de ces approches peuvent exiger beaucoup de temps et de ressources. Il existe peu de données probantes pour éclairer le choix des départements d’anesthésie quant aux stratégies à adopter.

Conclusion

Bien que la sensibilisation au détournement périopératoire de substances contrôlées se soit améliorée, il y a trop peu de données pour suggérer une approche optimale. Les départements d’anesthésie devront travailler en collaboration avec les pharmacies hospitalières et choisir activement des stratégies raisonnables qui tiennent compte des ressources locales.

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Author contributions

Michael J. Wong conceptualized the review, performed the literature search, wrote the first draft, and edited and approved this manuscript. Yongjun Wang wrote, edited, and approved this manuscript. Lindsay Blake performed the literature search, and edited and approved this manuscript. Janny X. C. Ke wrote, edited, and approved this manuscript.

Acknowledgements

The authors thank Dr. Gregory Dobson for his guidance and assistance in the planning of this manuscript.

Disclosures

Dr. Janny Ke reports receiving salary support as the Clinical Data Lead, St. Paul’s Hospital, Vancouver, BC, Canada, for the project “Reducing Opioid Use for Pain Management” from the Canadian Digital Supercluster and Consortium (Careteam Technologies Inc., Thrive Health Inc., Excelar Technologies (Connected Displays Inc.), Providence Health Care Ventures Inc., and Xerus Inc.). Dr. Ke has provided paid consulting for Careflow Technologies (Connected Displays Inc.), funded via Providence Health Care Ventures. Starting September 2023, Dr. Ke will receive research and salary support for the Project “Continuous Connected Patient Care” in patients with high perioperative risk, funded by the Canadian Digital Supercluster and Consortium: Medtronic Canada ULC, Cloud Diagnostics Canada ULC, Excelar Technologies (Connected Displays Inc.), Providence Health Care Ventures Inc., 3D Bridge Solutions Inc., and FluidAI (NERv Technology Inc.).

Funding statement

No funding was specifically provided for the preparation of this work.

Editorial responsibility

This submission was handled by Dr. Philippe Richebé, Associate Editor, Canadian Journal of Anesthesia/Journal canadien d’anesthésie.

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Authors and Affiliations

  1. Department of Anesthesia, Pain Management & Perioperative Medicine, Dalhousie University, Saint John, NB, Canada

    Michael J. Wong MD

  2. Department of Anesthesiology, Perioperative and Pain Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada

    Yongjun Wang MD

  3. UAMS Library, University of Arkansas for Medical Sciences, Little Rock, AR, USA

    Lindsay Blake MLIS, AHIP

  4. Department of Anesthesiology, Pharmacology & Therapeutics, The University of British Columbia, Vancouver, BC, Canada

    Janny X. C. Ke MD, MSc

  5. Department of Anesthesia, St. Paul’s Hospital/Providence Health Care, Vancouver, BC, Canada

    Janny X. C. Ke MD, MSc

  6. Department of Anesthesiology, Pain Management, and Perioperative Medicine, Dalhousie University, Halifax, NS, Canada

    Janny X. C. Ke MD, MSc

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  1. Michael J. Wong MD
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  2. Yongjun Wang MD
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  3. Lindsay Blake MLIS, AHIP
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Correspondence to Michael J. Wong MD.

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Wong, M.J., Wang, Y., Blake, L. et al. Preventing controlled substance diversion in perioperative settings: a narrative review. Can J Anesth/J Can Anesth 70, 1989–2001 (2023). https://doi.org/10.1007/s12630-023-02574-4

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  • DOI: https://doi.org/10.1007/s12630-023-02574-4

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