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The opioid epidemic has reached unprecedented depths — Americans are now more likely to die from opioid overdoses than car accidents, according to a 2019 analysis by the National Safety Council. While other aspects of this devastating public health crisis have caught mainstream attention, drug diversion in U.S. hospitals — in which health care workers divert opiates and other controlled substances away from patients for personal use or sale — is largely under discussed.

Hospital diversion should not be ignored. According to the Joint Commission, the practice threatens patient safety by interfering with their pain relief and potentially exposing them to infectious diseases. It also jeopardizes health care providers’ lives and livelihoods, damages hospital reputations, and can generate enormous fines.

To better understand diversion, the BD Institute for Medication Management Excellence commissioned KRC Research, a global public opinion research consultancy, to conduct a national survey of more than 650 hospital executives and providers to better understand hospital diversion perceptions, behaviors, and solutions. The findings are eye-opening.

According to the survey, hospital executives and providers may be in denial about substance use and drug diversion in their own hospitals. Despite evidence to the contrary, 26% of executives and 29% of providers surveyed believe substance use disorder is less prevalent among hospital employees than the general population. Though 85% of providers are concerned about hospital drug diversion, and 50% report observing suspicious activity, fewer than 20% believe it is a problem in their own facility.

Education may be part of the solution. While 60% of providers say they have either taken a diversion training course, talked about it in a work meeting, and/or received information from their hospital, 40% report they have not had any formal training. More than a third have not received diversion information from their hospital or discussed it at work. Among those who had not received any diversion-focused training or communication, 60% would like that to change.

Diversion should not be a taboo subject. Roundtables and informal peer discussions can help hospital staff understand the risks they face and guard against them.

Workplace stress may make providers vulnerable to substance use disorder. In the survey, 58% of nurses and 52% of anesthesiologists say their jobs are highly stressful. Among providers, 78% know a peer who may be stressed “to the breaking point.” And, though 74% of providers are comfortable seeking help, only 39% have actually sought assistance.

Hospitals have an opportunity to encourage frontline staff to engage with these programs. In addition, there are many anecdotes about suspected diverters who, once caught, express relief their ordeal is over. Providing an obvious pathway for people to self-report, without destroying their lives, could bring more to the table.

When asked if diversion is difficult to manage, 80% of executives and 60% of providers believe it is very or somewhat difficult. Most say their hospital currently uses electronic medical records, automated dispensing cabinets, and internal controlled substance audits to detect diversion. Just over half say they use internal inventory systems.

To improve their ability to detect drug diversion, those surveyed said more accurate data is needed to identify suspected diverters without generating false positives. In addition, machine learning can reconcile reports from automated drug dispensing cabinets, waste disposal, electronic medical records, and other sources, streamlining a cumbersome process.

This research should not be the last word on diversion. Rather, it should spark a national conversation, spur much-needed research, and ultimately encourage hospitals and health systems to adopt comprehensive diversion prevention programs. Through technology, communication and training, cultural shifts, and other means, diversion risk can be addressed in a meaningful way.

Visit for more information about this research, including a detailed white paper and resources guide.