Addressing drug diversion among EMS Providers
By W. Ann “Winnie” Maggiore, JD, NRP
It’s no secret that the United States is mired in an opioid abuse epidemic. The powerful opioid fentanyl has its roots in anesthesiology, and has affected medical professionals
in a very unfortunate way. Hardly a day goes
by without news articles addressing the issue.
In the medical field, with easy access to
narcotics, abuse of opioids has become a
major concern. Ethan Bryson, MD, wrote
the book Addicted Healers after hearing lectures by addicted physicians while he was
in his residency. During these talks, Bryson
learned about drug diversion, and particularly
about anesthesiologists who became addicted
to fentanyl. 1
Fentanyl is an opioid analgesic that’s 100
times more potent than heroin, and is generally regarded as an extremely powerful painkiller. Its origins go back to 1959, when it was
synthesized by Belgian chemist Paul Janssen. 2
Initially, it was developed for palliative care, but
its use soon expanded to anesthesia. Transder-mal use of the drug in the familiar “fentanyl
patch” became common in the 1990s. About
10 years ago, EMS providers began using fentanyl in the prehospital setting for pain control.
RECENT CASES OF ABUSE
In East St. Louis in early 2017, Jason Laut, a
former paramedic, was charged with 37 felony crimes in federal court after it was found
he was stealing fentanyl and morphine from
Metro East ambulance. 3 Laut wasn’t only
a paramedic, but also a supervisor and dispatch manager with MedStar Ambulance
Service. He’s also married, and the father of
Laut falsified trip logs to show trips that
were never taken and nonexistent patients,
and documented orders from a physician who
no longer worked at the hospital he claimed
he got orders from. The criminal indictment
charges Laut with “tampering, theft, misuse
and abuse of controlled substances, including
fentanyl and morphine” He faces a potential
20 years in prison.
Interestingly, the listed crime victim is
Memorial Hospital, which operates the
Southwestern Illinois EMS system. Fentanyl
diversion was suspected by service administrators there as early as 2014, and the drug was
removed from ambulances at that time. It was
re-initiated in 2015 after additional safeguards
were put in place.
In April 2015, former Grand County Col-
orado EMS employee Matthew Holmes was
sentenced to 90 days in jail after he was con-
victed of stealing drugs from EMS vehicles. 4
The criminal complaint alleged that Holmes
stole morphine and fentanyl from three dif-
ferent ambulances, replacing the drugs with
an “imitation controlled substance.”
In this case, the Colorado Department of
Public Health initially noted a diversion prob-
lem in 2013 and initiated its own investiga-
tion, but turned it over to the Colorado Bureau
Drug diversion is a tactful term used by the
Drug Enforcement Agency for theft of medications, usually a misappropriation of controlled substances by medical providers for
their own use. 5 Diversion of medications
meant for patients is both unethical and illegal.
Opioid abuse frequently begins with
legitimate use of medications for pain control.
Work-related injuries, such as back and knee
injuries, can result in surgery and long-term
recovery. All too often, after a course of pain
medications, addiction quickly follows and
the addict looks for access to more narcotics. 6
Easy access to narcotic pain medications
in EMS can lead quickly to diversion issues.
Employees under unusual stress may also be
at risk for addiction. Providers suffering from
opioid addiction may even look to steal drugs
from patients’ homes while on a call.
The actions of EMS providers who abuse fentanyl can have life-threatening consequences
for patients. It can also have profound consequences for the EMS service and the service’s
Fentanyl is particularly well-suited to the
high-functioning user because it delivers an
intense but short-acting effect. Euphoria and
analgesia last about an hour, making it also
appropriate to use in the prehospital setting.
An EMS provider who engages in drug
diversion could be subject to criminal liability for theft, embezzlement, battery or other
crimes. In addition, the provider could be terminated from employment and could face a
licensure action up to and including revocation from the licensing agency.
The EMS service could face legal problems including loss of certification, or penalties from the local pharmacy board if the
agency failed to take proper precautions to
prevent drug diversion. Agencies that fail to
act when informed of drug diversion could
face additional liability.
EMS agencies should make it clear to their
employees that failure to report suspected
diversion of narcotics is a serious breach of
legal and ethical duties to patients.