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An investigation into reports of diversion
should be initiated, and should involve the service’s medical director. Carefully review drug
logs and place suspect personnel on administrative leave. Law enforcement should also
be involved as appropriate.
Services should create a culture of reporting, emphasizing that it’s the right thing to do.
Keeping quiet when noticing signs of impairment in a colleague helps no one, and certainly
doesn’t help the provider.
If an impaired provider is identified, ask for
them to be evaluated by an addiction specialist. Your state may also require that the service
identify the provider, and the licensing agency
may initiate its own investigation. Some states
have a program that can facilitate rehabilitation
for the addicted provider. The provider should
return to work only upon a physician’s release.
Fentanyl abuse and diversion is a grow-
ing problem in the EMS community. Easy
access to this highly addictive medication
can open the door to major problems for
EMS services. “Learn from other’s experi-
ences,” Sinclair advises. “An EMS provider
who steals drugs from a patient is no longer a
Services need strict control over narcotics
used in the prehospital settings, policies for use
and wasting of drugs, and to maintain a cul-
ture of patient safety by encouraging reporting
of suspected diversion. Our patients, and our
co-workers, deserve nothing less. JEMS
1. Bryson E. Addicted healers: 5 key signs your healthcare professional may be drug impaired. New Horizon Press: Far Hills,
2. D’Souza R. (Oct. 23, 2016.) The first fentanyl addict. Tonic.
Retrieved Sept. 28, 2017, from http://tonic.vice.com/en_us/
3. Patrick R. (Jan. 25, 2017.) Charges say Metro East paramedic
stole painkillers from ambulances. St. Louis Post-Dispatch.
Retrieved Sept. 28, 2017, from www.stltoday.com/news/
4. Shell H. (Sept. 10, 2015.) Former Grand County EMS
employee sentenced in drug diversion case. SkyHi Daily
News. Retrieved Sept. 28, 2017, from www.skyhinews.com/
5. Stark R. (Nov. 10, 2016.) Drug diversion legal brief for EMS
leaders. EMS1. Retrieved Sept. 28, 2017, from www.ems1.
6. Givot D. (June 10, 2013.) Addiction in EMS: The real tragedy
behind the headlines. EMS1. Retrieved Sept. 28, 2017, from
7. Stanos SP, Bruckenthal P, Barkin RL. Strategies to reduce the
tampering and subsequent abuse of long-acting opioids:
potential risks and benefits of formulations with physical
or pharmacologic deterrents to tampering. Mayo Clin Proc.
W. Ann “Winnie” Maggiore, JD, NRP, is a
shareholder at the law firm of Butt, Thornton
& Baehr, PC. She’s been an EMT since 1978
and a paramedic since 1981. She’s on the
faculty of NAEMSP’s National EMS Medical