Dr. Cory P. Gaconnet – Chief Anesthesiologist and Commander at Navy Balboa Medical Center
The fentanyl overdose numbers are staggering.
Fentanyl has replaced heroin in many major American drug markets, causing an emergence of an even deadlier opioid epidemic phase.
New data published on Thursday from the Centers for Disease Control and Prevention show that drug overdoses killed more than 70,000 Americans in 2017, a record. The data also shows that the increased deaths correspond strongly with the use of a synthetic opioid known as fentanyl. Fentanyl is an opioid commonly administered in and out of the operating room (OR) as a treatment for surgical pain and procedural sedation. Fentanyl is a mainstay of anesthesia care and as a result is readily available throughout the operating theater, intensive care units, and the myriad of locations where anesthesia is administered.
Unfortunately, this widespread use and availability makes fentanyl a prime target for diversion by caregivers, and use for purposes outside of patient care. Fentanyl has not caused the opioid epidemic, human behavior has. As anesthesiologists, this is where we can make a difference in the systemic problem. Diversion is a symptom of the larger problem: today’s diversion solutions do not effectively control and manage human interaction with fentanyl. By seeking out new and innovative technologies, and working with companies to solve this problem, trailblazers in the anesthesia space can be on the forefront of solving this problem.
Anesthesiologists: Be part of the solution.
Managing controlled substances, such as fentanyl, is a nearly impossible task using existing barcode technology. Until recently, this was the only option for managing controlled substances in the operating room with compliance and accuracy estimated to be around 60%, at best. Hospitals “hope and pray” that they don’t have a reported diversion event. All the while, clinicians are in constant fear of even the mere accusation of diverting, which may have significant long-term career consequences. Bottom line: existing legacy technologies and surveillance tools don’t work.
Solutions providing real-time accountability of controlled substances are an absolute necessity. Hospitals must have the ability to accurately and reliably maintain inventory control.
If Amazon can track packages traveling thousands of miles, a hospital should be able to keep track of a fentanyl vial in their facility. Hospitals must also consider the potential for wrongful claims and legal fallout. It is imperative that claims of diversion against an employee be based on accurate and reliable data. This is important for clinicians as well, as the only defense when facing an accusation of diversion is a detailed chain of custody that proves, without any doubt, the clinician couldn’t have used the medication for any purpose outside of patient care.