Commander John Burke (retired) of the Cincinnati Police Department and now President and Founder of the International Healthcare Facility Diversion Association (IHFDA) has presented on multiple occasions about the problem of underreporting. During a conversation, Commander Burke reported to me that he had led a task force formed specifically to investigate diversion of controlled substances in hospitals. Formed in 1992, the task force operated for 10 years. Based on that experience, he described that significant numbers of healthcare facilities do not report diversion; that most frequently the offender is terminated or permitted to quit, primarily out of concern about media attention.1 In a recent presentation, he reviewed his own statistics for Cincinnati, apportioned them across the US population, and concluded that the number of arrests for diversion in the US per year is the number that should be occurring per day.
There is a publication by Inciardi et al2 that describes these numbers more precisely. In an 11-year period, from 1992 through 2002, there were 423 documented cases of drug diversion involving healthcare professionals—an average of 38.4 cases per year. The population of Cincinnati declined over that time, starting at 359,433 in 19923, and falling to 322,644 in 20024 (resulting in an average population of 341,038). The United States population started at 256.9 million in 19925 and rose to 287.6 million in 20026 (an average of 272.3 million).
Presuming that Cincinnati is representative of diversion generally in the United States, this incidence computes to 30,656 documented cases per year across the United States in that same period, or 84 documented cases per day.
In that same presentation, Burke indicated that the number of arrests in such cases total less than 100 per year. There do not appear to be any references to validate that number. However, even if the number of arrests are ten times Burke’s number (1,000 arrests per year), they are nowhere near the numbers suggested as a result of the work of the Cincinnati task force.