Administration and Leadership

How to Reduce the Risk of Personnel Narcotics Theft

Issue 2 and Volume 38.

Google is a phenomenal search engine. Within seconds of typing in a keyword, your search returns hundreds of related websites. But Google is good for much more than just searches. Google can also drop you an “email alert” on a specific keyword. By using this feature, I receive news alerts for articles and other news published on such keywords such as “fire chief,” “EMS” and my department.

I was recently reading through the headlines for my once-a-day news alerts for “fire chief,” when I spotted a headline that said, “Massachusetts fire chief facing drug charges resigns.”

Interested in this article, I clicked on it to learn that this past summer, prior to his resignation, the fire chief from Princeton, Mass., had been placed on paid leave after the Board of Selectmen learned that he was facing criminal charges connected to theft of drugs, including fentanyl, morphine and valium. It is alleged that he was stealing narcotics from the fire department’s ambulance.

Whether this fire chief is guilty, the incident certainly brings attention to the need for other EMS managers to ensure that the narcotics carried by their EMS agency are controlled properly.

A Widespread Problem
Speaking of Google, perform a Google search for “theft of ambulance drugs,” and you will see this problem isn’t isolated to a small town in Massachusetts. Regardless of the size of the EMS agency, there’s always the possibility that a paramedic with access to the drugs may be tempted to steal narcotics for use by themselves or a loved one, or to sell to someone else.

Most paramedics who get caught tampering with narcotics have substance-abuse problems; they’re typically given a probationary period to go through drug treatment programs. But a recent article highlighted the case of a Washington paramedic with 22 years of experience who was sentenced to 27 months in prison for stealing fentanyl. After his release from prison, he will be on another three years of supervision, plus he is required to pay $8,000 in restitution to the fire department from which he was stealing the drug. As is usually the case, the paramedic had been using the drug himself. The discovery and subsequent investigation was triggered when other paramedics noticed the fentanyl vials had been tampered with.

Some Solutions
So how can you stop narcotics tampering? After querying colleagues around the country, I’m not sure there’s a truly foolproof method because if someone wants to steal narcotics, they will find a way.

Still, the fact that no one solution is perfect doesn’t mean you shouldn’t put measures in place to reduce the likelihood of narcotics theft. Using an electronic lockbox, for which each paramedic has their own access code, is one solution. Although it may not show who tampered with a narcotic, it will give an electronic recording of who accessed the lockbox and when.
Some EMS agencies do drug checks randomly or “for cause” with their employees. My experience working in major cities is that you will always catch someone with an illegal substance in their system. Although I haven’t seen many cases where testing revealed narcotics abuse, I’ve seen plenty of examples of alcohol, marijuana and cocaine use.

Some EMS agencies seal narcotics in a tamper-evident bag. The narcotic is still visible through the bag so it can be checked for expiration date and clarity, but the paramedic can’t access it until they unseal the bag to use or if they have tampered with the bag to access the drug.

Regardless of the method your agency chooses, you must have a strong policy in place describing how the narcotic is stored and who handles it, as well as required documentation of checking the narcotics from one shift to another, including looking for evidence of tampering. The policy should also address what to do if a narcotic has been tampered with and how to handle missing drugs and damaged packaging. The policy should also include how the narcotic is accessed—with a key, swipe card or key coded into an electronic lock.

Minimize the Risk
Narcotics theft is a serious matter. Usually lost in the discussion is the fact that the patient didn’t receive the drug they needed for their condition, and on top of that, the hospital may be reluctant to give additional drugs since they’re under the impression the patient has already received the needed dosage.

As EMS managers, it’s imperative that you give significant attention to the storage, handling and distribution of narcotics in your agency. Proper policies and check and balances, along with awareness of the problem of narcotics theft, are all part of ensuring your department minimizes its exposure to narcotics tampering.