Hospitals Step Up Drug Diversion Surveillance, Bluesight Report Finds

Originally published by our sister publication Specialty Pharmacy Continuum

By Gina Shaw

Hospitals are investing more deeply in both people and technology to combat controlled substance diversion, according to the Bluesight 2025 Diversion Trends Report, which analyzed more than 266 million controlled substance transactions across 1,159 hospitals.

The data show steady improvement in documentation compliance, with the share of controlled substance transactions containing variances dropping from 7% to 6% between 2023 and 2024. That represents 2.6 million additional transactions with complete documentation.

At the same time, the proportion of unreconciled variances declined from 9% to 8%. “That’s still a lot of controlled substances going unaccounted for,” cautioned Sean Gilman, PharmD, DPLA, BCCCP, the director of clinical strategy at Bluesight, “but the trend is moving in the right direction.”

Most hospitals rely on both a diversion committee and software tools to detect diversion, he continued. “Software points you to concerning activity, but you still need human oversight: people who can add process control, operational and clinical context, conduct interviews, and drive performance improvement.”

Three-fourths of surveyed hospitals now have full-time staff dedicated to diversion monitoring, and nearly 70% operate cross-functional diversion committees that include pharmacy, nursing, compliance, anesthesia, and even human resources or law enforcement representatives. Forty percent plan to increase investment in diversion resources over the next year.

Of all controlled substance transactions tracked, 94% were automatically reconciled, while 6% required review for discrepancies. Roughly half of those variances stemmed from incorrect or late documentation, a slight improvement from the previous year. To reduce those errors, Dr. Gilman emphasized “transaction-level visibility” and a culture that allows nurses to concentrate on medication handling without interruptions. “Nurses are under enormous pressure,” he said. “As pharmacists, we can help by ensuring they have protected time during med passes and improve controlled substance handling accountability by flagging departments that struggle with delayed waste documentation, because the longer a controlled substance sits unwasted, the greater the opportunity for diversion.”

Pharmacy teams remain the most frequent participants in diversion oversight committees, but nursing involvement is expanding rapidly. According to the report, pharmacy participation rose from 84% to 90% of committees between 2024 and 2025, while nursing rose from 66% to 72%. “Joint ownership with nursing, compliance, and anesthesia is growing because the software tools make it easier to collaborate and prioritize what’s important,” Dr. Gilman said.

Hospitals conducted 61% more diversion investigations in 2024 than in 2023, but each case closed about 40 days sooner. Dr. Gilman attributed much of the improvement in investigative speed and accuracy to dedicated diversion teams, along with better data access.

“Health systems are adding resources and standardizing reviews,” he said. “A consistent workflow makes investigations more objective and much faster.” Still, diversion remains a persistent challenge: 1,517 confirmed cases have been recorded since 2018, averaging two new cases per day nationwide.

Fentanyl remains the top drug linked to variances (24%), followed by midazolam and hydromorphone. Propofol, although not federally controlled, doubled from 2% to 4% of variances last year. “Many hospitals treat propofol as a controlled substance because of its abuse potential,” Dr. Gilman explained. “Risk follows access and workflow, not DEA [Drug Enforcement Administration] scheduling. Diversion monitoring has to protect patients and staff.”

Looking ahead, Dr. Gilman said the next frontier is using generative artificial intelligence to streamline investigations and reporting. “Teams spend a lot of time packaging information for leaders,” he said. “AI can surface key trends, reduce manual review time, and help hospitals communicate more effectively.”

Dr. Gilman reported no relevant financial disclosures beyond his stated employment.