An ED nurse in Washington state who admitted to stealing opioids and other drugs intended for patients has been linked to hepatitis C virus (HCV) infections in at least 12 people who sought care in the ED, the CDC reports.1

The nurse apparently was infected by diverting drugs from a patient with HCV, then infected other patients through contaminated syringes, needles, or vials, the CDC noted.

“This nurse, who had tested anti-HCV-negative and HCV RNA-negative with a blood donation in 2013, admitted diverting injectable narcotic and antihistamine drugs from patients for personal use during current employment at the hospital ED, though she did not specify the mechanism,” the CDC found.

As with many other diversion outbreaks, the case may have been missed if not for the local health department, which identified two HCV infections in people with no typical risk factors in the first few months of 2018.

“Neither patient had behavioral risk factors associated with HCV acquisition,” the CDC reported. “However, both had received injectable narcotic opioid drugs from the same nurse during separate visits to an emergency department at a local hospital on Dec. 6 and Dec.16, 2017.”

Testing revealed that the HCV infecting both patients was genetically similar, suggesting a common source. Investigators found the nurse had accessed the automated drug dispensing system much more often than other staff. The nurse subsequently tested positive for HCV antibodies.

“It is possible that nurse A acquired the virus from [a] patient with chronic HCV infection during [a] Nov. 8 visit and was infectious during Nov. 22–Dec. 26, 2017, during which time at least 12 patients that she treated became infected,” the CDC reports.

The investigation is continuing, with 33 more patients recommended for HCV testing. State nursing officials suspended the nurse’s license. In light of the outbreak, the CDC recommends and reiterates the following:

  • Monitor staff access to drug dispensing systems to identify staff members with higher or abnormal dispensing patterns;
  • Prevent, identify, and report any loss, diversion, or theft of controlled substances as required by law.

Opioid Bust Snares HCWs

In another development involving opioids and healthcare workers, 31 physicians, eight nurse practitioners, and seven pharmacists were recently arrested by federal authorities on charges of illegal prescribing and distributing opioids.2

Some of those cited in federal documents include two physicians and three pharmacists in Ohio charged with obtaining controlled substances by fraud.

“In one case, a doctor who is alleged to have been at one time the highest prescriber of controlled substances in the state, and several pharmacists are charged with operating an alleged ‘pill mill’ in Dayton, Ohio,” authorities reported. “According to the indictment, between October 2015 and October 2017 alone, the pharmacy allegedly dispensed over 1.75 million pills.”

In another case, a doctor and an owner of a Florida compounding pharmacy were charged in connection with a scheme that involved the payment of alleged kickbacks in return for writing prescriptions for compounded drugs that included controlled substances.

“In the Western District of Tennessee, 15 individuals were charged, involving eight doctors and several other medical professionals,” according to a statement from the Department of Justice. “In one case, a nurse practitioner who branded himself the ‘Rock Doc’ allegedly prescribed powerful and dangerous combinations of opioids and benzodiazepines, sometimes in exchange for sexual favors.”

Also, an orthopedic surgeon in West Virginia was charged with using fraudulent prescriptions to obtain tablets of acetaminophen-codeine for his own use.

REFERENCES

  1. Njuguna HN, Stinson D, Montgomery P, et al. Hepatitis C Virus Potentially Transmitted by Opioid Drug Diversion from a Nurse — Washington, August 2017–March 2018. MMWR 2019;68(16):374-376.
  2. Department of Justice. Appalachian Regional Prescription Opioid (ARPO) Strike Force Takedown Results in Charges Against 60 Individuals, Including 53 Medical Professionals. April 17, 2019. Available at: https://bit.ly/2vaOlo0.