Preventing Opioid Diversion: Safeguards and Vulnerabilities in the Dutch Pharmaceutical Supply Chain: an exploratory interview study with stakeholders

Abstract

Background: Prescription opioid diversion has emerged as a concern in the Netherlands, raising the question whether more effective prevention strategies are required. To tackle this issue effectively, it is necessary to understand the viewpoints of stakeholders within the pharmaceutical supply chain. This study aims to explore and document the perspectives of stakeholders on existing safeguards, vulnerabilities and potential improvements in preventing opioid diversion in the Dutch pharmaceutical supply chain. Methods: In-depth, semi-structured interviews were conducted with 11 stakeholders within the pharmaceutical supply chain (one wholesale, one producer, one institutional pharmacy, two clinical pharmacies, two polyclinical pharmacies, two community pharmacies, one medical destruction company and one international health organisation). Interview guides were developed and based on provider-level controls from the American Society of Health-Pharmacists (ASHP). Interviews were audiotaped between May and June 2023. A directed content analysis was conducted on the transcribed interviews using NVivo. Results: Opioid diversion safeguards, vulnerabilities and potential improvements were identified and divided at all provider-levels into themes: (1) Distribution, (2) Procurement, (3) Storage, (4) Dispensing and administration of opioids, (5) Prescribing, (6) Waste, disposal and destruction, (7) Legislation. Stakeholders reported implementing a diverse range of safeguards, exhibiting variations attributed to the scale at which opioids are managed across different organisations. Identified vulnerabilities included high workloads due to paper-based record-keeping of opioid administration to patients, overprescribing leading to patient oversupplies, solitary work environments lacking security infrastructure and separate destruction of opioids. Conclusions: In spite of limited guidelines on opioid diversion prevention, stakeholders in the Dutch pharmaceutical supply chain take responsibility implementing safeguards, although vulnerabilities still exist. To address these challenges effectively, a collaborative effort among policymakers, politicians, and stakeholders is necessary. Reviewing and clarifying legislation and guidelines will empower stakeholders to implement safeguards that effectively address significant diversion risks while also considering practicality and cost-effectiveness.