Why do we so often wait until a nurse fails, an incident occurs, or patient safety is at risk before connecting someone with help?

In this episode of Drug Diversion Insights, Terri is joined by Abby Migliore and Shannon Opie of the Intervention Project for Nurses (IPN), Florida's alternative-to-discipline program for nurses with substance use disorders and other conditions that may affect safe practice.

A national survey found that 18% of registered nurses screened positive for a substance use problem, with approximately one-third of those screening positive for a substance use disorder. Those findings raise an important question: Are we doing enough to recognize and support healthcare professionals before a problem reaches a crisis point?

Abby and Shannon take us inside the alternative-to-discipline process and explain what structured recovery and return to nursing practice actually look like.

In this episode, we discuss:

• How alternative-to-discipline programs for nurses work
• What happens when a nurse enters IPN
• Evaluation, treatment, and ongoing recovery monitoring
• Drug and alcohol testing requirements and testing cadence
• Workplace restrictions during return to practice
• The role of supervised return-to-work plans
• What neurocognitive testing evaluates before a nurse returns to practice
• Medications for opioid use disorder in safety-sensitive healthcare roles
• The balance between workplace accommodation and patient safety
• Why healthcare organizations often wait for a “smoking gun” before intervening
• The opportunity to recognize problems and connect nurses with support earlier

Alternative-to-discipline doesn't mean eliminating accountability. It's about creating a structured pathway that supports recovery while keeping safe nursing practice and patient protection at the center.

This conversation is especially relevant for nurses, nurse leaders, healthcare executives, employee health professionals, diversion specialists, compliance teams, professional monitoring programs, and anyone interested in substance use disorder among healthcare professionals.

And there's more to come. Abby and Shannon will return for another conversation focused on cannabis in patient-facing healthcare roles, including the complicated question of cannabis-free workplace policies in states where cannabis is legal.

Follow Drug Diversion Insights so you don't miss Part 2.

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What happens when a pharmacy professional experiences a substance use disorder, enters recovery, and then returns to the same workplace—with the same colleagues and access to controlled substances?

In this episode of Drug Diversion Insights, we hear both sides of that experience.

One guest shares what it was like to return to pharmacy practice after substance use disorder and rebuild trust with colleagues. The other shares the perspective of the pharmacy leader responsible for maintaining the safeguards, accountability, and support needed to make that return safe for employees and patients alike.

Together, they tackle a difficult question healthcare organizations often avoid: Can a healthcare professional in recovery safely return to a role with access to controlled substances?

We discuss:

• What returning to pharmacy practice after substance use disorder really looks like
• The challenges of rebuilding trust with coworkers
• Accountability measures and safeguards that support a safe return to practice
• How pharmacy leaders can support recovery without compromising patient safety
• The role of state pharmacy recovery and professional monitoring programs
• Why transparency about recovery can be a strength
• How stigma can discourage healthcare professionals from seeking help
• Why open conversations about substance use disorder can strengthen workplace culture
• Whether having a professional in recovery on the team can actually increase awareness and accountability around controlled substances

Supporting recovery and protecting patients don't have to be opposing goals.

With appropriate monitoring, clear expectations, accountability, and a workplace willing to have honest conversations about substance use disorder, healthcare professionals can be supported while patient and medication safety remain the priority.

This episode is for pharmacists, pharmacy technicians, pharmacy leaders, diversion specialists, compliance professionals, healthcare executives, and anyone interested in creating a safer and more supportive approach to substance use disorder in healthcare.

Sometimes the safest pharmacy isn't the one where substance use disorder is never discussed. It's the one where people feel safe enough to talk about it.

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Substance use disorder rarely begins with the substance itself.

Long before addiction develops, many individuals are navigating a complex combination of chronic pain, mental health challenges, trauma, and other life circumstances that increase their risk. Understanding those connections helps us recognize substance use disorder earlier and respond more effectively.

In this episode of Drug Diversion Insights, Terri welcomes back Dr. Paul Lynch, anesthesiologist and CEO of US Pain Care, along with his father, Larry Lynch, a licensed clinical social worker. Together, they combine medical and behavioral health perspectives to explore why treating pain, mental health, and substance use disorder as separate conditions often falls short.

In this episode, we discuss:

• The relationship between chronic pain and substance use disorder
• How mental health influences both pain and addiction
• The concept of the tri-diagnosis: pain, mental health, and substance use disorder
• Expanding to the quad-diagnosis, incorporating homelessness as another critical factor
• The challenge of determining whether pain or mental health issues come first
• Why integrated, whole-person care leads to better outcomes
• The importance of reducing stigma surrounding substance use disorder
• How earlier intervention can improve both patient care and long-term recovery

Whether you're a physician, pharmacist, nurse, behavioral health professional, addiction specialist, healthcare leader, or simply interested in understanding the complexity of substance use disorder, this episode offers valuable insight into the factors that exist long before addiction becomes visible.

By looking upstream, we can better understand the root causes of substance use disorder and create opportunities for earlier intervention, more compassionate care, and better outcomes for patients.

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Can remote drug and alcohol testing deliver the same level of confidence as traditional collection methods?

In this episode of Drug Diversion Insights, Terri sits down with Chris Roames, Chief Operating Officer of RecoveryTrek, to explore how remote drug testing is transforming recovery monitoring, professional health programs, treatment centers, employers, and healthcare organizations.

RecoveryTrek has been supporting substance use monitoring programs since 2011. Its flagship platform, PROOF, enables participants to complete drug and alcohol testing remotely—from home or virtually anywhere—while incorporating guided specimen collection, identity verification, and safeguards designed to maintain specimen integrity.

Chris explains what makes remote testing effective, walks through the different specimen collection methods, and addresses one of the biggest questions organizations have: How can you be confident the sample came from the right person and wasn't tampered with?

In this episode, you'll learn:

• How remote drug and alcohol testing works
• The technology behind RecoveryTrek's PROOF platform
• How participant identity is verified during remote collections
• Methods used to help protect specimen integrity
• Different specimen types and when each is used
• Applications for healthcare organizations, treatment centers, employers, courts, and professional monitoring programs
• How remote testing can reduce barriers while improving compliance
• Where remote testing fits into today's recovery and healthcare landscape

Whether you work in healthcare, behavioral health, addiction treatment, professional monitoring, compliance, or employee health, this episode provides an inside look at how technology is making drug testing more accessible while maintaining the standards organizations depend on.

As monitoring programs continue to evolve, remote testing is helping improve convenience for participants while reducing administrative burden for organizations—without losing sight of accountability and compliance.

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How do you build a single, standardized drug diversion program across a large health system when every hospital, infusion center, and outpatient location has developed its own processes?

In this episode of Drug Diversion Insights, Terri welcomes Deepika Nayyar, Network Manager of Pharmacy Quality, Compliance, and Accreditation at Hackensack Meridian Health, to discuss the real-world challenges of implementing a system-wide diversion prevention program across diverse care settings.

Deepika shares how her team evaluated existing practices, established baseline standards, and created a consistent approach to diversion prevention while recognizing the unique operational needs of inpatient hospitals, outpatient pharmacies, and infusion centers.

The conversation also explores an often-overlooked area of diversion monitoring: medications with abuse potential that are not controlled substances. These medications frequently fall outside the capabilities of traditional diversion monitoring software, creating risks that require additional oversight, clinical expertise, and thoughtful auditing.

In this episode, you'll learn:

• How to standardize a diversion program across multiple healthcare facilities
• Why diversion monitoring differs between inpatient and outpatient settings
• Strategies for monitoring medications with abuse potential beyond controlled substances
• The limitations of current diversion software and analytics
• Data elements that could improve diversion detection
• How medication safety and sterile compounding experience strengthen diversion prevention efforts
• Practical lessons from leading pharmacy quality, compliance, and accreditation across a large health system

Whether you're a pharmacy leader, diversion specialist, compliance professional, medication safety officer, or healthcare executive, this episode provides practical insights for building a stronger, more consistent diversion prevention program.

Technology plays an important role—but successful diversion prevention still depends on strong processes, critical thinking, and a culture of accountability.

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Every diversion investigation begins with data—but the quality of your conclusions depends on the objectivity of your audit.

In this Quick Take on Diversion Insights, Terri explores one of the most overlooked challenges in diversion monitoring: confirmation bias. Before a report ever reaches leadership, bias can influence how data is interpreted, which transactions receive attention, and whether an employee is evaluated fairly.

This episode focuses on practical strategies for conducting objective, evidence-based audits that protect both patient safety and the healthcare professionals whose careers may be affected by the findings.

In this episode, we discuss:

• Why objectivity begins with the auditor
• How confirmation bias can influence diversion investigations
• The importance of comparing employees with appropriate peer groups
• Why trends over time are more meaningful than isolated events
• Understanding the strengths and limitations of your audit tools
• The questions every auditor should ask before drawing conclusions
• Building fair, consistent, and defensible diversion investigations

A strong diversion program isn't about proving a theory—it's about following the evidence wherever it leads.

Whether you're a diversion specialist, pharmacist, compliance professional, medication safety leader, nurse leader, or healthcare executive, this Quick Take offers practical guidance for improving the quality and integrity of your auditing process.

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What exactly counts as a "significant loss" of controlled substances?

It's one of the most common questions in diversion prevention—and one the DEA intentionally leaves unanswered. That ambiguity can make reporting decisions difficult, especially for large healthcare systems with multiple facilities.

In this episode of Drug Diversion Insights, Terri is joined by Calvin Parmiter, System Pharmacy Manager for Diversion and Compliance at WVU Medicine, and Shannan Molnar, Drug Diversion Coordinator, to discuss how their team created a standardized process for defining significant loss and built a diversion prevention program that works across an entire health system.

In this episode, we discuss:

• Why the DEA intentionally leaves "significant loss" undefined
• How WVU Medicine developed standardized reporting criteria
• Creating a checklist that removes guesswork from reporting decisions
• Building consistency across multiple hospitals
• The unique challenges of supporting rural and community facilities
• Preparing local leadership to respond effectively when diversion specialists aren't on site
• Lessons learned from implementing a system-wide diversion program
• Practical advice for organizations looking to improve consistency and strengthen compliance

Whether you're a diversion specialist, pharmacy leader, compliance professional, medication safety officer, or healthcare executive, this conversation offers practical strategies for creating scalable, standardized diversion prevention processes that support both regulatory compliance and patient safety.

Sometimes the most effective diversion programs aren't built around reacting to problems—they're built around creating consistent processes before problems occur.

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What really happens during a DEA inspection?

In this episode of Drug Diversion Insights, Terri sits down with Brennan Luke, Regulatory and Controlled Substance Pharmacy Manager at ECU Health, to discuss what he learned after building a drug diversion prevention program from the ground up—and leading it through three DEA cyclic inspections.

Drawing from firsthand experience, Brennan shares practical lessons on regulatory compliance, controlled substance accountability, and what it takes to build a diversion prevention program that earns the trust of frontline staff while standing up to regulatory scrutiny.

In this episode, we discuss:

• What to expect during a DEA cyclic inspection
• The findings that surprised Brennan the most
• Lessons learned from building a diversion prevention program from scratch
• How to prepare your organization before a DEA visit
• Common compliance gaps and documentation challenges
• Why successful diversion programs depend on collaboration—not suspicion
• How to engage nursing, anesthesia, pharmacy, and leadership as partners in diversion prevention
• Advice for organizations looking to strengthen their controlled substance oversight

Whether you're a pharmacy leader, diversion specialist, compliance professional, medication safety officer, nurse leader, or healthcare executive, this conversation provides practical insights for creating a sustainable diversion prevention program that protects patients, supports staff, and improves compliance.

Strong diversion programs aren't built on fear—they're built on trust, accountability, and continuous improvement.

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Drug diversion is a global challenge, but not every country approaches it the same way.

In this episode of Drug Diversion Insights, Terri welcomes Mark Jackson, whose work in the United Kingdom is roughly equivalent to the FDA's Office of Criminal Investigations in the United States. Together, they explore the similarities and differences between how the UK and US regulate controlled substances, investigate diversion, and address medication security across healthcare settings.

This wide-ranging conversation covers:

• How the UK classifies controlled substances using Classes A, B, and C
• How UK classifications compare to the US scheduling system
• Mark's journey into diversion prevention and investigations
• Diversion risks in pharmaceutical manufacturing and healthcare settings
• Why benzodiazepines appear more frequently in UK diversion cases than opioids
• Differences in opioid prescribing practices between the UK and US
• Cultural differences in pharmacy operations and medication access
• A UK perspective on American drive-thru pharmacies• Lessons both countries can learn from one another in preventing diversion

Whether you work in pharmacy, healthcare compliance, medication safety, healthcare security, or diversion monitoring, this episode offers valuable insight into how two healthcare systems tackle many of the same challenges in very different ways.

If you've ever wondered how drug diversion prevention looks on the other side of the Atlantic, this conversation provides a fascinating comparison.

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Think you need diversion analytics software to identify diversion risk?

Think again.

In this Quick Take on Diversion Insights, Terri shares a practical, structured approach to diversion monitoring using reports that most healthcare organizations already have access to through their Automated Dispensing Machines (ADMs).

The key isn't more software—it's more direction.

In this episode, you'll learn about a five-week directed audit cycle that helps organizations focus limited resources on the areas most likely to uncover risk.

Topics include:

• High-risk controlled substance dispense volume audits• Total waste audits• Full-dose waste audits• Controlled substance cancel transaction audits• Non-controlled substance cancel transaction audits• How ADM reports can identify audit populations• Why directed audits are often more effective than random reviews• One of the most overlooked indicators in diversion monitoring: barcode scanning compliance

Terri also explores a powerful but underutilized strategy—comparing barcode scanning habits for controlled substances versus non-controlled substances. Significant differences between the two may reveal workflow issues, policy drift, or patterns that deserve further investigation.

Whether you're a diversion specialist, pharmacist, compliance professional, nurse leader, or part of a medication safety team, this episode offers practical steps for strengthening diversion monitoring without investing in specialized software.

Sometimes the most effective audit program starts with data you already have.

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