Exploring the Mechanisms of in-Hospital Emergency Department Diversion: A Qualitative Single-Case Study.
6 affiliations
- 1Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
- 2HumanEra, Research and Innovation, North York General Hospital, Toronto, ON, Canada.
- 3Program for Health System and Technology Evaluation, Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada.
- 4Social Work, Faculty of Education and Health, Laurentian University, Sudbury, ON, Canada.
- 5Department of Public Health Sciences, University of Rochester, Rochester, NY, USA.
- 6Department of Political Science, Université Laval, Quebec, QC, Canada.
Abstract
Healthcare workers (HCWs) are at risk of substance use disorders (SUD) due to factors such as burnout, stress, and occupational trauma, which may contribute to drug diversion (theft or unauthorized redirection of controlled substances), placing HCWs at risk of overdose, death, professional discipline and legal consequences. Within healthcare settings, workplace social relationships may facilitate access to controlled substances. However, these dynamics are complex, and such relationships may reflect genuine personal, professional, and peer connections rather than solely attempts to obtain controlled substances. This exploratory single case-study design used semi-structured interviews and investigative reports to examine diversion mechanisms. Transcripts were pseudonymized and analyzed thematically to identify diversion mechanisms. Six diversion themes emerged: (1) professional relationships, legitimacy, and forged prescribing practices, (2) professional trust and authority in unauthorized prescriptions, (3) familial relationships and professional acquaintance as concealment, (4) peer relationships and collegial discretion, (5) emergency department (ED) workflow coordination through acquaintanships, and (6) community-based networks with people who use substances (PWUS) and prescription filling. This case illustrates how social connections may facilitate diversion and provides preliminary insights into relational mechanisms that warrant further investigation.
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BibTeX
@article{francis2026exploring,
title = {{Exploring the Mechanisms of in-Hospital Emergency Department Diversion: A Qualitative Single-Case Study.}},
author = {Troy Francis and Mark Fan and Sonia Pinkney and Sonia Meerai and Reza Yousefi-Nooraie and Mathieu Ouimet and Valeria E Rac and Patricia Trbovich},
journal = {Journal of drug education},
year = {2026},
month = oct,
doi = {10.1177/00472379261495387},
url = {https://europepmc.org/article/MED/42847336},
note = {CC BY-NC},
}
RIS
TY - JOUR
TI - Exploring the Mechanisms of in-Hospital Emergency Department Diversion: A Qualitative Single-Case Study.
AU - Troy Francis
AU - Mark Fan
AU - Sonia Pinkney
AU - Sonia Meerai
AU - Reza Yousefi-Nooraie
AU - Mathieu Ouimet
AU - Valeria E Rac
AU - Patricia Trbovich
PY - 2026
DA - 2026/10/08
JO - Journal of drug education
DO - 10.1177/00472379261495387
UR - https://europepmc.org/article/MED/42847336
AB - Healthcare workers (HCWs) are at risk of substance use disorders (SUD) due to factors such as burnout, stress, and occupational trauma, which may contribute to drug diversion (theft or unauthorized redirection of controlled substances), placing HCWs at risk of overdose, death, professional discipline and legal consequences. Within healthcare settings, workplace social relationships may facilitate access to controlled substances. However, these dynamics are complex, and such relationships may reflect genuine personal, professional, and peer connections rather than solely attempts to obtain controlled substances. This exploratory single case-study design used semi-structured interviews and investigative reports to examine diversion mechanisms. Transcripts were pseudonymized and analyzed thematically to identify diversion mechanisms. Six diversion themes emerged: (1) professional relationships, legitimacy, and forged prescribing practices, (2) professional trust and authority in unauthorized prescriptions, (3) familial relationships and professional acquaintance as concealment, (4) peer relationships and collegial discretion, (5) emergency department (ED) workflow coordination through acquaintanships, and (6) community-based networks with people who use substances (PWUS) and prescription filling. This case illustrates how social connections may facilitate diversion and provides preliminary insights into relational mechanisms that warrant further investigation.
SN - 0047-2379
SN - 1541-4159
ER -