Podcast on Drug Diversion Prevention Includes Expert Kim New

August 31, 2015

Evelyn McKnight and Lauren Lollini

Kimberly New, JD BSN RN, participated in a podcast on drug diversion

Kimberly New, JD BSN RN, participated in a podcast on drug diversion

Starting in July 2009, when we read reports of the outbreak at Rose Medical Center in Denver, HONOReform became involved in drug diversion prevention. An addicted healthcare worker diverted medication for her own use, refilled syringes with saline and then left them to be administered to patients. Diversion of narcotics is a patient safety issue and it’s an injection safety issue…and so much more.

One of our aims is to encourage colleagues throughout the country to address drug diversion at a national and federal level. We are grateful for the positive response we are receiving. We will provide an update with more specific information in the near future.

Drug diversion is not an uncomplicated problem. It is the space where bureaucracies, including healthcare systems and law enforcement, come together. Oftentimes, a thorough awareness of the problem is lacking—and the necessary and proper procedures are not in place.

We are glad to share this 17-minute podcast, a clear description of the problem and some of the solutions, on our blog this week. Kimberly New, JD RN, of Diversion Specialists, who is one of the leading voices of drug diversion prevention and a close colleague of HONOReform, talks with Dr. Howard Zucker, MD JD, Commissioner of the New York State Department of Health.

In this interview, Kim New says, “We need to identify problems quickly and protect patients from potential harm.” We could not agree more. Thank you, Kim and Dr. Zucker, for coming together to address the problem, and thanks to our colleagues at the New York Health Department for encouraging and organizing this conversation.

August is National Immunization Awareness Month

August 24, 2015

Evelyn McKnight and Lauren Lollini

Dr Angela Pannier explains a new model for vaccines that would eliminate the use of syringes, thus eliminating a potential source of transmission of disease through unsafe injections.

Dr Angela Pannier explains a new model for vaccines that would eliminate the use of syringes, thus eliminating a potential source of transmission of disease through unsafe injections.

Each year, 20 million Hepatitis B cases (30% of all new infections), 2 million Hepatitis C cases (40% of all new infections) and 2,500 HIV cases (5% of all new infections) occur because of unsafe injections globally. These unsafe injections are often caused because of poor injection practices throughout the world (especially in underdeveloped countries), including lack of education (i.e. trained medical personnel) and lack of appropriate storage conditions (i.e. refrigeration or freezer). Conditions throughout the world often do not allow for proper medical waste disposal, which in turn can further allow for possible misuse or reuse of syringes. Therefore, there is a significant need to eliminate unnecessary injections globally and find alternative delivery strategies. However, vaccinations, for a variety of reasons, are most effectively administered through injection.

Vaccination is considered to be one of the most successful public health interventions of the modern era, leading to a dramatic increase in life expectancy and complete eradication of smallpox worldwide. Further development of vaccines and immunization programs have led to the control of numerous infectious diseases including diphtheria, tetanus, pertussis, measles, mumps, and rubella. However, effective vaccination strategies are lacking for a number of pathogens of global health importance (e.g. rotavirus, malaria, HIV, and Toxoplasma among others). In addition, rapid emergence of new infectious disease pandemics, such as pandemic influenza A virus and Ebola, demonstrates the urgent need for vaccine platforms that quickly move from disease identification to vaccines.

Traditional vaccines use weakened or dead bacteria or viruses to stimulate an immune reaction and are administered through injection (or nasal spray) because the bacteria or viruses cannot elicit a protective response if given any other way (e.g. bacteria or virus become damaged if consumed orally or do not reach their intended targeted if given transdermally). Furthermore, current vaccines cannot survive without refrigeration, which limits their use in less developed countries, a health concern in its own right.

Our multidisciplinary team at the University of Nebraska is developing a new model for vaccines that would eliminate the use of syringes. Rather than using weakened or dead bacteria or viruses to stimulate an immune reaction, we propose using genetic material (i.e. DNA) to prompt an immune response, which could allow for oral delivery. This new vaccine model would contain a replica of encoded genetic material from a virus or bacteria. DNA is extremely stable and can be stored on the shelf, thus eliminating the need for cold storage that prevents worldwide administration of vaccines. DNA can also be created in the lab very quickly, allowing for response to pandemics within a matter of weeks. Our team is especially focused on the development of polymers to protect these DNA vaccines so that they could be delivered orally via pill form. Along with eliminating the need for syringes, this would greatly expedite global distribution.

For these pills we are using two natural, safe polymers, chitosan and zein, the former found in the exoskeleton of crustaceans and the latter one made from a biodegradable protein from corn currently used in food and drug manufacturing. Due to this unique combination of materials, we propose that the DNA vaccine can be taken orally and protected as it moves through the digestive system. Once it reaches the intestine, the genetic material can be absorbed by the body, prompt an immune reaction, and build up future immunity. Vaccines based on this model are already used in veterinary medicine but in injection form. We believe that with our proposed system, we will have safer, faster, and easier vaccines for humans that eliminate the possibility of unsafe injections and the use of syringes entirely.

Dr. Angela K. Pannier is a Biomedical Engineer, Associate Professor, and William E. Brooks Engineering Leadership Fellow in the Department of Biological Systems Engineering at the University of Nebraska-Lincoln. She also holds a courtesy appointment in the Department of Surgery and the Mary and Dick Holland Regenerative Medicine Program at the University of Nebraska Medical Center.

Dr. Pannier’s collaborators on the research described above are: Dr. Tadeusz Wysocki, Professor of Computer and Electronics Engineering, University of Nebraska-Lincoln; Dr. Amanda Ramer-Tait, Assistant Professor of Food Science and Technology, University of Nebraska-Lincoln; Dr. Deborah Brown, Associate Professor, School of Biological Sciences, University of Nebraska-Lincoln; and Dr. Paul Davis, Assistant Professor of Biology, University of Nebraska at Omaha.

Up to 1.5 million deaths, annually, caused by infections of viral hepatitis

August 17, 2015

Evelyn McKnight and Lauren Lollini

Steve Langan, director of HONOReform, will attend the inaugeral World Hepatitis Summit

Steve Langan, director of HONOReform, will attend the inaugeral World Hepatitis Summit

We stand alongside our many colleagues throughout the world, including representatives of the WHO, one of whom, Dr. Stefan Wiktor, refers to hepatitis as the “silent epidemic.” Hepatitis is the seventh leading cause of death throughout the world Many of these cases of hepatitis, especially in developing countries, are caused by unsafe injection practices.

HONOReform is honored to be included in the inaugural World Hepatitis Summit, which will occur early next month in Glasgow. We are grateful to the World Hepatitis Alliance for including us in these meetings. HONOReform continues to seek ways to expand and provide injection safety education and awareness in developing countries. I will report back from these meetings. In the meantime, we encourage you to read about the proposed WHO-led pilot program--in India, Egypt and Uganda–to which we aim to lend the leadership of Evelyn McKnight and HONOReform’s experience, determination and voice.

The Dire Need for Injection Safety Activism in India, by Dr. Mudasir Firdosi

August 10, 2015

Evelyn McKnight and Lauren Lollini

Dr Mudasir Firdosi shares his views on World Hepatitis Day activities

Dr Mudasir Firdosi shares his views on World Hepatitis Day activities

In this blog, reprinted with his permission from Greater Kashmir, our colleague, Dr. Mudasir Firdosi, reflects on World Hepatitis Day. Unlike many of the reflections on and around July 28 that appeared in the United States and throughout the developing world, it’s not happy news. Dr. Firdosi calls the fact that awareness and education programs hardly exist in India “a criminal silence.” At HONOReform, we continue to learn all we can about the need to shore up medical injection safety in India–and beyond. Our aim is to help make a difference, in the U.S. and throughout the world. No patient should ever receive an infection of hepatitis C while receiving healthcare. We thank our many colleagues, including Dr. Firdosi, for sharing their education and insight. We encourage you to read his full editorial here.

Methodist Mondays: Advocacy is Imperative to Patient Safety

August 3, 2015

Evelyn McKnight and Lauren Lollini


Cortney Pasek is a nursing student at Nebraska Methodist College

Cortney Pasek is a nursing student at Nebraska Methodist College

Following is another installment in our “Methodist Mondays” thread. Nursing student Cortney Pasek describes her commitment to safe injection practices from her perspective as a future health care provider.

After reading Dr. Evelyn McKnight’s book, A Never Event, and hearing her speak, safe injection practices are of the utmost importance. Her heart-wrenching story will forever stay with me and be the motivation behind my safe injection practices.

A patient safety advocate requires one to be a communicator, educator, supporter, and caregiver. Advocacy is imperative to patient safety, as is empowering patients to be their own advocate. Her story has helped healthcare professionals and patients alike, worldwide, to find their voices. The videos on the One and Only Campaign website were also very beneficial.

While we are taught to check the labels for usage and expiration dates, the videos discuss the reasons behind the protocols, which I thoroughly enjoyed. I can only hope that if I am ever faced with similar trials and tribulations as Dr. Evelyn McKnight that I handle them with as much grace and forgiveness as she has. She is truly an inspiration.


Reflection on FDA Guidance on Filliing of Medication Vials

July 27, 2015

Evelyn McKnight and Lauren Lollini

Steve Langan, director of HONOReform, shares recent FDA guidance on medication vials

Steve Langan, director of HONOReform, shares recent FDA guidance on medication vials

Thank you to Dr. Tom McKnight for sharing his experience last week in the blog post titled “Summertime and Safe Injections.” From what we have learned from nurses, techs, office administration and nursing students, some providers and others insist, subtly or directly, on not “wasting” any medication. Sadly, regrettably, using medication from single-dose vials more than one time is a widespread practice, and so is the misuse of the multi-dose vial.

We are grateful to FDA for this clear response on overfilling vials. It’s a helpful document to include in HONOReform’s ongoing advocacy work. As they say, it takes a village to raise a child; we are finding that it takes a village to raise a body of knowledge regarding safe injections. FDA and CDC and others have taken a clear stand on virtually all aspects of injection safety.

We encourage all health care workers to join us. We invite all patients to always ask for a safe injection. And we thank Tom McKnight for demonstrating that patient safety must be, in all settings, the uppermost concern.

Summertime and Safe Injections

July 20, 2015

Evelyn McKnight and Lauren Lollini

Dr Tom McKnight is a co-founder of HONOReform and a family physician in Fremont, NE

Dr Tom McKnight is a co-founder of HONOReform and a family physician in Fremont, NE

Everyone agrees that summer is meant for fun, especially fun in the great outdoors. But sometimes injuries happen in the pursuit of fun, resulting in a trip to the Emergency Department.

I practice medicine in a town that is near a state park. Thousands of people flock there in the summertime, boating and swimming in the pretty blue lakes. When I first began my family medicine practice 30+ years ago, our hospital did not have Emergency Room physicians. The primary care physicians on staff were called in to care for patients who needed to be seen. I wish I would have kept track of how many times I trekked to the ER to stitch up a camper from the state lakes, who cut himself on a piece of glass or during a fall while waterskiing. I think it would be interesting to know.

Sometimes the nurse who was helping me would bring out a vial of lidocaine that had been used for the previous patient. I wouldn’t know if the previous healthcare provider had used safe injection practices or if they had reused needles and syringes to access the vial, thus contaminating it. The vial was usually not labeled, either. I would direct the nurse to throw out the previously used vial, and use a new vial. Some of the nurses thought this was unnecessary and it took some time and thoughtful discussion before we all agreed on designating a vial for each patient.

With so many people at the lakes, we might have many emergencies at once. It was not unusual to have 10 people waiting to be seen when an ambulance would roar in and all the doctors and nurses would drop what they were doing and rush to participate in the code. The pace was stressful and fast – a combination that can lead to error. We all had to be on our toes at all times to make sure that every action was safe for the patients as well as the staff. During a code, many injections are given very quickly. With several healthcare providers standing close together around the patient, working rapid-fire, there was the possibility of accidental needlesticks and improper disposal of sharps.

Not long ago I myself was a patient at the ER. I was stung many times while harvesting honey from our beehives – the bees were not going to give up the result of their hard work without a fight! I swelled up like a balloon, and felt my throat closing. We rushed to the ER where I was given IV’s to reduce the swelling. I was so glad that the staff had had had the thoughtful discussions about injection safety. They saved my life that day, and protected me from any disease that could have been transmitted through unsafe injections.

Our hospital now has emergency room physicians on staff. I am grateful, and not just because it frees me from being called in at any time of the day or night. I am grateful for their knowledge of and committment to injection safety, because we are all patients at some time. Although I have given up beekeeping, I haven’t given up waterskiing; I just might need to be stitched up after a fall!

Methodist Monday: “You need to speak up when you see someting unsafe”

July 13, 2015

Evelyn McKnight and Lauren Lollini

Scott J. Greenwood is a Junior Level Nursing Student at Nebraska Methodist College

Scott J. Greenwood is a Junior Level Nursing Student at Nebraska Methodist College

Unsafe injection practices aren’t something I thought about until I read Dr. Evelyn McKnight’s book. I was under the impression that these sorts of things didn’t happen in the U. S. in this day and age. Now that I know how easily these things do happen, I will always pay extra attention when giving an injection to keep my patient safe.

Hearing her experience also made it clear that as a nurse, you need to speak up when you see something unsafe. It doesn’t matter who the person is. If I were doing something unsafe, even unintentionally, I would expect somebody to step in and to correct me.

I’m glad I was given the opportunity to hear Evelyn speak. It drove home the point as to why safe injection practices are so important.

In Gratitude for a Simple Gesture of Respect

June 29, 2015

Evelyn McKnight and Lauren Lollini

Newsweek ran a feature article on drug diversion in hospital settings

Newsweek ran a feature article on drug diversion in hospital settings

The cover story of Newsweek June 18, 2015 edition is When Drug Addicts Work in Hospitals, No One is Safe.

The lengthy article was written by Kurt Eichenwald and was the result of an interview and correspondence with David Kwiatkowski, the radiologic technician who was sentenced to 39 years in prison after infecting patients with hepatitis C through unsafe injection practices. Kwiatkowski, who was infected with hepatitis C, stole injectable pain medications from the hospital where he was working and injected himself. He changed the needle, rinsed the syringe with water, refilled the syringe with saline and put these syringes back on the medication cart for use with patients. In this way, at least 45 patients in seven states were infected with hepatitis C. One patient has died from the infection.

Regrettably, this scenario is not unusual in the United States. The CDC estimates that 30,000 people may have been exposed to hepatitis C over the past decade by infected hospital employees who have used narcotics intended for patients. Federal researchers estimate that 100,000 healthcare workers in the United States are addicts and their theft of narcotics from patients is believed to be widespread. As many as 379,000 health care workers in the United States are addicted to drugs or alcohol, according to New Jersey pharmacist Mitch Sobel, who delivered this information at a recent New Jersey Department of Health meeting.

Getting back to the excellent Eichenwald article, what is unusual is that Kwiatkowski apologized…and desribed how he diverted drugs so that we can correct the healthcare delivery system to prevent harm to the public.

Since he is not eligible for parole, Kwiatkowski has nothing to gain from his disclosures. In fact, he and prison officials fear the article might anger other inmates and place him in danger.

As one who contracted hepatitis C through unsafe injection practices, i want to commend Mr Kwiatkowski for apologizing and sharing his story. It is so meaningful to victims when there is an apology; I still yearn for the gift of this simple, but profound gesture of respect. It is very difficult to fully heal from harm of this magnitude without an apology–it is as if something is missing, and closure is impossible.

Kwiatkowski not only apologized, but gave us a clear picture of how diversion takes place in hospitals. This important “insider” knowledge–not unlike when casinos ask cheaters to help them catch other cheaters–will help us make the changes that are long overdue. As we reported in a previous blog, HONOReform is helping to head efforts at a national level to help prevent drug diversion. We encourage all stakeholders to join us.

In the Newsweek article, Kwiatkoski said he is “haunted by the knowledge that he hurt so many people and believes he needs to make amends by revealing the scope and methods of this medical crime that endangers un unknowing public. “

Somebody has to tell how it’s done, how easy it is and how the structure of the hospitals isn’t any good to stop it,’ he says of drug diversion.”

Examining all ways to prevent drug diversion has never been more important. Patients throughout the country are harmed, and there is no national system in place to stop diverters. From just one patient affected by unsafe injection practices, thank you, David Kwiatkowski, for your candor. We need you and others continue to tell us how to fix the system that is so easy to violate.


What Does It Mean for Patients?

June 22, 2015

Evelyn McKnight and Lauren Lollini

Lauren Lollini is a patient safety advocate who has been integral in changing laws to keep patients safe as well as a member of the Drug Diversion Prevention Committee.

Lauren Lollini is a patient safety advocate who has been integral in changing laws to keep patients safe as well as a member of the Drug Diversion Prevention Committee.

I am grateful HONOReform had the opportunity to respond in the June 12 Concord Monitor to the horrible but all too common report of provider drug diversion by a healthcare worker.

As Steve Langan, HONOReform executive director, said, “Drug diversion may likely be the most enormous elephant in the room, in healthcare.” Anyone who has tried to pay attention to the many conversations on healthcare in the United States knows that there are many gaps and there have been many breakdowns.

If we continue to look the other way and deny and ignore the fact of widespread drug abuse and drug diversion among healthcare workers, more and more systematic challenges will develop.

According to recent statistics, there are as many as 379,000 addicted healthcare workers right now in the United States.

What does this mean for patients? They may not be receiving the medication they have been prescribed, in the recovery room or in other hospital settings. And, worse yet, they may receive an infection of bloodborne pathogens, such as hepatitis C or HIV.

At HONOReform, we believe a first priority in American healthcare is protocol and regulations that prevent drug diversion. This is a problem that can and must be fixed.

Robust materials developed by partners at the Safe Injection Practices Coalition the One and Only Campaign will soon be in place. We welcome the opportunity to help distribute these materials to leadership at healthcare facilities throughout the country.

Messaging and education are essential, important; but, in this case, we need government leaders at all levels to take a stand. Patients have been placed over and over in a vulnerable position, and addicted healthcare workers continue to practice with very little oversight and not nearly enough intervention.

In the near future, we will make an announcement of an upcoming meeting on drug diversion prevention.