APRIL 8, 2026
Hospitals are investing more deeply in both people and technology to combat controlled substance diversion, according to the Bluesight 2025 Diversion Trends Report, which analyzed more than 266 million controlled substance transactions across 1,159 hospitals (bit.ly/47LGBMn).
The data show steady improvement in documentation compliance, with the share of controlled substance transactions containing variances dropping from 7% to 6% between 2023 and 2024. That represents 2.6 million additional
Hospitals are investing more deeply in both people and technology to combat controlled substance diversion, according to the Bluesight 2025 Diversion Trends Report, which analyzed more than 266 million controlled substance transactions across 1,159 hospitals (bit.ly/47LGBMn).
The data show steady improvement in documentation compliance, with the share of controlled substance transactions containing variances dropping from 7% to 6% between 2023 and 2024. That represents 2.6 million additional transactions with complete documentation. Additionally, the proportion of unreconciled variances declined from 9% to 8%. “That’s still a lot of controlled substances going unaccounted for,” cautioned Sean Gilman, PharmD, DPLA, BCCCP, the director of clinical strategy at Bluesight, “but the trend is moving in the right direction.”
Most hospitals rely on both a diversion committee and software tools to detect diversion, he continued. “Software points you to concerning activity, but you still need human oversight: people who can add process control and operational and clinical context, conduct interviews, and drive performance improvement.”
Three-fourths of surveyed hospitals now have full-time staff dedicated to diversion monitoring, and nearly 70% operate cross-functional diversion committees. Forty percent plan to increase investment in diversion resources over the next year.
Of all controlled substance transactions tracked, 94% were automatically reconciled, while 6% required review for discrepancies. Roughly half of those variances stemmed from incorrect or late documentation, a slight improvement from the previous year.
Hospitals conducted 61% more diversion investigations in 2024 than in 2023, but each case closed about 40 days sooner. Gilman attributed much of the improvement in investigative speed and accuracy to dedicated diversion teams, along with better data access. Still, diversion remains a persistent challenge: 1,517 confirmed cases have been recorded since 2018, averaging two new cases per day nationwide.
Fentanyl remains the top drug linked to variances (24%), followed by midazolam and hydromorphone. Propofol, although not federally controlled, doubled from 2% to 4% of variances last year. “Many hospitals treat propofol as a controlled substance because of its abuse potential,” Gilman explained. “Diversion monitoring has to protect patients and staff.”
By Gina Shaw
Gilman reported no relevant financial disclosures.
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