Guidelines for the prevention and detection of controlled substance diversion.

Controlled substance diversion is a problem all hospitals face with far ranging legal and medical implications. Drug diversion or tampering can take many forms, such as simple theft, theft by substitution, theft by charting, and under-medicating the patient. The diversion of controlled substances by professional staff from patient care areas can frequently be prevented and detected at the nursing staff level. Often, diversion can be detected in daily hospital practice by performing careful narcotic counts, witnessing the "wasting" of partial doses, and routinely examining product packaging. Such procedures should be hospital policy and strictly enforced. Use of the guidelines presented in this report in conjunction with an effective inservice program can educate health care professionals in the problem of drug diversion. Drug diversion must be reported to maintain patient care standards, employee morale, and ultimely provide the necessary help and guidance to an impaired staff member.

International prescription drug labeling.

Yesterday's therapeutic compounds were meticulously prepared, elegantly presented, and relatively innocuous (Dunlop). Today's powerful and complex drugs are manufactured with sophisticated technology and require clear, concise, and comprehensive information for the physicians throughout the world in order to provide maximum benefit for the patient. Our company, Merck & Co, Inc, has adhered for many years to strict requirements for full and balanced disclosure in all information disseminated to professionals about our products, including circulars, labeling, and advertising. Our practice is to provide complete information to physicians, pharmacists, and regulatory authorities, both on the recommended uses for our products and on their potential adverse effects. The cornerstone of our international disclosure system, the International Physicians Circular (IPC), is provided for each product and comprises part of the initial submission to each national health authority in connection with application for marketing approval. Each IPC sets forth the company's best scientific judgment with respect to both the positive and negative aspects of our drugs, defining actions, indications, and dosage, as well as all contraindications, precautions, and side effects. These circulars are updated in the process of continuous medical review.