1. Drug diversion & palliative care Indian perspective 2/22/2016 www.palliumindia.org

2. Essential steps to preventing diversion  Security of stock  Maintenance of records  Judicious prescribing 2/22/2016www.palliumindia.org

3. Security of stocking  Safe room; safe cupboard  One person responsible  Daily stock verification  Weekly verification by supervisor 2/22/2016www.palliumindia.org

4. Documentation  Name and age of patient  Registration number  Dose, strength, frequency, duration  Signature of doctor (legible) 2/22/2016www.palliumindia.org

5. Verification at review  Quantity dispensed  Understanding of dose regime  Quantity left over Any returned morphine is entered in stock and used again 2/22/2016www.palliumindia.org

6. Periodic verification  Matching stock on hand with documented balance  Investigating every discrepancy and accounting for it  Ensuring that minimum balance is always maintained 2/22/2016www.palliumindia.org

7. Study in Kerala 1723 patients over 2 year period No reports of thefts or unreasonable unsanctioned dose escalations Every discrepancy in stock investigated Lancet: 2001; 358: 139-43 2/22/2016www.palliumindia.org