What Can the US Learn From the UK's Approach to Drug Diversion?

What Can the US Learn From the UK's Approach to Drug Diversion?

This episode dives deep into the challenges and systems behind drug diversion control across the US and UK. If you're in healthcare and curious about how different countries handle controlled medicines, you'll get plenty to think about here. Terri Vidals sits down with Mark Jackson, whose law enforcement and regulatory background in the UK mirrors the FDA’s Office of Criminal Investigations.

Mark lays out how the UK uses Class A, B and C categories instead of US-style schedules, with opioids like oxycodone at the top, benzodiazepines in the middle, and cannabis-based medicines at the bottom. Mark shares how his team first stumbled onto a major diversion problem: UK-licensed medicines turning up in illicit markets, including hundreds of millions of doses of benzodiazepines and sleeping tablets.

As he puts it, supply chain data finally showed “there is something going on here we need to understand,” revealing big shifts in volumes and strengths that had gone unnoticed for years. You’ll hear how UK pharmacies can also hold wholesaler licences, creating gaps when responsibilities are split across different inspection bodies.

Mark and Terri compare this to US practice, and talk about how diversion cases in Europe often follow the money, sending opioids into high-demand markets like the United States. The conversation also contrasts prescribing culture: far fewer opioids in UK hospitals, limited pack sizes for over-the-counter painkillers, and a different attitude toward pain and risk, especially around suicide attempts with paracetamol.

Terri adds US anecdotes from birth experiences, dentistry, and hospital order sets to show how everyday practice shapes diversion risk. Through it all, Mark repeats a theme: “No one has diversion… everyone talks about the risks… but it doesn’t happen here – until they find it.” It’s a sober reminder that any system can have blind spots. If you work with controlled medicines, how confident are you that it isn’t quietly happening where you are?