This page summarizes the 716 documented federal and state drug diversion cases in the DivertGuard case registry — what was diverted, where it happened, and how each case progressed — for compliance officers, pharmacy directors and diversion program managers who need defensible reference numbers.

Snapshot, not a statistical sample: counts change as cases are added. Open See the numbers under any chart to read, copy or cite the underlying figures directly.

The registry at a glance

Panel of registry figures: 716 documented cases, 52 states and territories represented, case records spanning 1983-2026, and combined settlements, fines and restitution.

Drug Diversion Cases by State

Every catalogued case in this registry, placed where it occurred. Darker states have more documented cases — click one to jump to its cases below.

Diversion happens everywhere. Unshaded states have no case catalogued here yet — that is a gap in this collection, not evidence that nothing occurred. We are actively filling them.

Tap a state to open its cases below
716cases mapped
52states represented
43most in one state

Every state, ranked by case count

The map above shows abbreviations at a glance and the exact count once you zoom in on a state; this table has the precise number for all 52 states and territories the registry tracks, including the ones with no catalogued case yet.

Documented drug diversion cases by state and territory, ranked highest to lowest (52 rows).
State Cases
Maryland MD 43
Michigan MI 30
Texas TX 25
Massachusetts MA 24
Connecticut CT 23
Mississippi MS 22
Tennessee TN 22
Illinois IL 20
California CA 18
Vermont VT 18
Wisconsin WI 18
New York NY 17
North Carolina NC 17
Iowa IA 16
New Jersey NJ 16
Washington WA 16
Florida FL 15
Colorado CO 14
Louisiana LA 14
Minnesota MN 14
Montana MT 14
Nevada NV 14
New Hampshire NH 14
Oklahoma OK 14
Oregon OR 14
Pennsylvania PA 14
South Dakota SD 14
Kansas KS 13
Ohio OH 13
South Carolina SC 13
Arkansas AR 12
Virginia VA 12
Georgia GA 11
Indiana IN 11
Missouri MO 11
Alaska AK 10
Kentucky KY 10
New Mexico NM 9
Utah UT 9
Wyoming WY 9
Alabama AL 8
Delaware DE 8
District of Columbia DC 8
Hawaii HI 8
West Virginia WV 8
Nebraska NE 7
Idaho ID 6
Maine ME 6
Arizona AZ 5
North Dakota ND 4
Puerto Rico PR 4
Rhode Island RI 1

See every case, state by state ↓

Which states the documented cases come from

Bar chart of the ten states with the most documented diversion cases, with a note that counts follow where records are published rather than the underlying rate of diversion.

Documented Diversion Cases Over Time (2010–2026)

Bar chart of documented drug diversion cases by year from 2010–2026: 7 in 2010, 18 in 2011, 12 in 2012, 13 in 2013, 12 in 2014, 29 in 2015, 25 in 2016, 31 in 2017, 30 in 2018, 37 in 2019, 38 in 2020, 47 in 2021, 58 in 2022, 69 in 2023, 75 in 2024, 94 in 2025, 66 in 2026.

Case volume rises from 7 in 2010 to 66 in 2026 (2026 is a partial year, through September). This window covers 661 of the 716 registry cases; the rest are dated before 2010 and are shown in the case list and map but are too thin to chart on this scale.

See the numbers
Documented cases by year, 2010–2026 (n = 661 cases in this range; 716 in the registry overall).
YearDocumented cases
20107
201118
201212
201313
201412
201529
201625
201731
201830
201937
202038
202147
202258
202369
202475
202594
202666

Facility Settlements & Fines

Bar chart of civil settlements, civil penalties and criminal fines paid by healthcare organizations in documented diversion cases: University of Texas Southwestern Medical Center 4500000, Sovah Health 4360000, University of Michigan Health System 4300000, MultiCare Health System (Good Samaritan Hospital, Puyallup) 4000000, Massachusetts General Hospital 2300000, Cheshire Medical Center 2000000, Prisma Health Midlands 1000000, GMAJOS, LLC, Dr. Stephen Swetech, and Yasser Maisari 700948.

Healthcare organizations — hospitals, health systems and pharmacies — paid a documented $27,092,098 across 35 matters in this registry, ranging from $15,000 to $4,500,000.

These are civil settlements, assessed civil penalties and criminal fines — money the organisation itself was ordered or agreed to pay. Amounts paid by individuals (fines and restitution in a practitioner's sentence) are counted separately and are not included in the total above, which additionally documents $10,689,912 owed by individuals.

See all 35 settlements and fines, each linked to its primary source
University of Texas Southwestern Medical Center
$4,500,000 civil settlement · 2018 · TX
Sovah Health
$4,360,000 civil settlement · 2022 · VA
University of Michigan Health System
$4,300,000 civil settlement · 2018 · MI
MultiCare Health System (Good Samaritan Hospital, Puyallup)
$4,000,000 civil settlement · 2018 · WA
Massachusetts General Hospital
$2,300,000 civil settlement · 2015 · MA
Cheshire Medical Center
$2,000,000 civil settlement · 2023 · NH
Prisma Health Midlands
$1,000,000 civil settlement · 2022 · SC
GMAJOS, LLC, Dr. Stephen Swetech, and Yasser Maisari
$700,948 civil settlement · 2024 · MI
Trivial rounding discrepancy only ($0.42). Checked for double-counting given the three-party payer name: this is one joint total, not three separate $700,948 payments, so no duplication risk. payer_kind='facility' is a simplification (GMAJOS LLC is the landlord entity; Swetech and Maisari are individuals) but doesn't misstate who owes the money.
Oakley Pharmacy, Inc. (dba Dale Hollow Pharmacy) and Xpress Pharmacy of Clay County LLC
$450,000 civil settlement · 2026 · TN
Joint and several with the individual owner — reported as a facility payment.
Ready Pharmacy
$400,000 civil settlement · 2022 · NM
Yale University (Yale Medicine / Yale Fertility Center)
$308,250 civil settlement · 2021 · CT
Catholic Medical Center
$300,000 civil settlement · 2024 · NH
Allcare Discount Pharmacy
$250,000 civil settlement · 2019 · IL
Palomar Health
$250,000 civil settlement · 2024 · CA
Smith Family Pharmacy
$215,000 civil penalty · 2024 · KY
Emory University Hospital Midtown
$200,000 civil penalty · 2016 · GA
Savage Family Pharmacy
$180,480 civil penalty · 2020 · PA
Northern Maine Medical Center
$125,000 civil settlement · 2016 · ME
Ennis Pharmacy
$125,000 civil penalty · 2020 · MT
Best Veterinary Care
$125,000 civil settlement · 2024 · CA
Beckman's Greene Street Pharmacy, Inc.
$120,000 civil settlement · 2023 · MD
Consent decree names both the pharmacy and pharmacist John A. Beckman as jointly agreeing to pay.
Balboa Pharmacy
$105,000 civil settlement · 2022 · CA
Aspirar Pharmacy, LLC and Aspirar Pharmacy of Durham, LLC
$100,000 civil settlement · 2022 · NC
Tufts Medical Center
$100,000 civil settlement · 2016 · MA
Eaton Apothecary
$100,000 civil settlement · 2016 · MA
Upton Care Pharmacy, Inc.
$100,000 civil penalty · 2023 · MD
Consent decree names both the pharmacy and pharmacist Abtin Youssefi-Rashti as jointly agreeing to pay.
Confederated Salish and Kootenai Tribes' Pharmacy
$95,520 civil penalty · 2018 · MT
New York Methodist Hospital
$70,000 civil settlement · 2013 · NY
Children's Hospital of the King's Daughters, Inc.
$68,400 civil penalty · 2023 · VA
IU Health Ball Memorial Hospital
$44,000 civil penalty · 2024 · IN
State board penalty: Indiana Board of Pharmacy, ,000 per violation x 44 violations. News source only.
Baldpate Hospital
$29,500 civil settlement · 2011 · MA
Cadott Miller Pharmacy, Ltd.
$20,000 civil settlement · 2022 · WI
Riverbird, LLC (with two individual physicians, jointly)
$20,000 civil settlement · 2026 · ME
Joint settlement: paid by the clinic LLC together with two individual physicians, one of whom personally diverted; counted once as a facility payment.
Mid-Valley Hospital and Clinic
$15,000 civil penalty · 2024 · WA

Settlement amounts reflect what a facility agreed to pay to resolve allegations; they are not a finding of liability, and several were structured to be credited against related restitution. See every settlement and fine with its primary source →

Which Drugs Are Diverted?

Horizontal bar chart of drugs named in 716 drug diversion cases: oxycodone 162, fentanyl 143, hydrocodone 113, hydromorphone 105, morphine 74, alprazolam 27, amphetamine 22, tramadol 20, methadone 17, meperidine 13, codeine 13, lorazepam 13, midazolam 8, methylphenidate 6, propofol 6, ketamine 4, cocaine 4, buprenorphine 3, sufentanil 2, testosterone 2, phenobarbital 1.

Injectable opioids dominate the registry. Oxycodone appears in 162 case records and fentanyl in 143, while oral controlled substances such as oxycodone and hydrocodone appear in a small number of cases that are concentrated in pharmacy dispensing settings rather than at the bedside.

Counts sum higher than the 463 cases that name a drug because several cases involve more than one substance. Percentages below are shares of all 716 registry cases.

See the numbers
Drugs named in DivertGuard registry cases (n = 716 cases; 463 name a drug).
Drug Cases Share of 716 cases
Oxycodone16223%
Fentanyl14320%
Hydrocodone11316%
Hydromorphone10515%
Morphine7410%
Alprazolam274%
Amphetamine223%
Tramadol203%
Methadone172%
Meperidine132%
Codeine132%
Lorazepam132%
Midazolam81%
Methylphenidate61%
Propofol61%
Ketamine41%
Cocaine41%
Buprenorphine30%
Sufentanil20%
Testosterone20%
Phenobarbital10%

See the drug-by-drug breakdown with audit red flags →

Who Was Diverting?

Bar chart of the clinician role in documented diversion cases: Registered nurse (RN) 155, Pharmacy technician 108, Nurse (role unspecified) 97, Physician / surgeon 95, Pharmacist 91, Licensed practical / vocational nurse 30, Nurse practitioner / APRN 18, Nurse anesthetist (CRNA) 15, Paramedic / EMT 9, Dentist / oral surgery 6, Nurse aide / assistant 5, Veterinarian 4, Surgical / OR technician 4.

Registered nurse (RN) is the most common role by a wide margin — 155 of the 637 cases that name a role (24%), ahead of pharmacy technician at 108. Roles are read from each case record; the 79 cases that name no role are excluded rather than guessed.

See the numbers
Clinician role, most specific identifiable role per case (n = 637 cases that name one).
RoleCasesShare
Registered nurse (RN)15524%
Pharmacy technician10817%
Nurse (role unspecified)9715%
Physician / surgeon9515%
Pharmacist9114%
Licensed practical / vocational nurse305%
Nurse practitioner / APRN183%
Nurse anesthetist (CRNA)152%
Paramedic / EMT91%
Dentist / oral surgery61%
Nurse aide / assistant51%
Veterinarian41%
Surgical / OR technician41%

Which role diverts which drug?

Matrix shading how often each clinician role is recorded with each of the most-documented controlled substances.

Roles and substances are not evenly paired. Reading across a row shows which substances that role's cases actually name, which is more specific than either chart alone — the role table says who diverts, the drug table says what is diverted, and this says which pairing. A case is counted in every cell its record supports, so the cells are not meant to sum to the registry total.

Where Does Diversion Happen?

Horizontal bar chart of practice settings in 716 drug diversion cases: Retail pharmacy 250, Hospital / health system 240, Long-term care 37, Ambulatory surgery / OR 26, Home health / hospice 21, Emergency services / EMS 16, VA / federal facility 15, Dental / oral surgery 7, Fertility / reproductive 2.

Retail pharmacy settings appear in 250 of 716 cases (35%) — the settings with the largest controlled substance footprint and the most handoffs between dispensing, administration, and waste. Hospital / health system follows at 240 of 716 (34%).

Lower-volume settings still appear too: long-term care (37), ambulatory surgery / or (26), home health / hospice (21), emergency services / ems (16), va / federal facility (15), dental / oral surgery (7), fertility / reproductive (2). These are environments where a single practitioner often controls the entire medication chain with limited independent witnessing.

Setting counts sum higher than the 490 cases with an identifiable setting because several cases span more than one environment — for example a health system that also operated dispensing pharmacies. Percentages below are shares of all 716 registry cases, so they describe how often a setting appears, not a mutually exclusive split.

See the numbers
Practice settings in DivertGuard registry cases (n = 716 cases; 490 identify a setting; a case may span more than one).
Practice setting Cases Share of 716 cases
Retail pharmacy25035%
Hospital / health system24034%
Long-term care375%
Ambulatory surgery / OR264%
Home health / hospice213%
Emergency services / EMS162%
VA / federal facility152%
Dental / oral surgery71%
Fertility / reproductive20%

Compare unit-level risk profiles →

How Much Drug Was Taken?

What this measures: the largest quantity named in a single case record — not a total across cases, and nothing is estimated where the record is silent. Each dot is one case, placed by its own figure on a logarithmic scale, so the shape shows how far apart these numbers really are.

Dot plot, one dot per case record that states a quantity (72 of 716 cases), grouped by unit type on a logarithmic scale from 1 to 800,000: Pills & tablets (43 cases: 800000, 450000, 216630, 200000, 158000, 60000, 56108, 56108, 56108, 56000, 56000, 28000, 20344, 20344, 18269, 16000, 8505, 8505, 6540, 6000, 5000, 4184, 3762, 3500, 2500, 2500, 2500, 2100, 2000, 1980, 1171, 600, 500, 400, 300, 300, 270, 200, 167, 150, 80, 45, 10); Vials (18 cases: 35000, 2000, 1900, 1467, 650, 600, 450, 255, 252, 78, 78, 58, 58, 58, 40, 25, 18, 17); Bags, doses & other (11 cases: 80000, 67000, 60000, 60000, 24422, 22000, 2500, 483, 46, 3, 3).

The largest figure anywhere in the registry is 800,000 pills (oxycodone, New Jersey, 2025); the smallest is 3 blisters. Only 72 of 716 records state any countable quantity at all — 644 give no total, so this is what records documented, not what was typical. 45 cases state a weight instead, kept out rather than added to a count of vials.

See all 72 documented quantities
Every case record that states a quantity, largest first. Records that state only a weight in milligrams (45) are not listed here, because a milligram figure cannot be compared with a count of vials. The figure is the amount the court or agency record itself states.
QuantityUnitDrugWhereYearCase
800,000pillsoxycodoneNew Jersey2025Read case
450,000pillshydrocodoneCalifornia2024Read case
216,630tabletshydrocodoneCalifornia2015Read case
200,000pillshydrocodoneCalifornia2024Read case
158,000pillsoxycodoneNew York2019Read case
80,000unitsoxycodoneConnecticut2016Read case
67,000doseshydrocodoneMinnesota2014Read case
60,000pillshydrocodoneIdaho2019Read case
60,000doseshydrocodoneKentucky2022Read case
60,000doseshydrocodoneKentucky2022Read case
56,108pillshydrocodoneIllinois2019Read case
56,108pillshydrocodoneIllinois2019Read case
56,108pillshydrocodoneIllinois2019Read case
56,000pillsalprazolamIllinois2025Read case
56,000pillsalprazolamIllinois2025Read case
35,000vialshydromorphoneIndiana2024Read case
28,000pillsalprazolamIllinois2022Read case
24,422dosesnot namedNew Mexico2022Read case
22,000dosesalprazolamConnecticut2020Read case
20,344tabletsoxycodoneNew Mexico2016Read case
20,344tabletsoxycodoneNew Mexico2016Read case
18,269tabletsnot namedMinnesota2020Read case
16,000pillsoxycodoneMassachusetts2015Read case
8,505pillshydrocodoneHawaii2018Read case
8,505pillshydrocodoneHawaii2019Read case
6,540tabletsnot namedCalifornia2011Read case
6,000pillsoxycodoneOregon2013Read case
5,000pillsnot namedAlaska2022Read case
4,184tabletsbuprenorphineVermont2014Read case
3,762tabletsnot namedOklahoma2025Read case
3,500pillshydrocodoneIowa2025Read case
2,500pillsoxycodoneMontana2018Read case
2,500dosesnot namedIowa2022Read case
2,500pillsoxycodoneMontana2018Read case
2,500tabletsoxycodoneMontana2018Read case
2,100tabletsoxycodonePennsylvania2021Read case
2,000vialsfentanylMichigan2021Read case
2,000tabletsnot namedConnecticut2021Read case
1,980tabletsoxycodoneMissouri2026Read case
1,900vialsfentanylColorado2023Read case
1,467vialsfentanylNew York2021Read case
1,171tabletsoxycodoneOklahoma2025Read case
650vialsfentanylMassachusetts2017Read case
600vialsmorphineNebraska2026Read case
600pillsoxycodoneDistrict of Columbia2016Read case
500tabletshydrocodoneKansas2012Read case
483bagsfentanylKansas2018Read case
450vialsfentanylFlorida2023Read case
400tabletsoxycodoneNew Jersey2021Read case
300tabletsoxycodoneNew Hampshire2013Read case
300tabletsnot namedPennsylvania2026Read case
270pillsoxycodoneMaryland2012Read case
255vialsfentanylOregon2025Read case
252vialsfentanylIowa2018Read case
200tabletsoxycodoneOhio2026Read case
167tabletsoxycodoneMinnesota2020Read case
150tabletshydrocodoneNew Hampshire2013Read case
80tabletsamphetamineMinnesota2021Read case
78vialsfentanylNorth Carolina2023Read case
78vialsfentanylNorth Carolina2023Read case
58vialshydromorphoneWyoming2017Read case
58vialshydromorphoneWyoming2018Read case
58vialshydromorphoneWyoming2018Read case
46bottlescodeineWashington2024Read case
45pillsoxycodoneMaryland2023Read case
40vialsfentanylMassachusetts2017Read case
25vialstestosteroneUtah2023Read case
18vialsfentanylWisconsin2015Read case
17vialsmorphineWashington2021Read case
10pillshydrocodoneSouth Dakota2011Read case
3bagshydromorphoneConnecticut2024Read case
3blistersoxycodoneMassachusetts2020Read case

How Did the Cases Resolve?

Horizontal bar chart of the furthest documented stage in 716 drug diversion cases, one bar per case: No stage stated in the record 213, Sentenced 201, Charged or indicted, pending 89, Settled (civil) 80, Convicted at trial 79, Pleaded guilty, awaiting sentence 54.

213 of 716 cases have reached sentencing — the furthest stage most records document — and 89 are still only charged or indicted. A case can pass through several stages, so raw mentions overlap (229 records mention a sentence, 241 a guilty plea); the chart counts each case once, in its furthest stage, which is why the bars add up to 716.

The practical takeaway for compliance teams: a large share of these matters are still in progress at the time of documentation. Charges are allegations until a conviction is recorded.

See the numbers
Furthest stage documented, one row per case (n = 716). A case that pleaded guilty and was later sentenced is counted once, under Sentenced. Charges are allegations until a conviction is recorded.
Documented stage Cases Share of 716 cases
No stage stated in the record21330%
Sentenced20128%
Charged or indicted, pending8912%
Settled (civil)8011%
Convicted at trial7911%
Pleaded guilty, awaiting sentence548%

Cases Documented by Year (2018–2026)

Bar chart of documented drug diversion cases by year from 2018-2026: 30 in 2018, 37 in 2019, 38 in 2020, 47 in 2021, 58 in 2022, 69 in 2023, 75 in 2024, 94 in 2025, 66 in 2026.

Case volume in the registry is concentrated in the most recent years: 94 cases in 2025, against 30 in 2018 (2026 is a partial year, through September). The registry also catalogues cases from 1983-2026, which are shown in the case list and map but are too thin to chart on this scale.

Read this as documentation activity rather than incidence. Recent enforcement actions are easier to find and are added to the registry sooner, so the curve reflects both prosecutions and the pace of collection.

See the numbers
Documented cases by year, 2018-2026 (n = 514 cases in this range; 716 in the registry overall). A year showing 0 has no case catalogued in this registry yet — it does not mean no diversion occurred. Each case is dated by the charge, plea or settlement announcement (the court or agency record), not by the date the diversion itself occurred. 2026 is a partial year, through September.
Year Documented cases
201830
201937
202038
202147
202258
202369
202475
202594
202666

See what is trending in current enforcement reporting →

Every Case, by State

The map above plots these same cases. Open a state to read the headline and a short summary of each case — the summaries are written without naming the people involved.

Every state opens to its case headlines
Alabama 8 cases
Alaska 10 cases
Arizona 5 cases
Arkansas 12 cases
California 18 cases
Colorado 14 cases
Connecticut 23 cases
Delaware 8 cases
District of Columbia 8 cases
Florida 15 cases
Georgia 11 cases
Hawaii 8 cases
Idaho 6 cases
Illinois 20 cases
Indiana 11 cases
Iowa 16 cases
Kansas 13 cases
Kentucky 10 cases
Louisiana 14 cases
Maine 6 cases
Maryland 43 cases
Massachusetts 24 cases
Michigan 30 cases
Minnesota 14 cases
Mississippi 22 cases
Missouri 11 cases
Montana 14 cases
Nebraska 7 cases
Nevada 14 cases
New Hampshire 14 cases
New Jersey 16 cases
New Mexico 9 cases
New York 17 cases
North Carolina 17 cases
North Dakota 4 cases
Ohio 13 cases
Oklahoma 14 cases
Oregon 14 cases
Pennsylvania 14 cases
Puerto Rico 4 cases
Rhode Island 1 case
South Carolina 13 cases
South Dakota 14 cases
Tennessee 22 cases
Texas 25 cases
Utah 9 cases
Vermont 18 cases
Virginia 12 cases
Washington 16 cases
West Virginia 8 cases
Wisconsin 18 cases
Wyoming 9 cases

Key Findings

  • Oxycodone is named in 162 of 716 cases (23%) — ahead of fentanyl (143) and hydrocodone (113).
  • Retail pharmacy settings appear in 250 of 716 cases (35%), with hospital / health system second at 240 of 716 (34%).
  • 94 cases are dated 2025 — the largest single year in the registry, and 9 years in the 1983-2026 range (1985, 1986, 1987, 1988, 1989, 1992, 1996, 1998, 2002) carry no catalogued case.
  • 229 cases have reached sentencing, 161 are at the indicted or charged stage, and 241 records document a guilty plea.
  • Catalogued cases span 52 states (716 of 716 mapped) — Maryland has the most with 43.
  • Registered nurse (RN) is the most common role, in 155 of the 637 cases that name a clinician (24%) — ahead of pharmacy technician at 108. 79 cases name no role at all.
  • Only 72 of 716 records state a countable quantity taken — 644 give no total, which is itself a finding about how records are written.
  • A specific drug is named in 463 of 716 case records and a practice setting is identifiable in 490 of 716 — public case documents do not always specify either.

Methodology

The registry is compiled from public federal and state court records and news reporting. Drugs and practice settings are classified from each individual case record: not every case names a drug, and not every case identifies a setting, so the denominators differ (a drug is named in 463 of 716 cases, a setting is identifiable in 490 of 716). A single case may involve more than one substance, which is why drug counts sum higher than 463. Percentages are rounded to the nearest whole number.

This is a documentation snapshot, not a statistical sample. It should not be used to estimate the prevalence of diversion nationally. Use it to understand what documented cases look like — which substances and settings recur, and how those matters proceed.

Frequently Asked Questions

What is the most commonly diverted drug in federal cases?

In this registry, oxycodone. It is named in 162 of 716 documented cases (23%), followed by fentanyl in 143 cases and hydrocodone in 113. Injectable opioids account for the large majority of drug mentions.

Which healthcare setting sees the most diversion cases?

Retail pharmacy, with 250 of 716 cases (35%). Hospital / health system is second at 240 of 716 (34%). The remaining settings together account for 124 cases.

Are drug diversion cases increasing?

Documented cases per year are concentrated in recent years: 94 in 2025 — the largest year recorded. That trend describes documentation and enforcement activity captured in public records, not a measured change in how often diversion occurs.

How do drug diversion cases usually end?

Of the 716 cases, 229 have reached sentencing, 161 are documented at the indicted or charged stage, and 241 records note a guilty plea. These stages overlap, since a case can be charged, plead out, and be sentenced over time.

How often do public case records name a specific drug or setting?

A specific drug is named in 463 of the 716 cases, and a practice setting is identifiable in 490 of 716. The remainder describe controlled substances or employers only in general terms, which is why the percentages on this page use 716 cases as the denominator.

Turn These Numbers into Program Controls

Start with a gap assessment, read the underlying cases, or work through the guides that address the risks these figures point to.

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Last reviewed: September 2026 · Content is educational, not legal advice.