Most Commonly Diverted Drugs
Which controlled substances appear most often in documented diversion cases, and the audit controls each pattern points to.
A specific drug is named in 622 of the 931 documented cases in the DivertGuard case registry. Oxycodone is named most often, in 252 cases (27%), followed by fentanyl (182) and hydrocodone (158).
Counts sum higher than 622 because several cases involve more than one substance. See the diversion statistics page for drugs alongside settings and outcomes, and diversion penalties for what organizations paid in the underlying cases.
Which Drugs Are Diverted?
Every drug named in the registry, ranked
The chart above shows the top 8 for legibility; this table lists all 21 substances named in at least one documented case.
| # | Drug | Cases | Share of 931 cases |
|---|---|---|---|
| 1 | Oxycodone | 252 | 27% |
| 2 | Fentanyl | 182 | 20% |
| 3 | Hydrocodone | 158 | 17% |
| 4 | Hydromorphone | 126 | 14% |
| 5 | Morphine | 90 | 10% |
| 6 | Alprazolam | 35 | 4% |
| 7 | Amphetamine | 32 | 3% |
| 8 | Tramadol | 24 | 3% |
| 9 | Methadone | 23 | 2% |
| 10 | Codeine | 16 | 2% |
| 11 | Meperidine | 14 | 2% |
| 12 | Lorazepam | 14 | 2% |
| 13 | Midazolam | 9 | 1% |
| 14 | Methylphenidate | 8 | 1% |
| 15 | Propofol | 7 | 1% |
| 16 | Ketamine | 6 | 1% |
| 17 | Cocaine | 4 | 0% |
| 18 | Buprenorphine | 3 | 0% |
| 19 | Sufentanil | 2 | 0% |
| 20 | Testosterone | 2 | 0% |
| 21 | Phenobarbital | 1 | 0% |
Drug-by-drug: what the pattern looks like and what to audit
These are the 5 most-named substances, with a documented case example for each and the audit control its diversion pattern points to. General guidance, not a finding about any individual named below — see each case record for the full facts.
Oxycodone
252 of 931 cases (27%)An oral solid dispensed in bulk at retail and hospital pharmacies, oxycodone is diverted mainly through prescription fraud, forged scripts, and pill-count discrepancies at the pharmacy level. Audit controls: prescription verification against prescriber records, physical pill counts reconciled to dispensing logs, and corresponding-responsibility checks on early refills.
Documented case examples with a stated quantity:
- Trenton Pharmacy Owner Convicted of Diverting Millions of Oxycodone Pills — 800,000 pills, New Jersey, 2025
- Florida Pharmacist Sentenced to Over 7 Years in Prison for Massive Illegal Oxycodone Distribution Conspiracy — 335,351 pills, Florida, 2026
Fentanyl
182 of 931 cases (20%)Injectable, high-potency, and dosed in small-volume vials or patches, fentanyl is diverted mainly by vial substitution (saline or another clear fluid swapped in) and by tampering with patches or IV lines. Audit controls: witnessed waste on every partial dose, vial-return reconciliation against administration records, and tamper-evident packaging on high-risk floors.
Documented case examples with a stated quantity:
- Ann Arbor VA Nurse Anesthetist Stole 2,000+ Vials of Opioids — 2,000 vials, Michigan, 2021
- Denver Paramedic Supervisor Sentenced for Stealing 1,900 Vials of Fentanyl — 1,900 vials, Colorado, 2023
Hydrocodone
158 of 931 cases (17%)Almost always an oral combination product dispensed at retail pharmacies, hydrocodone is diverted through the same prescription-fraud and pill-count patterns as oxycodone. Audit controls: PDMP checks before dispensing, physical counts, and review of prescribers or patients with outlier fill patterns.
Documented case examples with a stated quantity:
- California pharmacist sentenced to more than seven years for dispensing over 450,000 opioid pills on fraudulent prescriptions — 450,000 pills, California, 2024
- Pharmacy technician diverted over 216,000 Norco tablets from a retail pharmacy while the pharmacist-in-charge failed to detect the theft — 216,630 tablets, California, 2015
Hydromorphone
126 of 931 cases (14%)Potent and often stored in automated dispensing cabinets on high-acuity units, hydromorphone is diverted through ADC overrides, syringe swaps, and diluted or substituted patient doses. Audit controls: override-report review by someone other than the unit manager, witnessed waste, and discrepancy resolution within the same shift.
Documented case examples with a stated quantity:
- Hospital Pharmacy Manager Stole 35,000+ Opioid Vials from Secure Vault — 35,000 vials, Indiana, 2024
- Indiana Pharmacist Charged in Opioid Diversion Case (2026) — 35,000 vials, Indiana, 2026
Morphine
90 of 931 cases (10%)Used across inpatient, hospice, and long-term care settings, morphine is diverted through under-administration to patients (with the difference kept) and through waste that is recorded but never witnessed. Audit controls: witnessed waste on every dose, especially in hospice and long-term care where independent witnesses are scarcest, and PRN administration patterns reviewed against documented pain scores.
Documented case examples with a stated quantity:
- Registered nurse accused of diverting morphine from OrthoNebraska surgical unit — 600 vials, Nebraska, 2026
- Confluence Health Clinic Nurse Tampered with Morphine Vials — 17 vials, Washington, 2021
For the behavioral, documentation, and inventory indicators that apply across every drug, see 15 Red Flags of Drug Diversion. For what to do once a discrepancy or red flag surfaces, see the Investigation Playbook.
Methodology
Drug counts are drawn from the same public registry that backs the diversion statistics page: 931 documented cases spanning 1983-2026. Not every case names a specific drug, and a single case can name more than one, so drug counts sum higher than the 622 cases that name at least one substance. Percentages are shares of all 931 registry cases, rounded to the nearest whole number.
Frequently asked questions
What is the most commonly diverted drug in healthcare settings?
In this registry, oxycodone, named in 252 of 931 documented cases (27%). The injectable opioids (fentanyl, hydromorphone and morphine) together account for the largest share of mentions, even though the single most-named drug is an oral solid.
Why do injectable opioids dominate the list?
Injectable opioids such as fentanyl and hydromorphone are administered at the bedside in small, easily concealed volumes, and the difference between an ordered dose and an administered dose is verified only if waste is independently witnessed. Oral solids such as oxycodone and hydrocodone are diverted through a different pathway — mainly prescription fraud at the pharmacy counter — rather than at the bedside.
Does a high count mean a drug is more dangerous or more often abused?
Not necessarily. This page counts how often a drug is named in a documented, public diversion case — it reflects what reaches an enforcement action or board order and gets reported, not a measured rate of misuse. A drug that is harder to trace with current controls could be under-represented here even if diversion of it is common.
Where can I read the full case behind one of these examples?
Every example above links to its full case record, including what happened, what went wrong, and how it could have been prevented. Browse the complete case registry for all 931 documented cases.
Audit the drugs your program is most exposed to
Start with a free program gap assessment, or read the red flags and investigation steps behind the patterns above.
Last reviewed: September 2026 · Content is educational, not legal advice.