According to a survey of 371 hospice providers published in February’s Journal of the American Medical Association, family caregivers, relatives, and the patients themselves are the people most likely to divert meds away from hospice patients.1 The research conducted by John Cagle, PhD, and his team from the University of Maryland, gives some detail and perspective to a long-suspected issue for hospice patients and hospice providers.
What Is Medication Diversion?
In healthcare, the term “diversion” refers to the act of using prescribed medications for something other than the intended purpose. Typically, it involves someone using the meds recreationally or selling them. The problem exists throughout all points of healthcare where certain medications are involved. One report conservatively estimated that medication diversion adds $301 million to the cost of healthcare annually. That includes the cost of the stolen drugs and the various prevention measures prescribers have deployed.
What Medications are Being Stolen from Hospice Patients?
Symptom control, and especially pain control, is a very big part of hospice care. Over 90% of hospice patients are prescribed opioids for pain management.2 Therefore, opioids make prime targets for those who want to divert prescriptions from hospice patients. In hospice, diversion tends to involve pain medications and psychoactive drugs in general. These include ketamine, benzodiazepines, and numerous others.
How Prevalent is Medication Diversion in Hospice?
Cagle et al. report three out of ten hospices having one or more confirmed cases of diversion in the previous 90 days. When we add suspected cases of diversion, six out of ten hospice agencies answer “yes.”
Who is Most Likely to Divert Meds from Hospice Patients?
The survey finds that the individuals most frequently involved in drug diversion are:
- Family caregivers (39%)
- Other family (38%)
- Patients themselves (34%)
How to Prevent Drug Diversion in Hospice
Hospice nurses commonly leave doses of important medications in the home with patients and caregivers, to allow symptom control to be delivered as needed. This is where diversion starts. Keep the presence of those drugs and the location of those drugs on a need-to-know basis. Keep records of when the drugs were administered and use those records to make sure the remaining supply is what it’s supposed to be.
It has been reported that a hospice patient may sell drugs to buy groceries or other necessities. When economic needs are that high, ask the hospice for help. From food to heating fuel, community assistance programs abound. Hospice agencies often make it part of their business to coordinate various community resources that each patient needs.
Related Article: Opioids and Sedatives Appear to Lengthen Life for Hospice Patients
- Cagle JG, McPherson ML, Frey JJ, Sacco P, Ware OD, Wiegand DL, Guralnik JM. Estimates of Medication Diversion in Hospice. JAMA. 2020 Feb 11;323(6):566-8.
- Cagle JG. Strategies for Detecting, Addressing, and Preventing Drug Diversion in Hospice and Palliative Care (P15). Journal of Pain and Symptom Management. 2019 Feb 1;57(2):360.