Hospices grap­ple with stolen meds as part of the opi­oid cri­sis

Hospices grap­ple with stolen meds as part of the opi­oid cri­sis

Imperial Valley Press - - FRONT PAGE - BY MELISSA BAILEY

Noth­ing seemed to help the pa­tient — and hos­pice staff didn’t know why.

They sent home more painkillers for weeks. But the el­derly woman, who had se­vere de­men­tia and in­cur­able breast can­cer, kept call­ing out in pain.

The an­swer came when the woman’s daugh­ter, who was tak­ing care of her at home, showed up in the emer­gency room with a life- threat­en­ing over­dose of mor­phine and oxy­codone. It turned out she was high on her mother’s med­i­ca­tions, stolen from the hos­pice- is­sued stash.

Dr. Les­lie Black­hall han­dled that case and two oth­ers at the Univer­sity of Vir­ginia’s pal­lia­tive care clinic, and un­cov­ered a wider prob­lem: As more peo­ple die at home on hos­pice, some of the pow­er­ful, ad­dic­tive drugs they are pre­scribed are end­ing up in the wrong hands.

Hospices have largely been ex­empt from the na­tional crack­down on opi­oid pre­scrip­tions be­cause dy­ing peo­ple may need high doses of opi­oids.

But as the na­tion’s opi­oid epi­demic con­tin­ues, some ex­perts say hospices aren’t do­ing enough to iden­tify fam­i­lies and staff who might be steal­ing pills.

And now, amid ur­gent cries for ac­tion over ris­ing over­dose deaths, sev­eral states have passed laws giv­ing hos­pice staff the power to de­stroy left­over pills after pa­tients die.

Black­hall first sounded the alarm about drug di­ver­sion in 2013, when she found that most Vir­ginia hospices she sur­veyed didn’t have manda­tory train­ing and poli­cies on the mis­use and theft of drugs.

Her study spurred the Vir­ginia As­so­ci­a­tion for Hospices and Pal­lia­tive Care to cre­ate new guide­lines, and prompted na­tional dis­cus­sion.

Most hos­pice pa­tients re­ceive care in the place they call home. Th­ese set­tings can be hard to mon­i­tor, but a Kaiser Health News re­view of gov­ern­ment in­spec­tion records sheds light on what can go wrong. Ac­cord­ing to th­ese re­ports:

• In Mo­bile, Ala., a hos­pice nurse found a man at home in tears, hold­ing his ab­domen, com­plain­ing of pain at the top of a 10- point scale. The pa­tient was dy­ing of can­cer, and his neigh­bors were steal­ing his opi­oid painkillers, day after day.

• In Mon­roe, Mich., par­ents kept “los­ing” med­i­ca­tions for a child dy­ing at home of brain can­cer, in­clud­ing a bot­tle of the painkiller methadone.

In other cases, paid care­givers or hos­pice work­ers, who work largely un­su­per­vised in the home, steal pa­tients’ pills.

Hos­pice, avail­able to pa­tients who are ex­pected to die within six months, is see­ing a dra­matic rise in en­roll­ment as more pa­tients choose to fo­cus on com­fort, in­stead of a cure, at the end of life.

There’s no na­tional data on how fre­quently pain med­i­ca­tions go miss­ing.

But “prob­lems re­lated to abuse of, di­ver­sion of or ad­dic­tion to pre­scrip­tion med­i­ca­tions are very com­mon in the hos­pice pop­u­la­tion, as they are in other pop­u­la­tions,” said Dr. Joe Rotella, chief med­i­cal of­fi­cer of the Amer­i­can Academy of Hos­pice and Pal­lia­tive Medicine, a pro­fes­sional as­so­ci­a­tion for hos­pice work­ers.

“It’s an ev­ery­day prob­lem that hos­pice teams ad­dress,” Rotella said. In many cases, opi­oid painkillers or other con­trolled sub­stances are the best treat­ment for th­ese pa­tients, he said. Hos­pice pa­tients, about half of whom sign up within two weeks of death, of­ten face sig­nif­i­cant pain, short­ness of breath, bro­ken bones, or aching joints from ly­ing in bed, he said. “Th­ese are the sick­est of the sick.”

There is no pub­licly avail­able na­tional data on the vol­ume of opi­oids hospices pre­scribe. But OnePoint Pa­tient Care, a na­tional hos­pice- fo­cused phar­macy, es­ti­mates that 25 to 30 per­cent of the med­i­ca­tions it de­liv­ers to hos­pice pa­tients are con­trolled sub­stances, ac­cord­ing to Erik Jung, a vice pres­i­dent of phar­macy op­er­a­tions.

Though Black­hall helped spark a na­tional dis­cus­sion about hos­pice drug di­ver­sion, she said she’s also wor­ried about re­strict­ing ac­cess to painkillers. Hospices must strike a bal­ance, she said.

“It’s im­por­tant to treat the hor­ri­ble suf­fer­ing that peo­ple have from can­cer,” said Black­hall. But sub­stance abuse is an­other form of suf­fer­ing which is “hor­ri­ble for any­one in the fam­ily or com­mu­nity that might end up get­ting those med­i­ca­tions.”


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