Data: Opioid theft in nursing homes a ‘concerning’ trend

“Medication diversion is an issue throughout the health care industry and across all provider types.” Chris Boyle, state department of Public Health spokesman

Theft of opioids from patients in long-term care facilities is a widespread and preventable problem, according to a UConn researcher.

Eilon Caspi is a gerontologist at UConn, studying ways of “improving understanding of various forms of elder mistreatment in long-term care homes.”

When Caspi was living and conducting research in Minnesota, he came across a data set of 107 investigation reports, all substantiated by the Minnesota Department of Health, dealing with what the department euphemistically called “drug diversion” in longterm care homes for older people.

Caspi doesn’t like the term “drug diversion,” saying it “devalues and dismisses the experience of the people to whom the pain medications belong, and it’s a very institution-centered term.”

“OK, the medications were diverted from point A to point B. It doesn’t even take into consideration the person to whom the medication belongs, let alone leaving them, in some cases, in pain that is avoidable,” he said.

Caspi prefers to call it theft of opioids.

“It’s very easily dismissed as, ‘Oh, no, these are just isolated cases, this nurse here and that nurse aide there, and we’re taking care of it, it’s fine,’ ” Caspi said. “But what we found is very concerning.”

While Caspi’s data set was from Minnesota, theft of pain medication is not a Minnesota-specific problem, he said. A search through Medicare data shows many similar cases in Connecticut.

“Medication diversion is an issue throughout the health care industry and across all provider types,” state Department of Public Health spokesman Chris Boyle said.

For example, an investigation into an incident in July of last year showed that a long-term care resident at Beechwood in New London did not receive his scheduled dose of medication for nine days. The file states, “The report also identified that resident #1 did not receive medication due to diversion of shipped medication.”

In response to a request for comment, Beechwood issued the following statement by email: “Beechwood has been family owned and operated for almost 70 years. We are proud to have always given the best quality care, including not a single death from COVID. We are not perfect though. When something doesn’t meet our expectations, we learn, we double our efforts, and we move forward. This matter was an isolated incident involving an isolated employee who is no longer employed by the facility. The facility was placed back in regulatory compliance after a plan of correction was submitted, received and validated by the Connecticut Department of Public Health.”

Officials in Connecticut have “identified 21 instances where an extended care facility reported a loss of controlled substances in schedule II, III, IV and V that resulted in an investigation” between January 2022 and March 16, 2023, according to state Department of Consumer Protection spokesperson Kaitlyn Krasselt.

How many of those were thefts of opioids, however, is not known: “We do not differentiate the types of controlled substances in the files,” Krasselt said.

Sen. Jan Hochadel, DMeriden, co-chair of the legislature’s Aging Committee, said she was appalled to learn how common opioid theft is. Her father, she said, spent his last days in hospice. Caspi’s study, she said, was released one day after her father died.

“I’m really actually surprised,” she said. “He was in a lot of pain, which is why this hit me really hard. “If somebody had been taking his pain medications, that would have just been unbearable.”

Though she said her committee had not yet considered opioid theft, Hochadel said that immediately after receiving media requests for comment, she spoke with her committee co-chair, Rep. Jane Garibay, D-Windsor, “and told her we need to get a meeting with the commissioner of aging and see if it’s on their radar, and see if this is a bill that we have to do for accountability purposes next year.”

Caspi said his team found several trends in the data: “The first one was many issues with policies and procedures, whether there was a lack of policies or procedures or inadequate policies or procedures or they had policies or procedures that were not followed internally within the setting.”

The second trend was opioid pain medications being left unsecured. “There were many, many examples of when it’s brought from the pharmacy, it’s placed on a nurse’s desk and sits there for hours,” he said. “All you need is someone to come in and just pick it up and leave.”

The thefts, Caspi said, are almost all preventable.

“I believe that the vast majority of them are preventable. I want to say all of them,” he said. “Many times, it came down to not doing basic, basic things such as not reconciling medication, so not comparing what has been logged out and what has been used and no cross-references, not doing a controlled substance count during shift change. I’m talking about really basic, basic things.”