Estimates of medication diversion in hospice

To characterize the problem of medication diversion in the hospice setting, where caregivers rely on opioids to keep patients comfortable, researchers surveyed a nationwide sample of 371 agencies. From June–September 2018, respondents reflected on their experiences with medication diversion.

To characterize the problem of medication diversion in the hospice setting, where caregivers rely on opioids to keep patients comfortable, researchers surveyed a nationwide sample of 371 agencies. From June–September 2018, respondents reflected on their experiences with medication diversion. The questions covered practices and policies—such as use of prescription drug monitoring programs, staff drug testing, and handling of patients or relatives with substance abuse addiction—as well as data on confirmed and suspected cases of diversion. One or more case of confirmed diversion was reported in 31% of the participating hospices during the previous 90 days. The research also identified family caregivers, other relatives, and patients themselves as the primary culprits, in that order. Diversion was much more likely with smaller agencies than with medium or large ones, and the risk also increased with hospices that deliver the bulk of care in the patient's own home. Confirmed plus suspected diversion was even more common, with 58% of hospices surveyed reporting at least one case. This trend also was associated with smaller agencies and predominantly at-home care, as well as with use of a prescription drug monitoring program. Additional study is required, the University of Maryland, Baltimore team concludes, to determine how hospices can minimize diversion while effectively managing patient pain.