Estimates of Medication Diversion in Hospice

Cagle, John G.; McPherson, Mary Lynn; Frey, Jodi Jacobson; Sacco, Paul; Ware, Orrin D.; Wiegand, Debra L.; Guralnik, Jack M.

doi:10.1001/jama.2019.20388

Cited by 14 publications

(10 citation statements)

References 3 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Vigilant medication monitoring (e.g., pill counts) can help providers identify when opioid medications are unaccounted for. 9,25 Findings from this project, but reported elsewhere, 9 estimate that 84% of hospices conduct pill counts, 78% screen for patients for risk of substance misuse or addiction, and 44% screen family members for such risks. Qualitative descriptions from hospice staff about the most recent case of confirmed diversion suggests that hospices are sensitive to diversion concerns, have taken measures to mitigate risks, and respond nimbly when diversion is identified, all while simultaneously working to ensure compassionate, high quality end-oflife care.…”

Section: Discussionmentioning

confidence: 75%

“…Our past work suggests that similar policies (i.e., those dealing with suspected drug misuse or diversion) are positively associated with confirmed cases of diversion. 9 Having a policy may help providers identify diversion cases, or perhaps hospices with frequent cases of diversion are more likely to adopt these policies. Vigilant medication monitoring (e.g., pill counts) can help providers identify when opioid medications are unaccounted for.…”

Section: Discussionmentioning

confidence: 99%

“…Published work from the present study found that nearly a third (31%) of hospices reported at least one case of confirmed drug diversion within the past 90 days. 9 Most hospice patients receive care at home (48%) or in a nursing facility (32%). 1 At home, family caregivers often manage patient medications.…”

Section: Introductionmentioning

confidence: 99%

“…Evidence suggests some family members and health care staff illegally divert opioids. 6,9 If pain medications for hospice patients are diverted, then these dying individuals are likely suffering from unrelieved pain or other distressing symptoms. In cases with persistent concern about drug diversion, hospice patients can be discharged from care for cause.…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

A National Survey of Challenges Faced by Hospices During the Opioid Crisis: Estimates of Pain Medication Shortages, Missing Medications, and Opioids Left in the Home Post-Death

Cagle

McPherson

Frey

et al. 2021

Journal of Pain and Symptom Management

Self Cite

View full text Add to dashboard Cite

Context. No national data exist on hospice medication shortages, the frequency that opioid medications go missing, and drug disposal practices.Objectives. To provide national estimates for hospices on: drug shortages; frequency of missing medications; and opioids left in the home post-death.Methods. A national survey of 600 randomly selected hospices stratified by state and profit status (data collection 2018). Sample weights were applied to adjust for non-response. Respondents were hospice representatives knowledgeable about agency policies and practices. Participants reported their knowledge and perceptions about medication shortages, frequency that opioid medications go missing, and the proportion of hospice deaths in which opioids are left in the home. Findings were stratified by agency size.Results. 371 hospices completed surveys (response rate = 62%), half (50%) of which were mid-sized (26-100 patients), and not-for-profit. Respondents had 7.5 years (SD = 7.7) of agency experience. 42% of hospices − and 61% of large hospices − reported medication shortages. Among the full sample, 28% of agencies indicated shortages of morphine; 20% reported shortages of hydromorphone. Nearly half (43%) of hospice representatives reported that missing opioid medications occurred within the last 90 days. 52% of representatives reported employees are not allowed to dispose of medications after a home death; and, among home deaths, unused opioids were left in the home 32% of the time. This suggests opioid medications are frequently left in U.S. households after a hospice home death.Conclusion. Hospices face numerous challenges during the national opioid crisis. Interventions are needed to ensure access to needed treatments, mitigation of diversion, and safe medication disposal.

show abstract

Section: Discussionmentioning

confidence: 75%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

A National Survey of Challenges Faced by Hospices During the Opioid Crisis: Estimates of Pain Medication Shortages, Missing Medications, and Opioids Left in the Home Post-Death

Cagle

McPherson

Frey

et al. 2021

Journal of Pain and Symptom Management

Self Cite

View full text Add to dashboard Cite

show abstract

“…4,[6][7][8] Therefore, we argue that attention to SUD is directly within the mission of PC to improve QoL, minimize suffering, and by doing so at times may contribute to improvements in survival. [9][10][11] Evidence suggests PC clinicians are uncomfortable providing SUD treatment without the collaboration of addiction specialists. 1,3,12 While collaboration with an addiction specialist is important, it is not always available and expanding SUD treatment to non-addiction specialists is a key public health strategy to decrease SUD harms.…”

Section: Adapting Palliative Care Skills To Care For People With Substance Use Disordersmentioning

confidence: 99%

Adapting Palliative Care Skills to Provide Substance Use Disorder Treatment to Patients With Serious Illness

Jones

Sager

et al. 2021

Am J Hosp Palliat Care

View full text Add to dashboard Cite

Background: The majority of Palliative Care (PC) clinicians report recently caring for a person with a Substance Use Disorder (SUD). The impact of an untreated SUD is associated with significant suffering but many PC clinicians report a lack of confidence in managing this population. Objective: This paper aims to demonstrate existing PC skills that can be adapted to provide primary SUD treatment. Methods: A comprehensive literature review was conducted on quality PC domains and core SUD treatment principles. To demonstrate the shared philosophy and skills of PC clinicians and SUD treatment, the National Consensus Project Clinical Practice Guidelines for Quality Palliative Care and resources outlining core Addiction Medicine and Nursing Competencies were used. Results: There is an abundance of overlapping domains in PC and SUD treatment. This paper focuses on the domains of communication, team-based care, quality of life considerations, addressing social determinants of health, and adherence to ethical principles. In each section, the shared domain in PC and SUD treatment is discussed and steps to expand PC clinician's skills are provided. Conclusion: PC clinicians may be among the last healthcare touchpoint for persons with SUD, by naming the shared skills required in PC and evidenced-based SUD treatment, we challenge the field to undertake primary SUD treatment as part of its constant pursuit to better serve people living with serious illness.

show abstract

Pain and Palliative Care

Baum¹,

Smith²

2022

Holland‐Frei Cancer Medicine

View full text Add to dashboard Cite

Overview Palliative care is an essential component of comprehensive cancer care. Palliative care is given concurrently with other disease‐modifying, life‐prolonging, and curative therapy. Palliative medicine specialists focus on helping patients and their families with a variety of care needs including symptom control, psychosocial support, physician–patient communication, addressing care goals in relation to the patient's condition, prognosis, values, and preferences, as well as with transitions in care. Cancer patients often experience significant symptom distress either from the illness itself or from the associated treatments. The beneficial effects of palliative care have been well documented. When integrated into early oncologic care, palliative care is associated with a significant improvement in quality of life, depression, and survival. As such, palliative care should be given throughout the trajectory of cancer care whether during early‐stage disease in which the focus is on cure or in more advanced disease when the focus is on maximizing quality of life. Currently, national and international organizations have clinical guidelines that recommend palliative care be routinely integrated into comprehensive cancer care.

show abstract

Estimates of Medication Diversion in Hospice

Abstract: Given the challenges of symptom management during hospice care, patients require responsive opioid prescribing. Within the context of the national opioid crisis, medication diversion in hospice is an increasing concern. 1

Cited by 14 publications

References 3 publications

A National Survey of Challenges Faced by Hospices During the Opioid Crisis: Estimates of Pain Medication Shortages, Missing Medications, and Opioids Left in the Home Post-Death

A National Survey of Challenges Faced by Hospices During the Opioid Crisis: Estimates of Pain Medication Shortages, Missing Medications, and Opioids Left in the Home Post-Death

Adapting Palliative Care Skills to Provide Substance Use Disorder Treatment to Patients With Serious Illness

Pain and Palliative Care

Contact Info

Product

Resources

About