August 21, 2017
Nothing seemed to help the patient — and the hospice staff didn’t know why.
They sent home more painkillers for several 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: She was high on her mother’s medications, stolen from the hospice-issued supply.
Leslie Blackhall, the doctor who supervised the care of that patient and two similar casesat the University of Virginia Health System’s palliative care clinic, uncovered a wider problem after unraveling the reasons for the pain: As more people die at home on hospice, some of the addictive drugs they are prescribed are ending up in the wrong hands.
Hospices have largely been exempt from crackdowns in many states on opioid prescriptions because dying people may need high doses of opioids. But as the opioid epidemic continues, some experts say hospices aren’t doing enough to identify families and staff members 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.
•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 painkillers were being stolen day after day, allegedly by neighbors.
•In Monroe, Mich., medications for a child dying of brain cancer kept disappearing. Among the items lost was a bottle of the painkiller methadone.
•In Clinton, Mo., a woman in hospice care began vomiting in the midst of a family conflict: Her son was fighting with a sibling suspected of stealing her medications. The son implored the hospice agency to move his mother to a nursing home to escape the situation.
In other cases, paid caregivers or hospice workers steal patients’ pills. In June, a former hospice nurse in Albuquerque pleaded guilty to diverting oxycodone pills by recommending prescriptions for patients who didn’t need them and then intercepting the packages with the intention of selling the drugs.
Hospice, available to those who are expected to die within six months, is seeing a dramatic rise in enrollment as more people choose to focus on comfort instead of a cure at the end of life.
There is no national data on how frequently these 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 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 die within two weeks of enrolling, 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.”
Read the full story on the Washington Post.