March 19, 2021
The national opioid crisis is posing complex challenges for US hospice providers in terms of drug access, opioid diversion, and opioid disposal, according to a survey-based study published online ahead of print in the Journal of Pain and Symptom Management.
“Many hospices are experiencing medication shortages and restrictions on medication disposal,” reported researchers from the University of Maryland.
The study is based on a national survey that generated responses from 371 hospices, half of which were mid-sized providers serving between 26 and 100 patients. Researchers aimed to gauge feedback on hospice drug shortages, missing opioid medications, and opioid disposal after a patient’s home death.
According to the findings, 42% of hospices overall—and 61% of large hospices—indicated shortages of basic pain medications for palliation. Some 28% of all hospices reported morphine shortages, and 20% reported hydromorphone shortages. Such shortages, researchers wrote, are likely contributing to unnecessary suffering in patients at the end of life.
Meanwhile, 43% of hospices, and 69% of large hospices, indicated cases of missing opioid medications within the last 90 days. Nevertheless, two-thirds of all hospices reported that opioid medications rarely or never go missing.
More than half (52%) of hospices reported that staff are not allowed to dispose of opioid medications after a home death. Consequently, in a third of home deaths unused opioids were left in the home, posing “extreme risk for misuse or diversion,” according to the study.
Hospices rules prohibiting employees from disposing of medications after a home death reflected federal law, state law, or local ordinances, respondents said.
“For example, under the past Controlled Substances Act, hospice staff could not dispose of unused controlled medications after a patient death because they technically became property of the estate,” researchers explained. “However, the SUPPORT Act was signed into law in October 2018, one month after the conclusion of data collection for our study. This new legislation permits hospice employees to dispose of controlled substances after a death. Despite this provision, the interpretation and application of the SUPPORT Act remains unclear.”
Cagle JG, McPherson ML, Frey JJ, et al. 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 [published online ahead of print, 2021 Feb 27]. J Pain Symptom Manage. 2021;S0885-3924(21)00212-8. doi:10.1016/j.jpainsymman.2021.02.023