State Legislation to Prevent Diversion of Opioids in Hospice Programs

Abstract

The problem of opioid diversion and its contribution to the opioid epidemic are well known nationally, existing even within hospice care. Proper disposal of opioids may be a critical factor in reducing diversion. In 2014, Ohio implemented legislation requiring a hospice employee to destroy or witness disposal of all unused opioids within a patient’s plan of care. The purpose of this study was to determine the impact of Ohio Revised Code 3712.062 on hospice programs’ policies and procedures to prevent opioid diversion in the home. Directors of Ohio-licensed hospices were surveyed to assess the percentage of programs with a written policy in place for disposal of opioids and to calculate a compliance score based on responses to survey questions assessing compliance with legislation components. Fifty-two surveys were completed (39.4%). All survey respondents reported having a written policy in place. A 95.5% average compliance score was calculated, with the largest disparity occurring with timing of opioid disposal. While Ohio Revised Code 3712.062 requires opioid disposal at the time of patient’s death or when no longer needed by the patient, only 84% of respondents report disposing opioids upon discontinuation. Overall, a high compliance rate was seen among hospice programs indicating such regulation is manageable to meet.

The Opioid Crisis and Hospice Care: Exploring Key Partner Experiences

“…These investigations show that hospices have experienced medication shortages, varied drug diversion and disposal policies, barriers to opioid disposal after patient death, and decreased opioid prescribing on discharge to hospice care. [8][9][10][11][12][13][14][15] One study interviewed hospice care clinicians to explore the epidemic's impact on prescribing practices and found limited opioid access, as well as undertreatment, stigma, illicit use, and fear among patients. 16 Our study expands on these findings by exploring hospice partners' experiences of the opioid crisis and prioritizing their perceptions of the most salient issues shaping hospice care.…”

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

“…4 Reports of new challenges hospices face during this national opioid crisis include limited access to needed medications (e.g., medication shortages, prescribing restrictions), 5 and medication misuse and diversion related to opioid medications going missing in the home, 6 and obstacles to safe drug disposal, especially post-death. 7,8 Medication misuse occurs when medication is taken in a manner or dose other than what is prescribed, such as taking too much or taking another's medication. Medication diversion, a type of medication misuse, occurs when a drug is channeled to someone other than the prescription recipient, usually to be taken by someone else or sold illegally.…”