Long-Term Care Facilities Not Unscathed by Opioid Diversion and Abuse
Hardly a week passes without a news story on the effects that the growing opioid crisis is having across the U.S. Although most reports deal with a younger population, the destructive tentacles of the opioid crisis are experienced within long-term care facilities through drug diversion and abuse.
A 2017 study from the University of Massachusetts Medical School reported that a large number (33%) of residents in long-term care facilities are prescribed opioids and about 14% have been relying on opioids for extended periods. Unfortunately, the opioids prescribed in these facilities are too often being diverted by staff members, either for their own use, or for sale on the black market.
A report in the 2019 Diversion Digest reported that in 2018, 47.2 million opioid doses went missing due to the misuse or theft by healthcare employees, and of that number, 18% were related to drug diversion in long-term care facilities. While recent analysis shows that the number of diversion incidents seems to be declining, the ideal goal for long-term care facilities should be a zero diversion rate.
The following are suggestions that a long-term care facility might consider in order to improve the management not only for opioids, but for all controlled medications:
- Educate staff about this issue and get them to “buy-in” to the goal of a zero diversion rate
- Rely on your long-term care pharmacy in developing programs to help you better secure doses and tablets
- Work to limit/prevent over-prescribing of opioids
- Document your chain-of-possession based on the U.S. Drug Enforcement Administration’s documentation requirements for all controlled substances (DEA)
- Install an onsite in-facility medication dispensing system provided by a reputable drug management company
Compliance Perspective
Failure by a long-term care facility to prevent diversion of residents’ prescribed controlled medications by staff who sell or take the drugs for their personal use may be considered abuse, neglect, misappropriation, and fraud, in violation of state and federal regulations.
Discussion Points:
- Review policies and procedures regarding the management of controlled substances to ensure that an effective zero drug diversion policy is in place.
- Train staff regarding the required documentation of and accounting for controlled medications prescribed and administered to residents, and to report any suspected incident of diversion to a supervisor or through the Hotline.
- Periodically audit to ensure that protocols for documenting and accounting for controlled substances are being followed.
