• Leslie J Blackhall, Elizabeth D Alfson, and Joshua S Barclay.
• Department of Medicine, Division of General Internal Medicine, Geriatrics, and Palliative Care, University of Virginia, Charlottesville, Virginia 22908-0466, USA. Lb9x@hscmail.mcc.virginia.edu
• J Palliat Med. 2013 Mar 1;16(3):237-42.

BackgroundAlthough inadequate treatment of pain is a problem for hospice patients, increases in the medical use of opioids have been accompanied by increasing levels of abuse and diversion in the community. Balancing pain relief with concerns about abuse and diversion is a difficult issue for hospices.ObjectivesThe aim of this study was to determine policies and practices in Virginia hospices regarding substance abuse and diversion in patients and their families.MethodsA survey was conducted of Virginia hospices about policies, perceptions, and training regarding substance abuse and diversion.ResultsTwenty-three of 63 hospice agencies responded (36.5%). Less than half (43.8%) required mandatory substance abuse training. Only 43.5% had policies regarding screening for substance abuse in patients; 30.4% had a policy regarding screening for substance abuse in family members. Policies regarding screening for diversion in patients (21.7%), and families (17.4%) were rare. Policies regarding opioid use in patients with a history of substance abuse or diversion were uncommon (33.3%, 30.4%, respectively); 30.4% had policies regarding use of opioids in patients whose family members had a history of diversion or abuse. Thirty-eight percent of hospices agreed that substance abuse and diversion was a problem for their agency, and these agencies were more likely to have written policies or mandatory training.ConclusionMost Virginia hospices lack mandatory training and policies regarding substance abuse and diversion in patients and family members. More than one-third felt that abuse and diversion were problems in their agencies. A national conversation regarding policies toward substance abuse and diversion in hospice agencies is needed.

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