• Orrin D Ware, John G Cagle, Mary Lynn McPherson, Paul Sacco, Jodi Frey, and Jack Guralnik.
• School of Social Work, University of Maryland, Baltimore, Maryland, USA.
• J Pain Symptom Manage. 2021 Apr 1; 61 (4): 789-796.

ContextThe nonmedical use of prescribed medications is a major public health concern in the U.S. Medications prescribed to hospice patients for pain management may be at risk of being diverted to be sold or used illicitly.ObjectivesUse responses from hospice agency representatives to explore the details of confirmed cases of medication diversion in the hospice setting.MethodsThis is a qualitative descriptive study based on responses from hospice agency representatives with surveys completed by phone or online. Template analysis was used to describe the context of confirmed diversion, specifically 1) means of how the diversion was confirmed, 2) clues/red flags, 3) who diverted, and 4) agency responses to the confirmed diversion.ResultsA total of n = 112 open-ended responses were analyzed. Respondents reported multiple ways in which medication diversion was confirmed, such as drug screening, witnessed firsthand by staff, and an overdose. Clues/red flags included reluctance to allow medication monitoring, family discord, and higher medication doses being requested. Those who diverted medications included informal caregiver/family member, family friend, and facility staff. Agency responses to diversion included limiting the supply of medication, restricting access to the medication, and increasing staff visit frequency.ConclusionGood clinical practice and vigilance may help agencies detect medication diversion. Moreover, diversion prevention techniques should not harmfully impact quality of patient care.Copyright © 2020. Published by Elsevier Inc.

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