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‘99% of caregivers’ handle opiates responsibly, misuse still possible

How does an agency that handles powerful opiates, among other drugs, prevent drug diversion?

Or, in other words, someone who you are supposed to trust misusing prescription drugs — committing a crime.

It’s a complex question that local providers, and prescribers, sat down to have a frank conversation about.

In the wake of major drug diversion issues coming to light, it can be difficult for the amount of work that goes into the responsible handling of medications to be featured.

Local physician Dr. Keith Price; Executive Director of Hospice of Warren County Lisa To; HOWC Patient Care Coordinator and Registered Nurse Linda Chase; and Nurse Practitioner Melissa Shene sat down to talk about the many facets of the drug diversion issue. Their overall consensus at the end of that conversation seemed to be that it could happen anywhere, but that’s not for lack of trying to keep it from happening, ever.

“It’s like retail companies that are always looking for ways to keep people from taking money out of the cash register,” said To.

Every business has a policy and procedure in place to keep sales associates from stealing from the till. But for every policy a store puts in place, one person is likely to find a way around it. This same example holds true for those working with powerful prescription painkillers, said To.

People “can and will perceive that somehow this is the nursing home’s or hospice’s fault,” she said. What she said needs to follow up stories of diversion are stories about “all the work and positive things that are done constantly by healthcare providers — namely nursing homes and hospices — to manage things so patients and families receive proper and good care.”

Pain, said To, “is what the patient says it is,” especially when that patient is seeing care from a hospice organization and is facing the end of an often lengthy struggle with terminal illness.

The reality is that “terminally- or chronically-ill individuals need pain management, and so often medicine, opiates, to achieve some kind of quality of life due to their pain, she explained.

Those facing end-of-life pain from debilitating illnesses deserve relief from their pain, she said, and agencies such as Hospice of Warren County are committed to providing those patients the highest quality of life they possibly can… for as much life as each patient has.

Unfortunately, the caregivers who handle those medications could be facing struggles of their own.

Namely, medical health professionals can find themselves facing issues of addiction that cause them to find ways around the protections their agencies or facilities have put in place. In the many years she’s been working with HOWC, and as a nurse, To has seen that, overall, “nursing homes and hospices and palliative care teams work very hard to manage pain appropriately.”

From detailed intakes that assess pain — which can only ever be rated subjectively by each individual patient, to reporting of dispensing of medications and having witnesses to leftover medications being destroyed following the death of a patient to whom they were prescribed — Agencies and facilities try to keep all medications managed appropriately. “Medication tracking involves checking the Pennsylvania drug monitoring database, documentation, narcotic checks, ordering practices,” and many other ways that everyone involved in a patient’s care work to keep their pain managed and their medications handled in the best possible way.

“Home care brings special challenges with pain management,” said To. A private home is not as controlled a setting as a nursing home, and those who provide in-home care to those with terminal illnesses face additional issues, such as family members who may or may not have addiction issues, and fewer eyes on the work being done.

Still, said To, “I speak only from our end of things at Hospice of Warren County, but 99 percent of caregivers and patients responsibly manage opioids in the home setting.”

While no provider or facility is immune to experiencing drug diversion issues, “It’s important that fingers not be pointed at one another in this sort of instance — because those diversion situations must be approached individually,” said To. “It’s a situation we find ourselves in (as providers). We didn’t create the situation, and we have to quickly find a way to get things back on track.”

Some of the ways that To said Hospice works to control the issue of diversion is limiting supplies when a patient or caregiver has an issue with addiction, but still requires medication to control pain, counting medications at each and every visit, and patient and family contracts.

“Generally,” said To, “if we don’t have a reliable caregiver, then we can agree to stay involved if the patient moves to another setting where pain can be managed appropriately. The patient should not suffer because the family or caregiver cant handle managing the pain meds.”

Essentially, all parties to the conversation agreed, “this could happen to any of us.”

Patients and their families should be made aware that every facility and care provider has a duty to provide the best care to each patient as that patient’s needs require, and most facilities and providers have plans in place to deal with diversion issues as they come up, although everyone who provides care to those in need of pain management hopes to never need those protections in the first place.

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