Study: Medication Diversion is Occurring in Hospice


Over 90% of hospice and palliative care patients are prescribed opioid medications for pain management, and many individuals receive home care.

Medication diversion in hospice is a growing concern, especially in light of the opioid epidemic.

Over 90% of hospice and palliative care patients are prescribed opioid medications for pain management, and many individuals receive home care.1 Prescription medications at home can be a source of diversion among family and friends, especially those with a history of substance abuse. Pharmacists can play an important role in managing patients’ pain as well as preventing drug diversion.

In a study published in JAMA, a national survey of hospices was conducted June-September 2018.2 There were 600 agencies randomly selected and surveyed via phone or online about practices, policies, and experiences regarding medication diversion. Surveys were completed by representatives from 371 hospices (response rate, 62%), and 31% of respondents reported at least 1 case of confirmed diversion in the past quarter.

Individuals most frequently involved in drug diversion were generally family caregivers (39%), other family (38%), and patients (34%). Additionally, the study revealed that there were 282 confirmed diversion cases within the past 90 days. Fifty-eight percent of hospices reported at least 1 case of confirmed or suspected diversion within the past quarter. Confirmed plus suspected medication diversion was significantly associated with small hospice size, providing the majority of care at home, and using a prescription drug monitoring program.2

This study provides important information about drug diversion in the hospice setting. Study limitations include that surveys involve self-reported data, and cause-and-effect cannot be established. Future studies are needed to shed further light on the balance between effective pain management and drug diversion prevention.

The Hospice Foundation of America (HFA) and the University of Maryland have developed recommendations for preventing medication diversion in hospice care.3 Educating the staff, patient, and family about opioid safety and medication management is important to balance prevention efforts with quality of care, and pharmacists can play an important role in the process.

Potential employees should be screened for history of substance abuse. Medication monitoring, including pill counts, and transdermal patch use, should be frequently conducted and documented. Pharmacists and other health care professionals should educate families about the importance of appropriate medication disposal after changes to the drug therapy or after the patient’s death.3


  • Cagle JG. Strategies for detecting, addressing, and preventing drug diversion in hospice and palliative care (P15). J Pain Symptom Manage. 2019;57(2):360. doi:
  • Cagle JG, McPherson ML, Frey JJ, et al. Estimates of medication diversion in hospice. JAMA. 2020;323(6):566-568. doi:10.1001/jama.2019.20388.
  • Cagle JG, Ware O. Hospice Foundation of America. 15 Recommendations for Preventing Medication Diversion & Misuse in Hospice Care. Hospice Foundation of America website. Accessed February 15, 2020.

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