ACTIVE AGE | The pain didn’t stop because her meds had been stolen
LaVonne Borsheim’s family did not understand why she was in such severe pain.
Borsheim, 86, had long suffered from rheumatoid arthritis and other health problems, including hip and knee replacements and heart failure. Her husband, Roger, looked after her in their tiny home in suburban Minneapolis, meticulously administering the prescribed daily OxyContin and Oxycodone that kept her active, tandem biking with him and stay involved in their Lutheran church.
But in 2018, Borsheim underwent ankle surgery and subsequent surgery to treat a resulting infection. Discharged from hospital with regular home health visits, she began an alarming decline.
Her daughter Kari Shaw recalled one of their daily calls: âDad said, ‘I think we’re losing mom. She’s really going down.’â Sleepy much of the day, Borsheim walked against the walls and s ‘collapsed at the table. At other times, her pain became so intense that “she begged God to take her,” Shaw said.
No one suspected wrongdoing by their seemingly dedicated new home nurse, who picked up Borsheim’s prescriptions from the pharmacy and filled her pack with pills. But when Borsheim took his wife to a pain clinic, blood and urine tests revealed no opioids in his system.
The family called the police.
How often are older Americans victims of drug diversion, in which someone steals or tampers with prescription drugs, especially opioids, for personal use or for sale? Researchers and advocates trying to protect older people from abuse and exploitation would like to know. Data is scarce and scattered, but hints at an important problem.
During the country’s current opioid crisis, which has seen 500,000 overdose deaths in two decades, manufacturers and too many volunteer doctors have flooded parts of the country with prescription drugs, especially oxycodone.
“There has been an increase in use in the elderly which reflects the increase in young people,” said Dr. Michael Steinman, geriatrician at the University of California at San Francisco and co-director of the US Network for Research on deprescribing.
Researchers at the University of Mississippi, analyzing annual data from millions of Medicare beneficiaries, reported that the proportion who received at least one new opioid prescription rose from nearly 7% in 2013 to over 10% in 2015, before dropping to around 8%. in 2016.
That year, about a third of Medicare Part D beneficiaries had at least one prescription for opioids, according to the inspector general of the federal Department of Health and Human Services.
Opioids can put older users at risk, increasing risks such as falls and cognitive problems, and interacting negatively with other medications. But their increasing use also makes older people vulnerable to exploitation and abuse.
“If you need medication, open your grandmother’s medicine cabinet,” said Pamela Teaster, a gerontologist at Virginia Tech who, along with Karen Roberto, also a gerontologist there, has undertaken early research into the hijacking. drugs.
In some cases, theft occurs in retirement homes and assisted living facilities. In 2019, when the National Consumer Voice interviewed 137 state and local ombudsmen who filed complaints about long-term care facilities, more than half reported complaints about drug diversion, drug theft or financial abuse resulting from opioid addiction.
Minnesota tracks drug diversion in long-term care and found that from 2016 to 2018, documented incidents in nursing homes increased from nine to 116. They similarly soared in assisted living facilities. state, from nine cases in 2016 to 69 two years later. then to 55 in 2019. Cases at both types of facilities fell back to single digits last year, possibly reflecting closures and restrictions related to COVID-19.
The authors, almost always employees, developed a remarkable ingenuity. An analysis of Minnesota data by Eilon Caspi, a gerontologist and researcher at the University of Connecticut, found that thieves forged signatures, altered documents and diluted drugs in syringes. Some opened the foil backing on pill cards, replaced the over-the-counter tablets, and re-glued the foil.
Employees left the facility with secreted pills in their handbags, belts, bras and socks, while their patients suffered the painful consequences. Prosecutors and news outlets have reported arrests of employees across the country, including in Iowa, Rhode Island, Georgia and Florida.
Often, however, victims of drug diversion live in their own homes, where the people who steal their drugs are likely members of their own families.
Roberto and Teaster first addressed the issue in 2017 by hosting focus groups with law enforcement, drug addiction, and adult protective services professionals in Ohio, Kentucky, Virginia. and West Virginia, states where opioid abuse is rampant.
âThey told story after story of the elderly not having access to the pain medication they neededâ after loved ones took them, said Roberto.
In a grim tale from Kentucky, a caregiver took a parent with dementia to several dentists seeking pain relief, then ultimately had the senior’s teeth pulled out to gain access to opioids.
The researchers then looked at three years of state data from eastern Kentucky, looking at 25 confirmed cases of elder abuse involving opioid use, most in families. âOften in these families we see an interdependence,â said Roberto. An adult child or grandchild, usually one with a criminal record, perhaps recently released from prison, moves in with the senior. They can provide care; they may also need housing, food or money. And they can use the elderly’s medication on their own.
âWhen things go wrong and get out of hand, the senior doesn’t want to get a family member in trouble,â Roberto said. âThey are very protective of themâ and refuse to report or confirm the abuse.
Opioid use by older adults may have plateaued, Steinman said, as federal guidelines and state drug monitoring programs have made these drugs more difficult to acquire and misuse. But opioids remain a thorny issue for older people, as alternative pain treatments can also be risky or ineffective.
Patients and family caregivers can help protect themselves by safely storing prescription drugs and overcoming their reluctance and reporting theft and exploitation.
La Vang, the registered nurse supposed to care for Borsheim, was arrested in August 2018 and found to substitute over-the-counter pain relievers and allergy pills for Borsheim’s medication. County prosecutors planned to offer a plea deal without jail time because Vang had no criminal record.
“A slap on the hand,” Shaw said. Enraged, she called the federal office of the Drug Enforcement Administration in Minneapolis, which led to a federal indictment. Investigators found that Vang, 29, had been fired by two previous home health agencies for stealing drugs from patients.
He admitted to being addicted to opioids and started treatment; in May 2019, he pleaded guilty in federal court to fraudulently obtaining a controlled substance. “I was supposed to be a person of trust, protection and knowledge for this victim, but I was not,” he said upon his conviction.
The judge handed down an 18-month sentence in federal prison – “above normal sentencing guidelines,” said Joel Smith, Borsheim’s lawyer. A civil lawsuit against Vang and Lifesprk Home Health, his employer, was resolved this summer ahead of trial. Vang lost his nursing license.
But for the family, the repercussions continue. Roger Borsheim passed away suddenly, aged 87, in May 2020. “My personal opinion is that the stress of it all killed my father,” Shaw said.
LaVonne Borsheim has since moved to an assisted living facility, where one of her three daughters visits her almost daily. She feels better but remains scared.
âSomeone was coming over to take care of you, gained all that trust and almost killed you,â Shaw said. “Now she’s so scared to be without one of us.”
“It’s heartbreaking,” she said. “How many other people has he done this to?” And how many more La Vang are there?
This article originally appeared in The New York Times.