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LaVonne Borsheim’s family couldn’t understand why she was in so much pain.
Ms. Borsheim, 86, had long struggled with rheumatoid arthritis and other health issues including hip and knee replacements and heart failure. Her husband, Roger, took care of her in their small home in the Minneapolis suburb and rigorously administered OxyContin and oxycodone daily, which allowed her to stay active, ride a tandem bike with her, and adhere to Lutheran churches.
But in 2018, Ms. Borsheim underwent ankle surgery followed by surgery to treat an infection that occurred. Discharged from the hospital with regular home health visits, an alarming decline began.
His daughter, Kari Shaw, recalled one of her daily calls: “My dad said, ‘I think we’re losing my mom. She’s getting really weak.’” Mrs. Borsheim, sleepy most of the day, walked up to the walls and collapsed on the dinner table. At other times, her pain was so intense that she “begged God to take her,” said Mrs. Shaw.
No one suspected any wrongdoing by the apparently dedicated new home health nurses who took Ms. Borsheim’s prescriptions from the pharmacy and filled her pack of pills. But when Mr. Borsheim took his wife to a pain clinic, blood and urine tests showed that he was free of opioids.
The family called the police.
Older Americans become victims of drug diversion where someone steals or tampers with prescription drugs, especially opioids, for personal use or sale? Researchers and advocates trying to protect the elderly from abuse and exploitation wish they knew. The data are sparse and scattered, but point to a significant problem.
During the country’s ongoing opioid crisisSeeing 500,000 overdose deaths in two decades, manufacturers and numerous aspiring doctors have flooded parts of the country with prescription drugs, particularly oxycodone.
D., a geriatrician and co-director of the US Center for Prescribing Research at the University of California, San Francisco. “There has been an increase in older adult use, reflecting the increase in younger people,” said Michael Steinman.
Researchers at the University of Mississippi Analyzing annual data of millions of Medicare beneficiariesreported that the percentage of people receiving at least one new opioid prescription rose from almost 7 percent in 2013 to over 10 percent in 2015, before falling to about 8 percent in 2016.
That year, about One-third of Medicare Part D beneficiaries He had at least one opioid prescription, according to the inspector general of the Federal Department of Health and Human Services.
Opioids can endanger older users, increase risks such as falls and cognitive problems, and may interact harmfully with other medications. But their increased use also makes the elderly vulnerable to exploitation and abuse.
“If you need drugs, open your grandmother’s medicine cabinet,” said Pamela Teaster, a gerontologist at Virginia Tech, who also conducted early research on drug diversion with Karen Roberto, a gerontologist there.
In some cases, theft occurs in nursing homes and assisted living complexes. in 2019, when National Voice of Consumers surveyed Of the 137 state and local ombudsmen who filed complaints about long-term care facilities, more than half reported complaints about financial exploitation resulting from drug diversion, drug theft or opioid addiction.
Minnesota tracks drug diversion in long-term care and found that from 2016 to 2018, documented incidents in nursing homes rose from nine to 116. They climbed similarly at assisted living facilities in the state, climbing to 69 two years after nine cases in 2016. It later increased to 55 in 2019. Cases at both types of facilities dropped to single digits last year, possibly reflecting Covid-related shutdowns and restrictions.
The perpetrators, who were almost always working, developed an extraordinary ingenuity. Analysis of the Minnesota data by Eilon Caspi, a gerontologist and researcher at the University of Connecticut, found that the thieves had forged signatures on syringes, altered documents, and diluted drugs. Some slits opened the foil backing on the pill cards, replaced the over-the-counter tablets, and re-glued the foil.
As employees left the facilities with the pills they secreted into their bags, belts, bras and socks, their patients faced painful consequences. Prosecutors and news outlets reported arrests of employees across the country. Iowa, Rhodes Island, Georgia and Florida.
However, often victims of drug diversion live in their own homes, where the people stealing their drugs are likely family members.
Robert and Dr. Teaster first studied the issue in 2017 by conducting focus groups with professionals in law enforcement, substance abuse, and adult protection services in Ohio, Kentucky, Virginia, and West Virginia, where widespread opioid abuse is common.
Dr. After their relatives took them, “they told the story of older adults who couldn’t access the pain medication they needed,” Roberto said.
In a brutal account in Kentucky, a caregiver took a relative with dementia to several dentists for painkillers and eventually had the senior’s teeth pulled out to gain access to opioids.
The researchers then analyzed three years of state data from eastern Kentucky and looked at 25 proven cases of elder abuse, most involving opioid use in families. Dr. “We often see interdependence in these families,” Roberto said. An adult child or grandchild moves in with the older person, usually with a criminal record, perhaps recently released from prison. They can provide care; they may also need shelter, food or money. And they can help the elderly with their medication themselves.
Dr. “When things go wrong and get out of control, the older person doesn’t want to get a family member in trouble,” Roberto said. They are “very protective of them” and refuse to report or acknowledge abuse.
Dr. Steinman, federal guidelines and state drug monitoring programs made these drugs harder to obtain and misuse. But opioids remain a vexing problem for older people because alternative pain treatments can also be risky or ineffective.
Patients and family caregivers can help protect themselves by safely storing prescription medications and overcoming their silence and reporting theft and abuse.
La Vang, the registered nurse who allegedly looked after Ms. Borsheim, was arrested in August 2018 and found to have used over-the-counter pain relievers and allergy pills instead of her medications. County prosecutors planned to offer a plea bargain without jail time, as Mr. Vang had no criminal record.
“A slap on the hand,” said Mrs. Shaw. Angry, he called the federal Drug Enforcement Administration office in Minneapolis, sparking a federal indictment. Investigators discovered that 29-year-old Mr. Vang had been fired by two previous home health care providers for stealing patients’ medicines.
He admitted to being an opioid addict and began treatment; He pleaded guilty to fraudulently obtaining a controlled substance in federal court in May 2019. “I was supposed to have some trust, protection, and knowledge for this victim, but I didn’t,” he said.
Ms. Borsheim’s attorney, Joel Smith, the judge sentenced to 18 months in federal prison — “above the normal sentencing rules,” he said. A civil lawsuit against Mr. Vang and his employer, Lifesprk Home Health, was settled this summer ahead of trial. Mr. Vang lost his nursing license.
But the repercussions for the family continue. Roger Borsheim died suddenly at the age of 87 in May 2020. “My personal view is that the stress of all this killed my father,” Ms. Shaw said.
Ms. Borsheim has since moved to an assisted living facility where one of her three daughters visits almost daily. She feels better but still afraid.
“Someone was coming to take care of you, he gained all that trust and nearly killed you,” said Mrs. Shaw. “He’s too afraid to be left without one of us now.”
“This is heartbreaking,” he said. “How many other people has he done this to? And how many more La Vang are there?”
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