Purdue Nursing researchers analyze medication theft in long-term care facilities

Wei-Lin Xue

Written by: Tim Brouk, tbrouk@purdue.edu

Drug theft, or the illegal distribution or abuse of prescription drugs, in healthcare facilities such as hospitals and clinics is an ongoing issue that can lead to patient harm, according to the Centers for Disease Control and Prevention.

In collaboration with Assistant Research Professor Eilon Caspi at the University of Connecticut, Purdue University School of Nursing researchers Wei-Lin Xue, a PhD student who was a registered nurse in Taiwan for four years, and  Marian Liu, assistant professor of nursing, investigated if the problem occurs in long-term care facilities such as nursing homes and retirement centers.

They obtained 107 drug-theft reports from 104 long-term care homes substantiated by the Minnesota Department of Heath between 2013 and 2021. The team discovered a total of 11,328.5 tablets, mostly opioids that qualify as controlled substances by the U.S. Drug Enforcement Administration, were stolen from 368 residents. Oxycodone and hydrocodone consisted of 57.5% of the stolen drugs. Close to half of the employees who stole medications were nurses.

Marian Liu

While some reports were more detailed than others, the Purdue College of Health and Human Sciences investigators determined drug theft is a significant problem in long-term care facilities. Findings were recently published in the Journal of Applied Gerontology.

“We’re not trying to criminalize the nurses. Instead, we would like to highlight a problem that is occurring in the healthcare profession that unfortunately the level and support they need doesn’t seem to be met. They’re turning to this potential way that can harm other people — the people they are caring for,” Liu explained. “On the one hand, it’s oversight from the facilities and state and federal governments, but on the other hand, what kind of resources do healthcare professionals need, and how can we provide those resources?”

This analysis of drug theft in long-term health facilities is believed to be a first in the field, and they obtained the public reports after a formal request to the Minnesota Department of Health.

Only scratched the surface

Xue stated most drug theft incidents go unreported, and when they do find evidence, the data is often incomplete. Twelve percent of the reports didn’t mention how many pills were stolen. For these, the researchers put “1” in the data set. Almost certainly, more than one pill was stolen in these cases.

“I do think our findings reflect the fact that this issue is underreported, and the level and amount of medication being stolen is also underreported,” Xue said.

Most reports uncovered details such as ongoing theft. One report revealed 1,900 tablets were stolen from one patient over a stretch of time. The longest ongoing theft was for about two years before discovered.

Most of the reports started with residents alerting other staff about their missing or lessened doses of medication. Xue hypothesized that many residents, especially those suffering from dementia or Alzheimer’s disease, do not have the capacity to initiate the report of theft.

The “why” is trickier, as most reports didn’t go into such details, but Xue correlated the stress of the job may turn nurses and other long-term care workers to diverting the drugs.

“We need to ask why they choose drug abuse,” she said. “I do believe there is a lack of mental support or resources for nurses or other providers for seeking help, especially after the (COVID-19) pandemic and the nurse shortage. This has made nurses still in the front lines suffer more stress. We need people to listen to those healthcare providers’ needs.”

Not quite half of the thefts came from nurses, who usually have the most contact with the residents. The reports revealed supervisors, assistants and unlicensed personnel comprised the other half of those questioned in the drug diversion reports. In all but one report, the staff member was the lone thief in the incident.

Surveillance vs. privacy

In long-term care and healthcare facilities, a patient’s privacy is a major concern. Therefore, not every room is monitored via security cameras. More surveillance would reduce drug diversion, but it could become a concern for the patient, resident or their families. Would their privacy be violated from added video cameras?

“We all know we need to protect patients’ privacy, so it’s really hard to install a camera in their room,” Xue said. “But they could install a camera in the nursing station or in medicine storage. Our paper wants to encourage and inform facilities that cameras have the function of preventing drug theft and need to be installed. We hope the government or agencies encourage facilities to install them.”

Xue pointed to some hospitals that installed small, sometimes hidden cameras where drugs determined to be controlled substances are stored.

Helping the ‘voiceless’

Many of the residents affected by the drug diversion suffered from dementia or Alzheimer’s disease. Some could not communicate how the drug diversion affected them, but the reports revealed some patients being “very upset” when their medications were lessened or missing. They were in “more pain” without their medications, the study revealed.

In another case, a nursing assistant stole a narcotic pain medication and replaced it with a blood pressure reducing medication which was given to a resident with low blood pressure. Staff and police stated the substitution could have resulted in the resident’s serious injury or death.

“As a researcher, being able to hear the voices of the residents through these reports, it reminds us why we’re doing the study that we do,” Liu said.

Drug diversion has a ripple effect that hurts the patient and those battling substance-use issues. Lessening the action via more surveillance and better reporting would help in the overall care of residents and their staff, the research stated. It can strengthen deterrence, support auditing, deter forgery, better detect thefts and protect innocent staff suspected of stealing.

“Our hope is that the study will encourage researchers to examine controlled substance theft in long-term care homes; shed light on its prevalence, risk and protective factors; healthcare costs; and develop and evaluate interventions to reduce it,” the research article stated.

Xue, whose elder mistreatment research recently won first prize at the Midwest Nursing Research Society annual meeting, wants her work to reach policymakers nationwide.

“Cases like these are all occurring in different states,” Xue said. “I do hope that other state agencies or governments can review the article and pay more attention, not only on the hospital setting but also the long-term care and nursing home setting.”