LaVonne Borsheim’s family could not understand why she was in such severe pain.
Ms. Borsheim, 86, has long struggled with rheumatoid arthritis and other health problems, including hip and knee replacements and heart failure. Her husband, Roger, cared for her in their tiny home in suburban Minneapolis, meticulously administering the prescribed daily OxyContin and oxycodone that allowed her to stay active, ride a tandem with him, and stay involved with their Lutheran church.
But in 2018, Ms. Borsheim underwent ankle surgery and subsequent surgery to treat a resulting infection. After being discharged from the hospital with regular home visits, she began an alarming decline.
Her daughter Kari Shaw recalled one of their daily phone calls: “Dad said, ‘I think we’re losing Mom. She’s really getting smaller.’” Mrs. Borsheim, sleepy much of the day, bumped into walls and slumped at the dining table. At other times, her pain became so intense that “she begged God to take her,” Ms. Shaw said.
No one suspected anything from their apparently dedicated new home nurse, who picked up Mrs. Borsheim’s prescriptions from the pharmacy and filled her pill box. But when Mr. Borsheim took his wife to a pain clinic, blood and urine tests showed no opioids in her system.
The family called the police.
How often do older Americans become victims of substance abuse, where someone steals or tampers with prescription drugs, especially opioids, for personal use or for sale? Researchers and advocates trying to protect seniors from abuse and exploitation wish they knew. The data is sparse and scattered, but points to a significant problem.
During the country’s ongoing opioid crisis, causing 500,000 overdose deaths in two decades, manufacturers and too many willing doctors flooded parts of the country with prescription drugs, especially oxycodone.
“There was an increase in use by older adults that reflected the increase in younger people,” says Dr. Michael Steinman, a geriatrician at the University of California, San Francisco, and co-director of the US Deprescribe Research Center.
Researchers from the University of Mississippi, analyzing annual data from millions of Medicare beneficiaries, have reported that the proportion receiving at least one new opioid prescription rose from nearly 7 percent in 2013 to more than 10 percent in 2015, before declining to about 8 percent in 2016.
That year, about one-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 elderly users at risk, increasing risks such as falls and cognitive problems and harmful interaction with other drugs. But its increasing use also makes seniors vulnerable to exploitation and abuse.
“If you need drugs, open your grandmother’s medicine cabinet,” said Pamela Teaster, a gerontologist at Virginia Tech who, along with Karen Roberto, also a gerontologist there, conducted early research into drug abuse.
In some cases, the theft takes place in nursing and care homes. In 2019, when? the surveyed National Consumer Voice 137 state and local ombudsmen handling complaints about long-term care facilities, more than half reported complaints of drug abuse, drug theft or financial exploitation as a result of opioid addiction.
Minnesota monitors drug abuse in long-term care and found that documented incidents in nursing homes rose from nine to 116 from 2016 to 2018. They climbed similarly in assisted living facilities in the state, from nine cases in 2016 to 69 two years later, then to 55 in 2019. The number of cases in both types of facilities fell to single digits last year, possibly due to Covid-related closures and restrictions.
The perpetrators, almost always employees, developed a remarkable ingenuity. An analysis of data from Minnesota by Eilon Caspi, a gerontologist and researcher at the University of Connecticut, found that the thieves forged signatures, altered documents and diluted drugs in syringes. Some cut open the foil backing of pill cards, replaced over-the-counter tablets, and reapplied the foil.
Employees walked out of the facilities with pills in their handbags, waistbands, bras and socks as their patients suffered the painful consequences. Prosecutors and news organizations have reported arrests of workers across the country, including in Iowa, Rhode Island, Georgia and Florida.
However, drug abuse victims often live in their own homes, where the people who steal their drugs are likely to be their own relatives.
dr. Roberto and Dr. Teaster first explored the issue in 2017 by conducting focus groups with law enforcement, substance abuse, and adult protection professionals in Ohio, Kentucky, Virginia, and West Virginia, states with rampant opioid abuse.
“They told story after story about older adults who didn’t have access to the painkillers they needed” after family members took them, said Dr. Roberto.
In a grim report from Kentucky, a caregiver took a relative with dementia to several dentists in search of pain relief, eventually having the senior’s teeth pulled to access opioids.
The researchers then examined three years of state data from eastern Kentucky, looking at 25 substantiated cases of elder abuse with opioid use, most of them in families. “We often see interdependence in these families,” said Dr. Roberto. An adult child or grandchild, usually one with a criminal record, perhaps recently released from prison, moves in with the elder. They can provide care; they may also need housing, food, or money. And they can help themselves to the senior’s medications.
“When things go wrong and get out of hand, the older person doesn’t want to get a family member in trouble,” said Dr. Roberto. “They are very protective of them,” refusing to report or confirm abuse.
Opioid use by older adults may be plateauing, said Dr. Steinman, as federal guidelines and state drug control programs have made it more difficult to obtain and abuse these drugs. But opioids remain an annoying problem for older people because alternative pain treatments can also be risky or ineffective.
Patients and caregivers can help protect themselves by safely storing prescription drugs and by overcoming their reluctance to report theft and exploitation.
La Vang, the registered nurse who would supposedly care for Ms. Borsheim, was arrested in August 2018 and found to be replacing over-the-counter pain relievers and allergy pills with her medications. Provincial prosecutors planned to offer a plea deal without jail time, as Mr Vang had no criminal record.
“A slap in the hand,” Mrs. Shaw said. Outraged, she called the federal Drug Enforcement Administration office in Minneapolis, leading to a federal charge. Investigators found that Mr. Vang, 29, had been fired by two previous home care agencies for stealing medications from patients.
He admitted to being addicted to opioids and entered 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 at his sentencing.
The judge imposed an 18-month sentence in federal prison — “above normal sentencing guidelines,” said Joel Smith, Mrs. Borsheim’s attorney. A civil suit against Mr. Vang and Lifesprk Home Health, his employer, was settled this summer before the lawsuit. Mr. Vang lost his nursing license.
But the consequences remain for the family. Roger Borsheim died suddenly, at the age of 87, in May 2020. “My personal opinion is that the stress of it all killed my father,” Ms Shaw said.
Mrs. Borsheim has since moved to an assisted living home, where one of her three daughters visits almost daily. She feels better, but remains scared.
“Someone came to take care of you, gained all that trust and almost killed you,” Mrs. 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 La Vangs are left?”