The rules for disposing of controlled substances have been evolving over the last couple of decades as several pieces of legislation attempt to clarify regulations,  improve safety and prevent drug diversion. Drug diversion occurs when prescriptions are misused by someone for whom they were not intended. Drug diversion is a big problem in the healthcare industry and contributes to the current opioid epidemic in the United States.  Healthcare facilities including hospice centers need to know exactly how they should handle pharmaceutical waste, particularly controlled substances, and must provide guidance and training to hospice staff.

The Secure and Responsible Drug Disposal Act of 2010, Disposal Act, implemented as an amendment to the Controlled Substances Act (CSA), allows for ultimate users, patients or family members, to deliver unused controlled substances to appropriate entities such as mail back packages for collection receptacles for disposal. This Act did not allow for hospice staff to take possession of medication for destruction unless authorized by state law. The Act created confusion in hospice care centers as prior to this most hospices were either disposing of patient unused medication or assisting with disposal to prevent drug diversion. 

A new law was enacted in October of 2018, the Substance Use – Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act (P.L. 115-271).  Under this legislation, hospice staff were provided the authority to dispose of controlled substances if they were dispensed lawfully to the patient receiving hospice.  While this act was signed into law on October 24, 2018 by then President Trump, this part of the legislation has no effective date leaving hospice centers to wait for guidance from the DEA on how to operationalize this effect.

Currently, hospice centers must rely on state regulations as some states grant authorization as noted in the Disposal Act, for hospice staff to dispose of controlled substances on behalf of patients. States which grant authorization to hospice centers to take possession of medications for disposal include: Florida, Kentucky, Louisiana, Maryland, New Jersey, Ohio, Pennsylvania, South Carolina and Virginia.

Hospice centers can prevent drug diversion and the potential abuse of prescriptions by having written policies and procedures in place for managing and disposing of controlled drugs. These policies should include procedures for managing controlled drugs in a patient’s home with proper disposal procedures relayed to the patient and family members.