A Review of Medication Disposal in Hospice

Hospices are faced with a difficult situation after a patient passes in the home or when medications change – what to do with unused medications? This burden can increase stress for caregivers, so it’s important that hospices do what they can to help.

Did you know:

  • In 2017, 53% of people age 12 and older who misused prescription pain medications obtained the drug from friends and family.
  • More than 70,000 Americans died from a drug-related overdose in 2019 and initial estimates suggest an alarming rise in 2020.
  • According to the National Center for Health Statistics at the Centers for Disease Control and Prevention, opioid-related overdose deaths significantly increased from 46,802 in 2018 to 49,860 in 2019.
  • 2019 National Survey on Drug Use and Health estimated 10.1 million people aged 12 or older misused opioids in the past year.
  • A study of young, urban injection drug users interviewed in 2008 and 2009 found that 86 percent had used opioid pain relievers nonmedically prior to using heroin, and their initiation into nonmedical use was characterized by three main sources of opioids: family, friends, or personal prescriptions.

With the growing opioid crisis, the proper and safe disposal of medications has become more critical than ever to prevent drug diversion, misuse, and abuse. This review provides a guide for medication destruction and disposal requirements in hospice along with policy considerations.

Federal and State Regulations

In 2018, the Substance Use Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act was signed into law to address the opioid epidemic. A provision permits, but does not require, qualified hospice employees to assist with the safe disposal of unused controlled substances following the patient’s death, medication expiration, and drug discontinuation due to a change in care plan.

Prior to this bill, the Secure and Responsible Drug Disposal Act of 2010 (“Disposal Act”), which amended the Controlled Substances Act (CSA), allowed “ultimate users” (i.e. patient or their family member) to deliver unused controlled substances to “appropriate entities” for disposal. Hospices were prohibited from taking possession of medications for destruction unless authorized by the state.

Hospices have been slow to take advantage of this law due to burdensome witness requirements and inconsistencies with state and local regulations. Hospice providers should consult their counsel to provide location-dependent guidelines for medication disposal.

Hospice Regulations

To prevent potential abuse of prescription medications, the Medicare Conditions of Participation (CoPs) require hospices to have:

  • Written policies and procedures for managing and disposing of controlled drugs in a patient’s home and discussions with the patient and family when controlled substance drugs are first ordered
  • Documentation in the clinical record that these policies and procedures were provided and discussed

Hospice Medication Disposal Best Practices

A hospice medication disposal policy should include these components:

  • Education: Educate the patient, family, and staff on safe medication disposal. A written hospice policy should include guidance for when a patient’s caregiver refuses to dispose of medications.
  • Collection: Contingent upon state law and hospice policy, the staff may help the family collect any unused medications.
  • Disposal: Dispose of medications in a manner that does not allow the drug to be unintentionally ingested or easily retrieved. Hospice staff may provide appropriate medication disposal options (see “Options for Proper Disposal of Medication”) or assist the family with disposal on-site.
  • Tracking: Procedures for documentation should follow state guidelines. When applicable, complete a form that lists medication name, dose, administration route, unused quantity, time, date, and destruction method. Provide a copy to the patient’s caregiver and store drug disposal documentation in the patient’s medical record.

Medication Disposal Methods

Disposal of Medications at Home
Always adhere to specific disposal instructions on drug labels or patient information leaflets.

If no disposal instructions are provided, medications should be disposed of in a way that prevents easy retrieval or unintentional ingestion. Options include:

  • Remove the drugs from their original containers
  • Mix unused drugs with undesirable substances such as coffee grounds, kitty litter or other non-toxic substances
  • Place the mixture in a sealable plastic bag or container and discard it in household trash

Medication Deactivation Products that render medications unusable:

  • Deterrer
  • DisposeRx
  • Drug Buster
  • Element MDS
  • Rx Destroyer
  • Pill Catcher
  • Pill Terminator

Medication Mail-Back Programs
These voluntary programs, conducted by authorized collectors, use packages made available at pharmacies and senior centers. Collectors must be capable of destroying the medications on-site or have a relationship with a reverse distributor with on-site destruction ability.

Medication Take-Back Programs, where drugs received are incinerated:

  • DEA National Take Back days (April and October)
  • Police stations
  • Pharmacies

For additional information on these products and programs, we recommend visiting these sites:

Further Reading