The Substance Use Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act was signed into law by President Trump in October 2018. This legislation is aimed at addressing the opioid epidemic sweeping through the nation, with thousands of lives lost or ruined due to rampant abuse of prescription pain medications. In addition to making addiction treatment options more widely accessible to those who need it, this particular law brings a helpful change to those working in hospice and palliative care. Although the act was passed at the end of 2018, we continue to receive questions from those still uncertain about who can dispose of controlled substances as well as when and how they can do it.

Under the previous 2014 DEA regulations, hospice staff were not permitted to dispose of unused controlled substances following medication discontinuation, expiration, or patient death unless permitted by state law. The SUPPORT Act aims to address this shortfall by allowing properly credentialed hospice personnel (those licensed to provide medical or nursing services as determined by jurisdiction) to dispose of unused controlled substances. NHPCO has recommended that hospice organizations work on integrating these changes into their regular workflow, while maintaining that procedures may need to be changed following further guidance from the DEA.

Under the SUPPORT Act, qualified hospice employees are permitted, but not required, to handle and assist families with onsite controlled substance disposal if a medication is either expired or no longer needed due to death of a hospice patient. Qualified personnel include physicians, physician assistants, and nurses (NP, RN, and LPN) employed by or under contract with the hospice. Only physicians who are DEA-registrants are permitted to destroy controlled substances for a living patient in response to a change in their plan of care.

Hospice personnel planning to assist with controlled substance disposal must complete a training program addressing secure and responsible drug disposal before they can perform this task. Additionally, hospices will need to develop written policies and procedures for assisting with drug disposal and provide this information to the patient or patient’s representative(s) with the first order of a controlled substance. It’s vital that every party involved understands how controlled substances will be disposed so patient-friendly, non-clinical language should be used and hospices should place a note in the patient’s record documenting that the policies and procedures were shared and discussed. Following destruction, the hospice should document the following in the patient’s clinical record: date and time of disposal, disposal method, the type of controlled substance, dosage, dosage form, route of administration, quantity of medication disposed.

While the SUPPORT Act doesn’t specifically address methods for disposal, NHPCO believes that hospice personnel aren’t required to adhere to rules applicable to DEA registrants and can use disposal methods currently available to ultimate users (e.g., permanent drug take-back programs, periodic local take-back events, onsite drug disposal boxes, mail-back programs, or by following FDA guidelines for safe medication disposal).

In response to the opioid crisis, Google has made efforts to help facilitate the disposal of unused medications. In 2018, they partnered with the DEA by developing a tool to help people find locations where they could drop off their medications for National Prescription Take Back Day – the DEA collected a record 1.85 million pounds of unused prescription drugs that year alone. Then, last year, Google revealed that search queries for “medication disposal near me” on their search engine had reached an all-time high

In early 2019, Google announced a new Google Maps feature that helps consumers find permanent locations offering drug disposal year round. It’s a coordinated effort with the U.S. Drug Enforcement Administration (DEA), Department of Health and Human Services (DHHS), CVS, Walgreens, and state government and law enforcement to make it easier for consumers to get rid of unwanted and unused medications. By using the search terms “drug drop off near me” or “medication disposal near me”, users are provided with a list of permanent disposal locations at pharmacies, hospitals or government buildings. State governments in Alabama, Arizona, Colorado, Iowa, Massachusetts, Michigan, and Pennsylvania contributed data to identify disposal locations and Google hopes to expand coverage and add more locations.

These efforts to streamline the drug disposal process are welcome changes to help prevent unused medications from ending up in the wrong hands and assist families with drug disposal at home, a critical step in drug safety.

Written by:  

Ernestas Sutas, PharmD Candidate, 2019

Roosevelt University College of Pharmacy

&

Melissa Corak, PharmD

Clinical Pharmacist, OnePoint Patient Care