June 16, 2020

Controlled Substance Waste and the Opioid Epidemic

According to the Department of Health and Human Services (HHS), over 10 million people misuse prescription opioids annually and contribute to the overall opioid crisis. Healthcare organizations that understand and mitigate the risks associated with these potentially addictive drugs can not only support a healthier care environment but also minimize the risk of drug diversion, which is a primary element fueling the opioid crisis, and prevent contamination of surrounding ecosystems.

What Is a Controlled Substance?  

A controlled substance is any drug that is regulated by the Drug Enforcement Agency (DEA). The DEA organizes controlled substances into groups—called schedules—based on a drug’s risk of abuse or harm. Schedule I drugs have a higher potential for psychological and/or physical dependence, whereas Schedule V drugs represent the least potential or abuse. Prescription opioids, such as oxycodone, hydrocodone and morphine, are controlled substances, and the DEA considers them to be either Schedule II or Schedule III substances depending on the drug.

What Are Controlled Substances Used For?

Prescription opioids are a common controlled substance in healthcare. They are often used for pain management after a medical procedure or to treat chronic pain. Unfortunately, inappropriate use of these drugs can lead to addiction. Currently, more than 10 million Americans misuse prescription painkillers. These drugs can also serve as a gateway to even more dangerous opioids, including heroin. Recognizing America’s opioid crisis, healthcare organizations should be mindful to take measures in reducing the risks within their workplace and community posed by controlled substances that are used in treating patients.

How Should an Organization Dispose of Controlled Substances?

At one time, it was common practice to flush unused controlled substances, which can have a negative impact on the environment. However, in 2019 the Environmental Protection Agency (EPA) released its Final Rule banning drain disposal of all pharmaceuticals that are considered hazardous (flushing, sewering).

Although the DEA is not prescriptive on the type of containers an organization should use to dispose of controlled substance waste, industry best practice involves using specially-designed receptacles that immediately deactivate the drug on contact and ensure it cannot be retrieved once discarded. Organizations should consider placing these containers in patient care areas where controlled substances are dispensed. They should also partner with a licensed waste management vendor to remove controlled substance waste containers at predefined times and replace them with new, empty ones. Not only does this reduce the burden on staff to empty the containers, it also maintains their safety by limiting their contact with controlled drug waste.

What Is Drug Diversion?

Drug diversion occurs when controlled substances meant for medical treatment are used for recreational purposes. The risk of drug diversion increases when controlled substances are not stored or administered properly, are left unattended or are incorrectly thrown away. For instance, leftover prescription painkillers should never be tossed in red bags or sharps containers, as they can be accessed relatively easily and have been hotspots for drug diversion. This makes using the right container for disposal critical to preventing drug diversion.

Where Does Drug Diversion Happen?

Although drug diversion most often occurs in hospitals and health systems, due to increased access to controlled substances, it can happen anywhere, such as non-acute care settings, veterinary practices and long-term care facilities. Consequently, healthcare organizations of all types should have policies in place that address how to prevent drug diversion and regularly train staff on the topic.

Healthcare facilities are not alone when it comes to facing the challenges of drug diversion. There is risk of diversion anywhere that controlled substances are stored or kept, including at home. According to Stericycle’s 2019 Drug Takeback Survey, more than one-third of those surveyed hold on to leftover medications for future use, highlighting the need for safe and convenient disposal methods for consumers. The longer that unused or leftover prescription drugs stay in the medicine cabinet or are stored within reach of others, the higher the chances they might be diverted.  

How Do You Prevent Drug Diversion?

There are several steps involved in developing a drug diversion prevention program. First, an organization should have a comprehensive policy that describes how to handle and dispose of controlled substances safely and compliantly. This should outline the procedures involved as well as the equipment that should be used.

An organization must then provide frequent and thorough staff training to ensure employees fully understand their role in preventing diversion. Staff should be trained on the organization’s policy, the reasons behind it and the individual and community risks that drug diversion presents. The procedures for disposing of leftover or expired controlled drugs, as well as how to witness the process should also be covered in training. Organizations will want to make sure that staff fully understand the job and licensing ramifications if they do not closely follow defined wasting and witnessing procedures.  Learning how to recognize suspicious situations and where and how to report them can also be beneficial to preventing drug diversion.

To verify that practice follows policy, organizations should regularly audit how drugs are being administered and disposed, making sure staff are consistently following procedure and reinforcing training. This may involve conducting risk rounds in which department leaders observe employees and check waste containers. In addition, leaders should ask staff to state the organization’s policy and demonstrate the disposal process.

How Can Patients Dispose of Controlled Substances?

Oftentimes, a patient will have leftover doses of their painkiller prescription, and they may ask staff what to do with them. Although the DEA forbids organizations from collecting unwanted controlled medications directly from patients, staff should be able to provide them with other secure methods or resources for secure disposal. These may include drug take back envelopes that a healthcare organization could make available to patients. The pre-paid envelopes let patients turn in up to eight ounces of unused medication directly for incineration.

Staff may also encourage patients to participate in Drug Take Back days or to dispose of unused medication in drug collection kiosks, which can frequently be found in police departments, pharmacies and other public areas. Using these kiosks, individuals can confidentially drop off their leftover medications.

To learn more about how Stericycle can help your organization ensure proper controlled waste disposal and prevent drug diversion, visit our Controlled Substance Waste Disposal hub.

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