June 30, 2023

CsRx® Containers: A Valuable Solution for Mitigating Drug Waste Diversion

The opioid epidemic continues to pose a significant challenge in the United States, and while the country makes up 4.4% of the global population, it consumes over 80% of the global opioids. Deaths from the misuse of synthetic opioids and stimulants have increased in recent years, and the unfortunate truth is that these numbers are on the rise. According to the most recent data released by the Centers for Disease Control and Prevention (CDC), nearly 110,000 people died in 2022 from drug overdoses in the United States, with synthetic opioids contributing to about 75,000 of these deaths.

Healthcare organizations and facilities play a crucial role in combating the crisis, and it is important for them to understand the importance of responsible waste management to help mitigate the potential risk of diversion (unlawful acquisition or use) of addictive drugs. The use of drug sequestration units, like CsRx®, can help prevent these drugs from falling into the wrong hands.

Stericycle's controlled substance wastage containers provide a valuable solution to help mitigate drug diversion. The containers are designed for the secure capturing of controlled substance wastage immediately after patient administration. These containers help prevent the diversion of drugs compared to discarding in the regular trash.  Stericycle incinerates all returned CsRx® containers, which also helps keep active pharmaceutical ingredients out of waterways compared to disposing of them down the drain. Stericycle’s CsRx® Controlled Substance Waste Service includes the following components:

  • Staff training with instructions on best practices
  • Lockable wall-mounted brackets and hardware installed by Stericycle’s installation team
  • Containers prefilled with deactivating, deterring, and solidifying agents
  • Ongoing and proactive container management (for full-service customers)
  • Destruction of waste by incineration

With these comprehensive measures, the CsRx® containers can help you mitigate the risk of drug waste diversion at your facility and send your waste for incineration, protecting individuals and the environment from potential harm.

How to Properly Dispose of Controlled Substances

A controlled substance is any drug that has been scheduled by the Drug Enforcement Administration (DEA). The DEA places substances into one of five schedules. This placement is based on the substance’s medical use, and its potential for abuse or dependence. Examples of drugs that have been scheduled by the DEA include:

  • Schedule I: Heroin, LSD, Marijuana, Ecstasy, Methadone
  • Schedule II: Oxycodone, Fentanyl, Dilaudid
  • Schedule III: Ketamine, Tylenol w/ Codeine, Testosterone
  • Schedule IV & *V: Xanax, Darvocet, Valium, *Robitussin AC

Schedule I substances have a higher potential for psychological and/or physical dependence, whereas Schedule V drugs are those that have the least potential for abuse. Prescription opioids, such as oxycodone, hydrocodone, and morphine, are Schedule II controlled substances at the federal level.

To determine the appropriate disposal method for controlled substance waste, it is important to consider various factors, such as understanding the difference between wastage and inventory, as inventory cannot be placed in CsRx® containers.

Inventory: Refers to the controlled substances that belong to the registrant, who holds the responsibility for their use, transfer, and disposal as outlined by DEA regulations. Proper disposal of inventory requires rendering it non-retrievable. Some examples of inventory include:

  • Expired vial of testosterone at a clinic
  • Box of fentanyl patches in an ambulatory surgery center
  • Full/unopened vial of ketamine from a veterinary clinic
  • Expired vials of morphine from a hospital pharmacy
  • Unopened cups of methadone at a narcotic treatment center

In all the examples above, the material is part of the facility's inventory and is not eligible for disposal in CsRx.

Wastage: Wastage refers to what is left over after a controlled substance has been dispensed by a practitioner for immediate administration at a registered location pursuant to an order for medication. The DEA does not mandate destroying this type of waste, meaning it does not need to be rendered non-retrievable. However, the DEA strongly recommends that practitioners implement security controls to prevent the diversion of wastage. Some examples of wastage include:

  • Partial vial of testosterone at a clinic
  • Fentanyl patch removed from a patient at an ambulatory surgery center
  • Partial syringe of ketamine from a veterinary clinic
  • Partial IV or PCA pump of morphine from a hospital surgical area

Learn more about Stericycle’s CsRx® Controlled Substance Waste Service, which is designed to help practitioners that are DEA registrants mitigate the risk of drug diversion. Stericycle also offers services designed to help ultimate users (patients) dispose of their controlled substance medications, including Seal&SendTM Consumer Medication Mail Envelopes and MedDropTM Medication Collection Kiosks.

Frequently Asked Questions 

Which Controlled Substances Can Go in CsRx® Containers?

Wastage from controlled substances included in DEA Schedules II-V can be disposed of in CsRx® containers.

Which Controlled Substances Can Never Go in CsRx® Containers?

  • Controlled substance inventory (expired and other unused controlled substances)
  • Schedule I controlled substances (substances with no currently accepted medical use per the DEA, including Heroin, LSD, and Marijuana)
  • Controlled substances from ultimate users (the person the controlled substance was prescribed to), including abandoned controlled substances left at a doctor’s office or police station

How to Dispose of Controlled Substance Wastage in a Hospital?

Registered practitioners can utilize a trusted ally, like Stericycle, to manage wastage in a sequestration device to help protect against diversion. Stericycle’s program provides deactivation of controlled substance wastage, acts as a deterrent to prevent ingestion of contents, and facilitates the solidification of waste for safe storage and transportation.

How Can Healthcare Organizations Help Mitigate the Risk of Drug Misuse?

Healthcare organizations can help mitigate the risk of medication diversion and abuse by following proper waste management processes, particularly when it comes to disposing of controlled substances.

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