An update on The Disposal Act
October 29, 2014 08:43 AM
NAHC and its affiliated Hospice Association of America (HAA) continue to receive questions about the recently effective Disposal of Controlled Substances final rule. In September, NAHC Report reported on this final rule as it pertains to hospices.
The Disposal Act provides that, ‘‘if a person dies while lawfully in possession of a controlled substance for personal use, any person lawfully entitled to dispose of the decedent’s property may deliver the controlled substance to another person for the purpose of disposal under the same conditions as provided’’ for ultimate users (21 U.S.C. 822(g)(4)). What this means is that a member of the decedent’s household can give the medications to hospice staff for disposal if that staff person is legally authorized to receive it and dispose of it. Otherwise, home hospice and homecare personnel are not authorized to receive pharmaceutical controlled substances from ultimate users for the purpose of disposal.
NAHC and HAA believe that express authorization by the state for hospice and/or home care personnel to receive and dispose of a medication is required. Therefore, we are suggesting that hospice and home care providers review their policies regarding the handling of medications/disposal of medications and include the following in that policy”
Hospice/home care personnel should not receive or dispose of medications unless authorized to do so in the state.
Hospice/home care personnel can assist by providing an envelope for the mail-back programs and other event information but may not place the medication in the mail-back envelope and may not transport and dispose of medications unless authorized to do so in the state.
Hospice/home care personnel will make patient/family aware of proper disposal methods including information about take-back events, mail back programs, and collection receptacle locations in the area - as well as FDA guidelines for the proper disposal of medications. FDA information can be found here.
If the family is going to dispose of the medications, the hospice/homecare personnel should document this in the medical record. The hospice or home health agency may want to encourage their personnel to be a witness to the disposal of medications performed by the ultimate user or another authorized party.
It is also helpful to reference the DEA’s General Public Fact Sheet, specifically Question #6, which is copied below:
6. Can I dispose of a friend or family member’s pharmaceutical controlled substances for them?
You may dispose of a member of your household’s unused or unwanted pharmaceutical controlled substances. But, if they are not a member of your household, you may not dispose of their pharmaceutical controlled substances on their behalf. Only ultimate users may dispose of pharmaceutical controlled substances. An ultimate user, which includes a household member of the person or pet who was prescribed the medication, may transfer pharmaceutical controlled substances to authorized collectors or law enforcement via a collection receptacle, mail-back package, or take-back event.
If someone dies while in lawful possession of pharmaceutical controlled substances, any person lawfully entitled to dispose of the decedent’s property may dispose of the pharmaceutical controlled substances; and
A long-term term-care facility may dispose of a current or former resident’s pharmaceutical controlled substances.
Hospices should be looking to governing state rules and regulations for further guidance.
NAHC and HAA are in the process of gathering state-by-state information with the intent of compiling the information in one document for future reference and obtaining further guidance from the DEA.