Questions remain about the U.S. Drug enforcement agency’s rules on secure disposal of controlled substances and exactly how they will be implemented with regard to the disposal of controlled substances by hospice personnel. A copy of the final rules as published in the Federal register is available at http://www.deadiversion.usdoj.gov/fed_regs/rules/2014/2014-20926.pdf.

The rules, which took effect October 9, 2014, and were aimed at expanding options for secure disposal of controlled substances and decreasing improper drug diversion and disposal, pose significant challenges for hospice providers caring for patients in their homes. Hospice staff frequently handle controlled substances as part of patient care, and the DEA rules surprised many by providing that, absent specific authority under state law, home hospice personnel are not authorized to receive controlled substances from a hospice patient or a member of the patient’s household for purposes of proper disposal. There is no North Carolina law or rule authorizing hospice personnel to take possession or dispose of unused controlled substances of a hospice patient (either alive or deceased) or a member of the patient’s household. The prohibition against hospice staff disposal of unused controlled substances would seem to increase the risk of abuse or diversion in many instances.

National trade associations are in the process of seeking clarification from the DEA regarding the implementation of the new rules for hospice personnel. However, pending further guidance on these issues, now is a good time for hospices to reexamine and tweak their written policies and procedures for management and disposal of controlled substances in a patient’s home, to bring them in compliance. Keys to success for hospice providers in this arena include:

• Educating hospice patients and/or their families about disposal options and how to use them; 
• Assisting patients and their families in authorized disposal methods; and
• Partnering with authorized collectors of unused controlled substances to facilitate participation in legal disposal methods such as take-back and mail-back programs, and disposal in collectors’ authorized receptacles. 

Hospice agencies should review their practices and policies governing transport and disposal of controlled substances  to incorporate only those options allowed by law.