A federal law recently approved by Congress gives hospice nurses and licensed independent practitioners authorization to dispose of unused opioid medications at the site of care following a patient’s death.
The Substance Use–Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities (SUPPORT) Act is part of the federal government’s strategy to stem the tide of the opioid epidemic, which claims the lives of 130 people in the United States each day, according to the U.S. Centers for Disease Control and Prevention.
A key provision in the law indicates that the drugs cannot be removed from the site of care prior to destruction.
Before the law, families were left with the task of drug disposal, creating opportunities for misuse, theft or diversion of the drugs. Hospices were authorized to dispose of medications when the patient had no next of kin, often by throwing them in the trash — where they could be stolen — or by flushing them in the toilet or sink, contributing to water contamination.
“There are a series of laws across the country that gave rights to hospices to take possession of personal effects, such as prescribed medications, within homes that had no heirs or estates, to help avoid diversion of opioids, but properly prescribed opioids were still being diverted within those homes,” William Dombi, president, National Association for Home Care & Hospice, told Hospice News.
Drug diversion—the transfer of a prescription medication from a lawful to an unlawful channel of distribution or use—exists throughout the health care continuum. Hospice providers and other organizations that provide care in the home face unique challenges because the medications are unsecured.
A study published in the February issue of the Journal of Pain and Symptom Management indicated that prescription medications in the home are a “well-known entry point” for family members or visitors to access potentially addictive substances. The risk is particularly high if people in the home have a history of substance abuse.
“Compliance with this law will play an astronomical role in eliminating diversion in hospice,” David Schiller, former DEA special agent in charge, told Hospice News. “Hospices knew the problem existed, they just didn’t know what to do about it.”
But compliance with the law may be tricky as the federal government does not intend to issue any new regulations for hospices outside of what has been written, according to Dombi.
“It will be up to the hospice to develop a business model that is going to work for them,” Schiller said. “The law stipulates that to be held in compliance, hospices must document each step taken to dispose of medications.”
Required documentation includes medication type (name), dosage, disposal method, and the signature of a witness. To ensure the family isn’t surprised by the protocol, some hospices have begun educating families about drug disposal policies, offering resources in a language and format the family can understand.
“Hospices should be reviewing the law and doing some education on who should be doing the disposal as well as setting up processes to comply with the law. Establishing a good set of policies only behooves the hospice in mitigating any challenges with compliance,” Dombi said. “One would have to estimate that the majority of hospice patients have some number of opioids within the home, just due to end of life scenarios. So while difficult to measure, I’m sure it will have a significant impact.”
Written by: Audrie Roelf