Hospices Encounter Barriers to Safe Opioid Disposal

A number of hospices nationwide are hitting barriers to effectively disposing of medications following a patient’s death while remaining in compliance with current law and regulation, according to a report released today by the U.S. Government Accountability Office (GAO). Proper disposal of medications is a critical factor to preventing drug diversion.

Drug diversion — the transfer of a prescription medication from a lawful to an unlawful channel of distribution or use — is a prevalent issue throughout the health care continuum. Hospice providers and other organizations that provide care in the home face unique challenges due to the potential easy access to the patients’ medications.

“Hospice care helps patients who are terminally ill maintain their quality of life. Most patients get hospice care at home, which typically includes use of controlled substances, including opioids such as oxycodone, to provide pain relief,” GAO said in the report. “When hospice patients die at home, they often leave behind unused controlled substances, which can be diverted and misused by anyone with access to them.”


Congress in 2018 approved the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act (SUPPORT Act), which for the first time permitted employees of qualified hospice programs to dispose of unused controlled substances by collecting and destroying the drugs in patients’ homes. This was in addition to laws on the books in a number of states.

The SUPPORT Act requires GAO to report to Congress information on the law’s impact each year. For the 2020 report, GAO interviewed representatives from seven hospice providers as well as 11 selected state hospice associations in addition to staff from federal agencies and national industry organizations. 

Since the law’s enactment, hospices have struggled with the cost of certain disposal methods, the unavailability of a witness to the disposal process, and inconsistencies between state laws and federal law concerning which hospice employees may dispose of controlled substances, GAO found.


“Disposal can sometimes be a time-consuming and resource-intensive activity. According to two state hospice association officials, sometimes a patient’s family will ask the disposing hospice employee to dispose of all of the patient’s unused prescription drugs that remain in the home, not only controlled substances or drugs prescribed under hospice care,” GAO reported. “Officials from two of our selected hospices and two state hospice associations told us that it is not atypical for a hospice patient to have bags or boxes full of unused medications, though the officials did not describe this as a disposal challenge for hospices.”

The report contained some best practices for drug disposal in compliance with the SUPPORT Act. These included staff education on controlled substances and disposal, the use of lockboxes for medications, prescription drug counts, coordination with pharmacies and the use of in-home disposal products, among others.  

Despite the seriousness of the issue, identified instances among hospices may be rare. A study published earlier this month in the Journal of the American Medical Association found that among 371 hospices that participated in a phone survey, nearly two-thirds had not found an incident of diversion in the previous 90 days.