Policy & Procedure: Controlled Substances Part 2

Controlled Substances Part II: Disposal

When a resident cannot use what remains of a controlled substance that was prescribed to them, your staff is responsible for disposing of the medication in accordance with federal and state laws.

We’ll outline below Washington State requirements for the disposal of controlled substances in communities like yours. For more detail on the laws governing communities located in Washington State, visit the legislature’s website for pharmaceutical services.

Schedule II drugs

• These medications must be destroyed on the premises of your community.

• Destroy them within 30 days of discontinuation, discharge or death.

• To destroy these medications, you must have one of the following:

1. Two licensed nurses

2. A nurse and an authorized ALC staff

3. Three authorized ALC staff

4. A licensed pharmacist and an authorized ALC staff

• You may request a representative of the Washington State Board of Pharmacy come to your community and destroy these drugs on your behalf.

Schedule III, IV and V drugs

• When discontinued by a resident’s physician or left over after the resident’s discharge or death, these drugs must be destroyed:

• Within 90 days

• In the presence of two authorized ALC staff

• Record all such instances of destruction.

Records of disposal

Record the destruction of all controlled medications on the Medication Disposition Record. This record must be retained on the premises for three years and should include the following information:

• Name of the resident to whom the drug was prescribed

• Pharmacy name and prescription number

• Name and strength of the medication

• Quantity of medication destroyed

• Reason for disposal

• Signature(s) of witness(es)

• Date of disposal

Method of disposal

To destroy controlled substances, and other medications, use the following procedures:

• Wearing gloves, take unused, unneeded and expired drugs out of their original containers.

• Mix the drugs with an undesirable substance, such as kitty litter or used coffee grounds, and place them in an impermeable, non-descript container, such as empty cans or sealable bags.

• Place in the trash.

• Do not crush medications. Place whole tablets into the mixture. Capsules will need to be opened.

• Patches, such as fentanyl, are to be folded onto themselves and placed in the mixture or flushed.

• Liquid medications may be disposed of by pouring down the sink while the water is running; containers should be rinsed and discarded.

• Make sure all resident information has been removed/blacked out to comply with HIPAA.

Sharps disposal

Special regulations exist specifically for the disposal of syringes and needles in order to keep you, your staff and your residents safe. These regulations include:

1. Never recap a syringe, as doing so increases the risk of inadvertent sticks

2. Never bend or break a needle or syringe on purpose

3. Immediately deposit used needles into specialized one-way, puncture resistant containers—in other words, sharps containers.

Sharps containers are made for the sole purpose of storing needles and syringes. Never, under any circumstances, should any other items be placed in these containers.

Any of your residents who self-administer or receive medications via syringe from your staff must have such a sharps container present in their apartment or room.

Seal and dispose of all sharps containers with other hazardous waste when they are filled to two-thirds.

For more information on federal regulations, the Drug Enforcement Administration (DEA) website is a good place to start your research. You can find everything from the final rule on federal regulations surrounding the disposal of controlled substances to fact sheets focused specifically on the disposal of such medications in long term care communities.