[Pharmwaste] Does your state allow hospice workers to transfer controlled substances to drug disposal programs?

Jan Harris jharris at sharpsinc.com
Mon Jul 31 17:26:54 EDT 2017


Thanks Jennifer. I think you are talking about the disposable pouches you can buy at the retail pharmacy that are placed into the trash when filled. They are not the DEA-approved mailback systems. That is why a DEA-compliant mailback managed by a DEA-registered collector reverse distributor, and not a pouch that can be disposed of in the trash, is easier. I always hesitate to talk about systems/products in this group, but we designed a 1 and 2-gallon DEA-approved mailback box (as well as the envelope) specifically for hospice due to the variety of drug delivery systems and volume in the home, e.g. liquids, pills, others as you mentioned. The family member simply places all the drugs still in their packaging into the box, seals it, and mails it.

From: Pharmwaste [mailto:pharmwaste-bounces at lists.dep.state.fl.us] On Behalf Of Volkman, Jennifer (MPCA)
Sent: Monday, July 31, 2017 4:15 PM
To: Pharmwaste, the list <pharmwaste at lists.dep.state.fl.us>
Subject: Re: [Pharmwaste] Does your state allow hospice workers to transfer controlled substances to drug disposal programs?

I think that approach looks to be much simpler than counting pills and tracking them. We have to trust family members to dispose of waste medications through a local collection option, but if one isn’t available, mail back seems to be the next best approach. If you use the pouches, you’d have to have at least a dozen of them per home, and then you’d have to take all of the pills, liquids, patches, lollipops out of the containers/pop packs and mix in the liquid, etc., definitely using whatever gloves guard you against fentanyl or other drug absorption.

From: Pharmwaste [mailto:pharmwaste-bounces at lists.dep.state.fl.us] On Behalf Of Jan Harris
Sent: Monday, July 31, 2017 3:52 PM
To: Ed Gottlieb <EGottlieb at cityofithaca.org<mailto:EGottlieb at cityofithaca.org>>; Bickford, Barbara J - DNR (Barb) <Barbara.Bickford at wisconsin.gov<mailto:Barbara.Bickford at wisconsin.gov>>; Pharmwaste, the list <pharmwaste at lists.dep.state.fl.us<mailto:pharmwaste at lists.dep.state.fl.us>>
Subject: Re: [Pharmwaste] Does your state allow hospice workers to transfer controlled substances to drug disposal programs?

Barbara and Ed,

As we know, hospice or home health can partner with a DEA-registered reverse distributor and provide the family or other “legally entitled” person a mailback package, (i.e., mailback envelope or box) that the family can contain and mail the unused controlled and other drugs. Is there a reason the WI bill’s drafters would rather the hospice employees take the drugs? I am assuming it is the fear the family member will just divert them. I’m concerned as well that the liability of taking the drugs would be concerning for an organization. I know most hospice employees over the years have disposed of a patient’s controls with the deceased’s family member over the sink. In this same way, could they not provide the mailback and watch the family member place them in it? In the LTC facility, the drugs can be placed into a receptacle of course (given they have one) or also use a mailback.

…it is unlawful for ultimate users to transfer pharmaceutical controlled substances to unauthorized persons, and it is unlawful for unauthorized persons to receive such substances. It is also unlawful for any person to possess a controlled substance unless authorized to do so under the CSA (i.e., an ultimate user, an entity registered with the DEA, or an entity exempt from registration with the DEA). 21 U.S.C. 844(a). Home hospice and other homecare providers are encouraged to assist their patients, and their patients’ families, in disposing of pharmaceutical controlled substances in accordance with the CSA and its implementing regulations. While education is paramount, home healthcare agencies are also encouraged to partner with authorized collectors to promote or jointly conduct mail-back programs.

I am eager to hear others’ thoughts on this important issue. Thanks!

Jan Harris
Director, Regulatory Compliance
Sharps Compliance
www.sharpsinc.com<http://www.sharpsinc.com>
jharris at sharpsinc.com<mailto:jharris at sharpsinc.com>
713-927-9956




Jan Harris | Director, Environmental Health & Safety

Sharps Compliance, Inc.
d- 713-927-9956 | o- 800-772-5657 | f- 713-660-3596

jharris at sharpsinc.com | <mailto:jharris at sharpsinc.com> http://www.sharpsinc.com
From: Pharmwaste [mailto:pharmwaste-bounces at lists.dep.state.fl.us] On Behalf Of Ed Gottlieb
Sent: Monday, July 31, 2017 2:53 PM
To: Bickford, Barbara J - DNR (Barb) <Barbara.Bickford at wisconsin.gov<mailto:Barbara.Bickford at wisconsin.gov>>; Pharmwaste, the list <pharmwaste at lists.dep.state.fl.us<mailto:pharmwaste at lists.dep.state.fl.us>>
Subject: Re: [Pharmwaste] Does your state allow hospice workers to transfer controlled substances to drug disposal programs?


Hi Barb,



New York State does not have legislation allowing hospice staff to take possession of controlled substances for disposal.  Source: Dept. of Health, Bureau of Narcotic Enforcement.

It is hard to imagine how illegal diversion could be prevented once they are handed over to a hospice worker.



One method that might work is to have two hospice workers sign a transfer of custody form, with an inventoried list of controlled substances, when accepting them from the person responsible for decedent's personal property.  Someone else would then have to check what is turned in against the inventory.  Difficult enough without the issue of mixed loose pills that need to be identified...


Ed Gottlieb
Chair, Coalition for Safe Medication Disposal
Board Member, New York Product Stewardship Council
Industrial Pretreatment Coordinator
Ithaca Area Wastewater Treatment Facility
525 3rd Street
Ithaca, NY  14850
(607) 273-8381
fax: (607) 273-8433
________________________________
From: Pharmwaste [pharmwaste-bounces at lists.dep.state.fl.us] on behalf of Bickford, Barbara J - DNR (Barb) [Barbara.Bickford at wisconsin.gov]
Sent: Monday, July 17, 2017 3:17 PM
To: Pharmwaste, the list
Subject: [Pharmwaste] Does your state allow hospice workers to transfer controlled substances to drug disposal programs?
Dear List-readers,

Wisconsin legislators have proposed a bill, AB444, which would allow hospice staff to transfer controlled substances of deceased persons to drug disposal programs.  Here is a link to the bill:
https://docs.legis.wisconsin.gov/2017/proposals/ab444

According to the DEA’s Final Rule for the Disposal of Controlled Substances, DEA would allow this practice if state law allowed it.
https://www.deadiversion.usdoj.gov/fed_regs/rules/2014/2014-20926.pdf
See page 53546, in the second to last paragraph, where it states “…a member of the hospice patient's household may dispose of the patient's pharmaceutical controlled substances, but the home hospice or home care provider cannot do so unless otherwise authorized by law (for example, under state law) to dispose of the decedent's personal property” (emphasis added).

I’m curious.  What other states have adopted laws related to disposal of controlled substances by hospice staff?  If your state has adopted such a law, how does the state help prevent diversion of the controlled substances by hospice staff or by persons posing as hospice staff?

--Barb
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