June 16, 2021

Controlled Substance Waste and the Opioid Epidemic

There are many contributors which may lead to a person’s misuse of prescription and over-the-counter medications. This misuse is concerning, as it is easy for users to become addicted to opioids, resulting in serious illness and even death. Healthcare organizations that understand and mitigate the risks associated with these potentially addictive drugs are not only creating a healthier care environment, but are also minimizing the risk of drug diversion, which is a primary element fueling the opioid crisis, and preventing contamination of surrounding ecosystems.

What Is a Controlled Substance?

A controlled substance is any type of drug that the federal government has categorized as having a higher-than-average potential for abuse or addiction. These drugs are categorized based on their potential for abuse or addiction and range from illegal street drugs to prescription medication.

What Are Controlled Substances Used For?

Prescription opioids are a common controlled substance in healthcare. They are often used for pain management after a medical procedure or to treat chronic pain. Unfortunately, inappropriate use of these drugs can lead to addiction. These drugs can also serve as a gateway to even more dangerous opioids, including heroin. Recognizing Canada’s opioid crisis, healthcare organizations should be mindful to take measures to reduce the risks within their workplace and community posed by controlled substances that are used to treat patients.

How Should an Organization Dispose of Controlled Substances?

The Government of Canada advises that controlled substances should not be flushed down the toilet or sink as this can lead to environmental contamination (drugs leaching into waterways).

Although the Government of Canada is not prescriptive on the type of containers an organization should use to dispose of controlled substance waste, industry best practice involves using specially-designed receptacles that immediately deactivate the drug on contact and ensure it cannot be retrieved once discarded. Organizations should consider placing these containers in patient care areas where controlled substances are dispensed. They should also partner with a licensed waste management vendor to remove controlled substance waste containers at predefined times and replace them with new, empty ones. Not only does this reduce the burden on staff to empty the containers, it also maintains their safety by limiting their contact with controlled drug waste.

What Is Drug Diversion?

Drug diversion occurs when controlled substances meant for medical treatment are used for recreational purposes. The risk of drug diversion increases when controlled substances are not stored or administered properly, are left unattended or are incorrectly thrown away. For instance, leftover prescription painkillers should never be tossed in medical waste or sharps containers, as they can be accessed relatively easily and are hotspots for drug diversion. This makes using the right container for disposal critical to preventing drug diversion.

Where Does Drug Diversion Happen?

Although drug diversion often occurs in hospitals and health systems, due to increased access to controlled substances, it can happen anywhere, such as non-acute care settings, veterinary practices, and long-term care facilities. Consequently, healthcare organizations of all types should have policies in place that address how to prevent drug diversion and regularly train staff on the topic.

Healthcare facilities are not alone when it comes to facing the challenges of drug diversion. There is risk of diversion anywhere that controlled substances are stored or kept, including at home. The longer that unused or leftover prescription drugs stay in the medicine cabinet or are stored within reach of others, the higher the chances they may be diverted.

How Do You Prevent Drug Diversion?

There are several steps involved in developing a drug diversion prevention program. First, an organization should have a comprehensive policy that describes how to handle and dispose of controlled substances safely and compliantly. This should outline the procedures involved, as well as the equipment that should be used.

An organization must then provide frequent and thorough staff training to ensure employees fully understand their role in preventing diversion. Staff should be trained on the organization’s policy, the reasons behind it, and the individual and community risks that drug diversion presents. The procedures for disposing of leftover or expired controlled drugs, as well as how to witness the process should also be covered in training. Organizations will want to make sure that staff fully understand the job and licensing ramifications if they do not closely follow defined wasting and witnessing procedures. Learning how to recognize suspicious situations and where and how to report them can also be beneficial to preventing drug diversion.

To verify that practice follows policy, organizations should regularly audit how drugs are being administered and disposed, making sure staff are consistently following procedure and reinforcing training. This may involve conducting risk rounds in which department leaders observe employees and check waste containers. In addition, leaders should ask staff to state the organization’s policy and demonstrate the disposal process.

How Can Patients Dispose of Controlled Substances?

Oftentimes, a patient will have leftover doses of their painkiller prescription, and they may ask staff what to do with them. Staff should be able to provide them with secure methods or resources for secure disposal. This may include drug take back envelopes that a healthcare organization could make available to patients or encouraging patients to participate in drug take back programs, which can frequently be found in police departments, pharmacies, and other public areas.

Learn more about how Stericycle can help your organization ensure proper controlled waste disposal and prevent drug diversion.