Guidelines for Proper Disposal of Medications in Hospice

Introduction

Out of concern for the environment, the disposal of many types of medications down sinks and toilets is no longer recommended. A number of medications may now be disposed of in the trash, if properly altered to make them unusable or undesirable.

The guidelines were designed to assist hospice staff when disposing of unused medications in homes and other residential settings. They do not apply in any hospice facility. Suncoast Hospice continues to require that certain medications which could be particularly harmful to children or animals, if inappropriately ingested. Out of concern for the safety and welfare of others, hospice employees are still required to dispose of narcotics and other Class II drugs by flushing.

Class II Drugs

All narcotics and other Class II drugs must be flushed.

Brand Name (Generic Name)
1. Ambien (zolpidem)
2. Ativan (lorazepam)
3. Klonopin (clonazepam)
4. Librium (chlordiazepoxide)
5. Lomotil (diphenoxylate/atropine)
6. Lyrica (pregabalin)
7. Marinol (dronabinol)
8. Oxandrin (oxandronone)
9. Ritalin (methylphenidate)
10. Soma (carisoprodol)
11. Valium (diazepam)
12. Versed (midazolam)
13. Xanax (alprazolam)
14. Ritalin (methylphenidate)
15. Soma (carisoprodol)
16. Valium (diazepam)
17. Versed (midazolam)
18. Xanax (alprazolam)

Any drug containing:
1. morphine sulfate
2. oxycodone
3. hydrocodone
4. fentanyl
5. codeine
6. dilaudid
7. methadone
8. phenobarbital

Follow These Seven Steps to Safety

1. Remove prescription medications from their original containers (see instructions below. Use felt marker to conceal any personal information prior to discarding containers in trash.

2. Have two persons count and record all narcotics and other Class II controlled substances prior to disposal.

3. Render all medicines unusable or undesirable to prevent unintended use:

• Pour pills or liquid into impervious bag containing kitty litter.
• Remove protective cover from non-narcotic transdermal patches, cut patches in half and place in impervious bag containing kitty litter. Use disposable gloves, when available, to remove patches from packaging and cut patches in half carefully, handling by edges.
• Remove wrappers from suppositories and put into impervious bag containing kitty litter.
• Squeeze medicated ointments and creams into an impervious bag containing kitty litter or mix dirt, cayenne pepper or flour into original container.

4. Add sufficient water or other liquid to impervious bags containing kitty litter. Wet kitty litter sufficiently to cause clumping/hardening.

5. Ziplock, or otherwise seal, impervious bags and any other original containers which still contain medicated ointments, etc. Place in a brown bag or other opaque, non see-through container to discourage identification of contents and potential tampering.

6. Fold paper bag or seal other containers used and dispose of in a trash bin.

7. Do not put bags or containers filled with disposed meds in a recycle bin.

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