[RubyRN,CHPN]

I was approached this week by a former colleague with a question. I thought I'd throw it to the experts:

Is it becoming common at time of death for hospice nurse to release unused narcotics to funeral home/director to give to coroner's office for disposal? Have you seen this done at your hospice or know of a hospice where this is being done? What is your policy?

[Sabby_NC]

Hi

The procedure we follow is that any opioid we have had prescribed for the patient while under our care is disposed at the time of death.

We have a family member observe us counting and flushing the opioids then signing the appropriate Med Disposal Form.

Personally I would be very uncomfortable signing over unused opioids to Funeral Home or Coroner's office to dispose of.

For me I wanna see those suckers circling the drain LOL

[marachne]

I can see your point Shabby NC, and we used to have a joke when we had a pt die inpt at the facility I used to work at -- we knew there were sewer rats and one nurse you'd to always go "here you go, happy rats" -- but that brings up an important issue. We are having problems with the water supply being decontaminated by medications, and I therefore am becoming a lot less comfortable with flushing things down the drain. If there was someone/place I could trust for safe disposal, I'd like that option.

[Sabby_NC]

Originally Posted by marachne

I can see your point Shabby NC, and we used to have a joke when we had a pt die inpt at the facility I used to work at -- we knew there were sewer rats and one nurse you'd to always go "here you go, happy rats" -- but that brings up an important issue. We are having problems with the water supply being decontaminated by medications, and I therefore am becoming a lot less comfortable with flushing things down the drain. If there was someone/place I could trust for safe disposal, I'd like that option.

Very true and that is a valid concern... Just wonder how else we could safely destroy opioids where no roaming fingers could help themselves!!

[marachne]

Originally Posted by Sabby_NC

Very true and that is a valid concern... Just wonder how else we could safely destroy opioids where no roaming fingers could help themselves!!

Valid concern as well -- but diversion happens in every setting, and drug abuse is rampant in healthcare unfortunately (not to mention diversion of drugs by families). I suppose there is the potential for more temptation in the transferring process, but I would think the coroner's dept would be as trustworthy as a hospital or home health agency/hospice -- they are also medical professionals and have standards they have to adhere to. I'm sure funeral homes also have regulations, but I have to admit, that is not as comfortable a choice to me.

[earle58]

although our p&p doesn't cite the method in which we are to dispose, it only states that 2 rn's are required.
over the yrs, we were wasting down the sink/toilet.
but now, contamination is a concern.
now, we're disposing everything in our sharps containers.
we discard solutions in there (not the vials/bottles, only solution);
crush pills then discard into sharps;
and cut up patches into little pieces then discard.

most everyone seems to be satisfied with this method.

leslie

[marachne]

Any idea how things are being disposed of after they go into the sharps containers? And pouring liquid in there doesn't get messy? I know one thing that always bothered me was when we'd get a new bag/syringe/cassette of opioid hung right before someone died and then we'd have to waste 30 ml/50 ml of perfectly good drug. Especially when it was something expensive. Just felt like such a waste...but then we have an incredible amount of waste in medicine in general

[earle58]

yes, it gets quite messy.
the housekeeper is the one who disposes of the contents, power-washes and returns.
his office is filled w/all sorts of osha doodads/containers...

once upon a time, a don saved all narcs in her office.
that and she lasted less than 6 months...

leslie

eta: hmmm...i think he washes it.
ha.
maybe they're just new containers.
not sure...

[Hopefull2009]

Here is another USEFUL option for old drugs:

Your local veterinarian.

Veterinarians used the same drugs as they do for people...just in different doses.

They can even use expired medications on a dog or those that have belonged to a human.

Vets will use these drugs to treat animals where someone doesn't have the money to pay, to help out animal shelters, etc. That way the vet can use the meds for free because even vet offices run out of money to keep donating meds.

Vets DO NOT re-dispense these meds to the public....they are only used for treatment while under controlled care.

That is what my father always did with meds that expired in his office. He had a trusted nurse that "witnessed" the disposal...which was to a vets office down the street.

He thought it was a crying shame to throw drugs away that could have a useful purpose...plus him and the the nurse were huge animal lovers.

Is it totally Kosher? Nope....but in all of his years of practice until his retirement, no one ever said anything.

[marachne]

Originally Posted by earle58

yes, it gets quite messy.
the housekeeper is the one who disposes of the contents, power-washes and returns.
his office is filled w/all sorts of osha doodads/containers...

once upon a time, a don saved all narcs in her office.
that and she lasted less than 6 months...

leslie

eta: hmmm...i think he washes it.
ha.
maybe they're just new containers.
not sure...

But it still gets to the same question: how does the housekeeper then dispose of it? Is it still going down a drain somewhere? Hopefull, thanks for that thought. It's also possible to think the opposite way -- I will ask my vet for a human prescription sometimes b/c it's often cheaper (or even better when you can use an OTC medication -- like the famotidine I give my cat...) I remember when I worked for an adult foster home for people with HIV/AIDS. On those occasions where people did die and we'd have all these expensive retrovirals that we couldn't find a home for! Crazy making