I had an interesting conversation the other day with a home health care and hospice nurse regarding medication disposal after death. I asked her, "What happens to all the medications when the patient dies?" When a patient on hospice dies, they may be on large doses of opiates such as morphine, Roxanol, Fentanyl , Oxycontin, Oxycodone, Dilaudid, and Demerol. They may also be taking sedatives such as Ativan or Valium.
These drugs are highly restricted by the FDA. I have heard that some doctors, specifically anesthesiologists, and nurses have a higher rate of drug and alcohol addiction due to their easier access to these controlled substances. If you are a nurse with a drug problem, I think being a home health care and hospice nurse would be the greatest job in the world.
What other job would give you access to the most powerful controlled substances in the world and nobody would ever know if a dose here or there was missing? That begs the question to be asked. What happens to all those narcotics and sedatives when the patient dies? What happens to the 500 mg of morphine and 30 mg of Ativan sitting around the home of the newly deceased?
Where does all the medication go when someone dies? And what is the appropriate medication disposal plan for the deceased. This home health care and hospice nurse told me a shocker.
"I flush it down the toilet"
Wow. I had no idea the regulations for disposal of prescription medications included flushing them into the city water system. I suppose the drug addicted nurses could steal the medication for their own use or try and sell it on the street for profit. All the rest must flush the medication down the toilet as a routine policy.
What does the FDA say about medication disposal after death? The FDA says most medications can be disposed of in the trash by placing an unpalatable substance (such as coffee grounds) with it and sealing it in a container. The FDA recommends most medications not be flushed down the toilet or sink. But they do recommend some medication be flushed because of the harm that could come by children or animals that could get into them. Interestingly, the list of unused medications that should be flushed down the toilet or sink includes mostly narcotics/opiates.
I guess my shock at flushing meds down the toilet was unfounded. If your medication is not on the list it should be disposed of in the trash as stated above or you can contact your refuse service or your local pharmacy to see if they have any take back programs to incinerate the medications.
A few years ago some firemen in Happy's neck of the woods were convicted of stealing pain medications from little old grandmas while responding to distress calls. Which begs the question: What happens if the death is unexpected and the police and rescue teams are first on site? What happens to all the seizure, diabetes, blood pressure, and pain medications? Are the cops or rescue personnel required to confiscate all medications in the home for investigative purposes? Are they required to return them? And if so, is there a system to monitor missing doses in the police station?
If an autopsy is required, what is the standard protocol for chain of command for documenting the disposal of all the deceased person's medications, including powerful sedatives and opiates? I've read stuff in the past about measurable traces of seizure, blood pressure and diabetes prescription medications showing up in city drinking water systems from natural urine and feces excretionand from medication dumping. Apparently, the filtration process that clears community water systems of bacteria and minerals does not have the ability to clear out the medication molecules.
There you have it folks, straight from the mouth of a home health care and hospice nurse in the know. Your meds get flushed. I suspect they all do as a matter of policy as I doubt they carry a bag of coffee grounds around with them every day while waiting for their patients to die.