DOH Issues Controlled Substance Storage and Disposal Guidance

The Department of Health's (DOH) Bureau of Narcotics Enforcement (BNE) issued guidance on April 5, 2024 for nursing homes with Class 3A Institutional Dispenser Limited Licenses regarding storage and disposal of controlled substances. Members are encouraged to read the new guidance in its entirety. The following are some key elements related to disposition of controlled substances:

• When a resident is discharged, all prescribed controlled substances must be turned over to the resident, unless they are discontinued by the prescriber. The facility may not legally possess the controlled substance after the resident is discharged.
• Upon a resident's death while residing in the facility, the licensee may retain possession of the prescribed medications for purposes of proper disposal.
• Facilities should take steps to reduce the amount of controlled substances coming into their premises, in order to reduce diversion. They should work with medical directors and pharmacy consultants to make appropriate decisions about controlled substance prescriptions, including whether they should be partially filled or whether prescriptions may be issued for a shorter time period.
• Collection receptacles may be maintained in nursing homes by hospital and retail pharmacies. Controlled and non-controlled substances may be co-mingled in these receptacles. However, the facility may only dispose of controlled substances that were lawfully prescribed to a resident. Licensed 3A facilities may not transport controlled substances or a filled drop box liner outside of the facility.
• Facilities may participate in the Drug Take Back program. More information about the program is available here.

The guidance includes specific instructions regarding storage of methadone. The following are some highlights:

• The facility should have separate BNE-approved storage for methadone used for treatment of substance use disorders (SUDs) and methadone used for pain management. These storage units must be kept separate from all other end-user controlled substances under the 3A license. This is to limit the number of staff who require access to each supply of methadone and reduce the potential for diversion.
• When a resident with a controlled substance prescription leaves the facility, all medications must be given to the resident, unless they are discontinued by the prescriber. This also includes methadone, whether it is prescribed for pain management or dispensed by a narcotic treatment program (NTP) for SUDs.
• If a resident refuses to take their dispensed methadone with them or leaves their methadone at the facility when they are discharged:
  • The facility should ask the NTP to collect the methadone, pursuant to a memorandum of understanding between the NTP and the facility.
  • If the NTP cannot or will not retrieve the methadone, the facility must contact local law enforcement to collect the methadone, since it is now considered contraband.
  • If local law enforcement will not collect the methadone, the facility may submit a request to BNE for destruction. The process for requesting destruction is set forth in the guidance.

Unfortunately, BNE does not distribute its guidance documents via email to licensees, nor does it post its guidance to the Health Commerce System (HCS). BNE guidance documents are available on the BNE pages of the DOH website here.

Contact: Karen Lipson, klipson@leadingageny.org