How Should Controlled Drugs Be Disposed of by Patients & Caregivers?

Reported on The Straits Times on 2 Apr 2023

Caregivers of elderly patients who opt for home-based palliative care may be left with Class A medications such as fentanyl and morphine after the patient dies. After her mother died in January, freelance fundraiser Pam Hong had 15 bottles of liquid morphine left. "We were prescribed with enough (morphine) until the next consultation visit, which is often six months later. Because it is used to manage pain, we wanted to make sure we never run out. Otherwise it would mean stress and rushing to get a refill. So we took what was offered," she said.

National University Hospital (NUH) pharmacists told her in March that they can't accept medication that has already been dispensed, even though the bottles were sealed. "I was told I could just throw them away 'like garbage.' But this is a controlled drug," Ms. Hong said. Since leaving Singapore, she locked the medicines in her late parents' home.

Rising Trend

With an increasing number of elderly preferring palliative care at home, and with Singapore moving to reduce the proportion of people dying in hospitals from 61 percent to 51 percent by 2027, this issue will be faced by many caregivers.

The Misuse of Drugs Act (MDA) classifies opioids used to treat pain as Class A drugs, and it is an offence to traffic, manufacture, import, export, possess, or consume them.

Will a Caregiver in Possession of Drugs Be Charged?

Criminal lawyer, Ms. Gloria James-Civetta from GJC Law said it is a worrying situation, "as one can ordinarily be tempted to use such controlled drugs readily, especially since we are living in an ageing population era and many caregivers, who are the adult children, are facing undue stress and management of the elderly". But if a caregiver were to be found in possession of such controlled permitted drugs, the reason for this needs to be established, she said. "It is highly unlikely for a charge under MDA (Misuse Drugs Act) to be preferred against the caregiver. But if a routine urine test turns positive, the caregiver is most likely to face a charge for consumption and possession."

How Should Drugs Be Disposed Of?

While "morphine as syrup concentration is not considered a controlled drug," senior principal clinical pharmacist Wong Yuet Peng from the Division of Oncology Pharmacy at NUH said that "We counsel patients on proper storage and disposal where relevant and whenever the opportunity arises, and family members can return the unused medication that cannot be disposed at home to our pharmacy counters."

The Ministry of Health (MOH) reassures patients who have been prescribed controlled drugs by a medical practitioner are legally allowed to possess these drugs. "While it is not unlawful for family members or caregivers to possess these drugs after the patient has passed on, they are advised to dispose of these drugs properly and promptly," its spokesman said. But the spokesman did not specify a timeframe.

Lee Yeng Ching at the Singapore General Hospital urged, "Patients and/or their next of kin can return them to any SGH pharmacy for safe and proper disposal." While head pharmacist Hooi Pik Yee at Alexandra Hospital said the drugs have to be returned to the pharmacy directly "as the staff have to remove all labels prior to disposal to ensure no PDPA (Personal Data Protection Act) breach."