Diversion Control Division, US Department of Justice, Drug Enforcement Administration

Narcotic Treatment Programs Best Practice Guideline



The following sections provide information to assist NTPs in differentiating between and responding to spillage and accountable losses of medication. Procedures for recording/reporting spillage and accountable losses and for destruction and disposal of medication are discussed.

Spillage and Accountable Loss

The procedures NTPs should follow when reporting/recording the destruction and disposal of individual doses of medication that are spilled differ from the procedures used when there are accountable losses of bulk inventory.

Spillage of Individual Patient Dose

When spillage of an individual patient dose occurs, the following should take place:

  • The employee who spilled the medication or who witnessed a patient spilling the medication should immediately report the incident to a supervisor.
  • After the spilling of medication has been reported to a supervisor, the medication should be properly disposed of.
  • Documentation of spillage should be completed, indicating the drug, its strength and amount, and the date of spillage and signed by both the employee involved and a supervisor.
  • Documentation of spillage should be maintained in a readily retrievable manner and reviewed periodically to determine if a pattern is developing.
  • Documentation of spillage does not need to be sent to the local DEA diversion field office, but should be available for inspection by DEA.
  • Any liquid or dust resulting from a spill or from the process of compounding diskettes should not be sent to DEA. Rather, these materials should be disposed of immediately in a manner that will prevent any further use of the medication, and should be witnessed by the employee involved and the supervisor.
  • This disposal should be documented by the NTP and be maintained in their records in a readily retrievable manner.

Accountable Losses

Controlled substance bulk inventory lost through breakage, damage, or spillage (other than an individual patient dose) should be considered an accountable loss. Disposal of such controlled substances must be in accordance with DEA requirements and must be reported on a DEA Form-41 (Registrants Inventory of Drugs Surrendered). [21 CFR 1307.21(a)].(See Appendix B).

General procedures for such disposal are reviewed in the section, "Disposal of Liquid or Solid Medication."

Disposal of Liquid or Solid Medication

NTPs that have medication requiring destruction should contact their local DEA diversion field office for authority and instructions related to the disposal of the substances. (Local DEA diversion field offices are listed in Appendix D).

Procedures related to destruction and disposal include the following:

  • Any medication, regardless of form, should be destroyed if contaminated or beyond expiration date.
  • An NTP using medication in solid form should gather and retain all recoverable chunks or chips of the medication.
  • Medication to be destroyed must be listed on the DEA Form-41. [21 CFR 1307.21(a)].
  • The Special-Agent-in-Charge (SAC) at the local DEA diversion field office has the discretion to authorize the destruction of medication by an NTP, in a manner determined by the SAC. [21 CFR 1307.21(b)].

If the local DEA diversion field office approves of the disposal, the office will instruct the NTP in the procedures to be followed. These may include the transfer of the medication to a registrant authorized to dispose of controlled substances, or by destruction in the presence of an individual from DEA or another authorized person.

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