DEA regulates these entities to limit  diversion and prevent abuse. The Disposal Act stipulates that the  regulations cannot require an entity to participate in or establish any of  the disposal options. Requirements for Authorized Collectors of Unused Prescription Drugs

To participate as authorized collectors of unused prescription drugs,  eligible entities—retail pharmacies, hospitals/clinics with an on-site  pharmacy, narcotic treatment programs, reverse distributors, distributors,  and drug manufacturers that are already authorized by DEA to handle  controlled substances—must modify their DEA registration. According to  DEA officials, such modification is free and simple to do. About 3 Percent of Eligible Pharmacies and Other Entities Voluntarily Participate as DEA-Authorized Collectors of Unused Prescription Drugs

About 3 percent of pharmacies and other eligible entities have voluntarily  chosen to become DEA-authorized collectors of unused prescription  drugs, according to DEA data. As of April 2017, 2,233 of the 89,550 (2.49  percent) of eligible entities—which are already authorized by DEA to  handle controlled substances—had registered to use disposal bins to  collect unused prescription drugs. Most of the authorized collectors— about 81 percent—were pharmacies, followed by hospitals or clinics. We also found that participation rates varied by state, though in most  states relatively few of the eligible entities had registered with DEA to  become authorized collectors of unused prescription drugs. In 44 states,  less than 5 percent of the eligible entities had registered. Stakeholders Cited Cost and Other Factors as Affecting Decision to Become DEA-Authorized Collectors of Unused Prescription Drugs

According to officials from the 11 stakeholder organizations we  interviewed—which represent authorized collectors and long-term care  facilities—several factors may explain why relatively few pharmacies and  other eligible entities have chosen to become authorized collectors of  unused prescription drugs. We found that as of  April 2017, over a quarter of the 2,233 authorized collectors using  disposal bins received external funding to pay for the costs associated  with installing and maintaining the disposal bins. In 2015, we recommended  that DEA identify and implement cost-effective means for communicating  regularly with pharmacies and other entities authorized to handle  controlled substances. Furthermore, pharmacy stakeholders noted that because of the  availability of other prescription drug collection efforts in their  communities, they did not think that maintaining a disposal bin at their  locations was needed. The officials also indicated that the  availability of disposal options at law enforcement agencies contributes to  the low participation rates among pharmacies as authorized collectors of  unused prescription drugs. DEA, part of the Department of Justice, provided technical  comments, which we incorporated as appropriate.
Why GAO Did This Study

In 2015, 3.8 million Americans reported misusing prescription drugs within the last month, and deaths from prescription opioids have more than quadrupled since 1999. About half of the people who reported misusing prescription drugs in 2015 received them from a friend or relative.
One way to help prevent this kind of diversion and potential misuse is by providing secure and convenient ways to dispose of unused, unneeded, or expired prescription medications. The Secure and Responsible Drug Disposal Act of 2010 authorizes pharmacies and other entities already authorized by DEA to handle controlled substances to also collect unused prescription drugs for disposal. In 2014, DEA finalized regulations for the implementation of the Act, establishing a voluntary process for eligible entities to become authorized collectors of unused prescription drugs using disposal bins.
GAO was asked to review participation among authorized collectors that maintain disposal bins. In this report GAO describes (1) participation rates among entities eligible to collect unused prescription drugs and (2) factors that affect participation. GAO analyzed the most currently available DEA data from April 2017 on entities eligible to participate and those participating as authorized collectors. GAO also conducted interviews with DEA officials and a nongeneralizable sample of 11 stakeholder organizations selected to illustrate different types of authorized collectors and long-term care facilities. GAO is not making any recommendations. DEA provided technical comments, which GAO incorporated as appropriate.

What GAO Found

GAO found that about 3 percent of pharmacies and other entities eligible to collect unused prescription drugs for disposal have volunteered to do so. The Drug Enforcement Administration (DEA) authorizes these entities to dispose of unused drugs to help reduce their potential misuse. Analysis of DEA data shows that as of April 2017, 2,233 of the 89,550 (2.49 percent) eligible entities—that is, certain entities already authorized by DEA to handle controlled substances—had registered with DEA to use disposal bins to collect unused prescription drugs. Most—about 81 percent—of the authorized collectors were pharmacies, followed by hospitals or clinics. GAO also found that participation rates varied by state, though in 44 states less than 5 percent of the state's pharmacies and other eligible entities had registered to become authorized collectors.
Stakeholders cited several factors that may explain why relatively few pharmacies and other eligible entities have registered with DEA as authorized collectors of unused drugs. Most notably, stakeholders representing authorized collectors told GAO that because participation is voluntary, the cost associated with maintaining a disposal bin—which includes purchasing and installing the bin according to DEA requirements and paying for the destruction of its contents—is an important factor to weigh against potential benefits. DEA noted that availability of disposal by law enforcement agencies also contributes to low participation.