Objective: To describe the amount and types of unused controlled substances (CS) at the time of death in home hospice and to describe methods used by hospice nurses to destroy CS after patients expire. Methods: Retrospective chart review of 105 home hospice patients with a narcotic waste destruction record who expired during a 3-month period in 2007 while receiving care from 4 small hospices (average daily census [ADC] <60) and 1 large (ADC = 160) hospice in the Southeastern Pennsylvania region. Data were collected through review of narcotic waste destruction records as recorded by nurses at the time of patient death. Strength of formulation was recorded sporadically. Hospice nurses were surveyed about CS disposal methods. Results: Mean age of the patients was 78, (range 44-103); majority (57%) was diagnosed with cancer, followed by heart failure (24%). Average length of stay in hospice was 42 days (median 21). Almost all patients had unused CS; morphine concentrate (20mg/ml) was the most common medication (average 31.8 ml./patient). Collectively, over 3 liters (64,680 mg) of morphine were destroyed. Lorazepam was the next most common drug with 990 tablets and 397 ml liquid wasted. Other CS remaining at the time of death included varying strengths of long-acting morphine (251 tablets); OxyContin (90 tablets); and unused transdermal fentanyl (57 patches). Hospice nurses disposed of all unused CS by flushing them down the toilet. Conclusion: Although not excessive on an individual level, the amount of CS waste in hospice is significant when viewed in the aggregate. When flushed, these medications reach water ways, potentially posing environmental or health hazards. Regulatory changes are required to address disposal of unused CS. Future analyses should examine the cost of CS medication waste in hospice.