There are no uniform protocols in the United States for safe, environmentally acceptable disposal of controlled substances by patients. In addition, there are conflicting protocols used by various institutions for the disposal of narcotic medications. Although the US Drug Enforcement Administration oversees the prescribing, acquisition, and distribution of controlled substances and works to prevent the illegal diversion of these products, it stops short of recommending specific mechanisms for consumers to dispose of unused medications. The lack of specific regulations in this area increases the risk of illegal diversion of prescription medications and other controlled substances. The authors review and examine the dilemma posed by an ill-defined set of guidelines for disposal of controlled substances by patients and institutions not registered with the US Drug Enforcement Administration. The authors encourage public officials to update and reform ambiguous policies regarding opioid disposal by consumers and allied healthcare workers.