The U.S. Food and Drug Administration (FDA) and the White House Office of National Drug Control Policy developed
federal guidelines that are summarized here:
- Follow any specific disposal instructions on the prescription drug labeling or patient information that accompanies the medicine. Do not flush medicines down the sink or toilet unless this information specifically instructs you to do so.
- Take advantage of community drug take-back programs that allow the public to bring unused drugs to a central location for proper disposal. Call your city or county government's household trash and recycling service (see blue pages in phone book) to see if a take-back program is available in your community. The U.S. Drug Enforcement Administration, working with state and local law enforcement agencies, periodically sponsors National Prescription Drug Take-Back Days.
- If no disposal instructions are given on the prescription drug labeling and no take-back program is available in your area, throw the drugs in the household trash following these steps. 1. Remove them from their original containers and mix them with an undesirable substance, such as used coffee grounds or kitty litter (this makes the drug less appealing to children and pets, and unrecognizable to people who may intentionally go through the trash seeking drugs). 2. Place the mixture in a sealable bag, empty can, or other container to prevent the drug from leaking or breaking out of a garbage bag.
Ilisa Bernstein, Pharm.D., J.D., FDA's Deputy Director of the Office of Compliance, offers some additional tips:
- Before throwing out a medicine container, scratch out all identifying information on the prescription label to make it unreadable. This will help protect your identity and the privacy of your personal health information.
- Do not give your medicine to friends. Doctors prescribe medicines based on a person's specific symptoms and medical history. A medicine that works for you could be dangerous for someone else.
- When in doubt about proper disposal, talk to your pharmacist.
Bernstein says the same disposal methods for prescription drugs could apply to over-the-counter drugs as well.
The Product Stewardship Institute Inc. has released a How-to Guide for Drug Take Back: Managing a Pharmacy-Based Collection Program for Leftover Household Pharmaceuticals. Find the Guide here.
- This guide offers best practices for running a drug take-back program, regulatory instructions for controlled substances, collection systems, cost and funding information as well as strategies from promotion.
- This guide is designed to help pharmacists and pharmacy managers, local and government officials and leaders, healthcare providers, drug abuse and prevention programs, waste managers, environmental advocates and those in rural communities.
Why the Precautions?
Prescription drugs such as powerful narcotic pain relievers and other controlled substances carry instructions for flushing to reduce the danger of unintentional use or overdose and illegal abuse.
For example, the fentanyl patch, an adhesive patch that delivers a potent pain medicine through the skin, comes with instructions to flush used or leftover patches. Too much fentanyl can cause severe breathing problems and lead to death in babies, children, pets, and even adults, especially those who have not been prescribed the medicine.
"Even after a patch is used, a lot of the medicine remains in the patch," says Jim Hunter, R.Ph., M.P.H., a pharmacist reviewer on FDA's Controlled Substance Staff, "so you wouldn't want to throw something in the trash that contains a powerful and potentially dangerous narcotic that could harm others."
Environmental Concerns
Some people are questioning the practice of flushing certain medicines because of concerns about trace levels of drug residues found in surface water, such as rivers and lakes, and in some community drinking water supplies. "The main way drug residues enter water systems is by people taking medicines and then naturally passing them through their bodies," says Raanan Bloom, Ph.D., an environmental assessment expert in FDA's Center for Drug Evaluation and Research. Bloom goes on to say "many drugs are not completely absorbed or metabolized by the body and can enter the environment after passing through waste water treatment plants."
With this increasing skepticism, federal agencies have embarked to collaboratively review the matter. They’re researching the occurrence of pharmaceuticals in the environment and any effects related to their occurrence. In 2013, the U.S. Environmental Protection Agency (EPA/OW), the U.S. Department of Agriculture (USDA/ARS), the U.S. Department of Health and Human Services (HHS/FDA) and the U.S. Department of Interior (DOI/USGS), established a Memorandum of Understanding (MOU) to enhance the coordination and collaboration among the agencies. This has resulted in more recent EPA and USGS findings suggesting that certain drugs may cause ecological harm. Of particular interest because are antibiotics and medications that interfere with the functioning and development of hormones or endocrine disruptors and their impacts on fish and amphibians.
As states await findings from the federal research, residents are encourage to take unused medications to collection sites for incineration, which destroys chemicals, preventing the discharge of additional pharmaceuticals to our water. For a complete list of medications that the FDA recommends be flushed for disposal due the risks associated with unintentional poisoning, please see the FDA's webpage on Disposal of Unused Medicines.
Disposal of Inhaler Products
Another environmental concern lies with inhalers used by people who have asthma or other breathing problems, such as chronic obstructive pulmonary disease. Traditionally, many inhalers have contained chlorofluorocarbons (CFCs), a propellant that damages the protective ozone layer. However, CFCs have been phased out of inhalers and are being replaced with more environmentally friendly inhalers by the end of 2013.
Read handling instructions on the labeling of inhalers and aerosol products because they could be dangerous if punctured or thrown into a fire or incinerator. To ensure safe disposal that complies with local regulations and laws, contact your local trash and recycling facility.
This article appears on FDA's Consumer Updates page, which features the latest on all FDA-regulated products.
Source: U.S. Food and Drug Administration, How to Dispose of Unused Medications, www.FDA.gov/forconsumers/consumerupdates/ucm101653.htm, updated June 4, 2015; Michigan Department of Environmental Quality