Drug Disposal – to Flush or Not to Flush?




Toilet in home

Richard Asher, considered one of the preeminent medical thinkers of the 20th century, said, “If you give a man a pill there are only two things he can do with it: he can swallow it or he can throw it away.” As the production and use of medications increases worldwide, it has become clear that a solution to the problem of consumer drug disposal is essential. In the past, many consumers have been told to flush unused or expired medications; however, concerns regarding accumulation of active pharmaceutical ingredients (APIs) in the water supply and the unknown environmental impact have increased the awareness for proper disposal methods. Furthermore, imprudent disposal may increase the risk of accidental poisoning and drug misuse.

This problem of unwanted drug disposal has created quite a dilemma for patients who need an acceptable and safe alternative to flushing unused medications. According to the National Community Pharmacists Association (NCPA), “Consumer surveys demonstrate that local pharmacies are the most convenient locations where consumers seek to return unused for expired medicines.”

The United States Food and Drug Administration (FDA) has established guidelines for the disposal of unused medicines. They recommend that take-back programs for disposal are the best and primary way consumers should use when discarding expired, unwanted, or unused medicines. When no take-back program is locally available to the consumer, the FDA provides specific guidelines for disposal of medicines in household trash, which include mixing the medication with a substance such as cat litter or used coffee grounds, placing the mixture in a container or sealed plastic bag, and disposing the container in the household trash.

The FDA has published a list outlining specific medications that, due to their especially harmful effects when used by someone other than the patient for whom the medication was prescribed, should be disposed of by flushing when they can not be disposed of via a take-back program. This again poses the concerns over risk of such substances to human health and the environment. The FDA states that, “The majority of medicines found in the water system are a result of the body’s natural routes of drug elimination (in urine or feces). Scientists, to date, have found no evidence of harmful effects to human health from medicines in the environment.” The FDA contends that the few medications disposed of by flushing contribute a small fraction to the overall total amount of drugs found in the water supply and propose that the health and environment risk associated with this method of disposal is exceeded by the possible life-threatening risks from accidental ingestion of these medications.

Apparently drug take-back efforts are having a positive effect and serving as a useful method of unwanted drug collection. The latest national drug take-back day was organized by the Drug Enforcement Administration (DEA) and held on April 30, 2011. According to the DEA, the collection at over 5300 sites brought in 188 tons of unused prescription medicine from the public. The drugs collected by authorities were incinerated.

References

Controlled substance disposal a natural for community pharmacies. Drug Topics E-News, 2011.

Disposal of unused medicines: what you should know. FDA, 2011.

Daughton CG. Drugs and the environment: stewardship & sustainability. National Exposure Research Laboratory, Environmental Sciences Division, US EPA, Las Vegas, Nevada, report NERL-LV-ESD 10/081, EPA/600/R-10/106. 2010 Sept 12.
 

Taylor R. Towards better prescribing. Journal of the Royal College of General Practicioners. 1978 May;28:263-270.

Frolund, F. (1978). Better prescribing. BMJ, 2 (6139), 741-741 DOI: 10.1136/bmj.2.6139.741

  • Daniel Keaton

    You make some very good points on drug disposal. Take backs are not always possible, especially with Hospice nurses who are required to dispose of medicine when a patient passes.

  • Barbara Stott

    I have a medication allergy, and live in an area where water is recycled. The resulting irritating skin rash has caused me a problem on more than one occasion that I attribute to amoxycillin being disposed of in the water. When water has to be recycled for tap water this issue becomes particularly important.

    My medication allergy is only irritating, but a more serious allergy to medcines disposed of in this way could kill someone.

    One man’s medcine is another man’s lethal poison.

    Never flush medcine down the toilet; but please hammer the point home particularly in desert areas where the water is or could be recycled!

    Most people don’t think about where their waste goes. The pharmaceutical industry needs to think about it for them, and remind them repeatedly.

Angela M Sexton, PharmD

Angela M Sexton, PharmD, is a licensed pharmacist and freelance medical writer with experience in clinical pharmacy, retail pharmacy, and pharmacovigilance in both the United States and Europe. She is an honors graduate of The Samford University McWhorter School of Pharmacy with a Doctor of Pharmacy degree and also earned a bachelor’s degree in biology from the University of Alabama. Her professional interests include traditional pharmaceutical therapies, immunizations, and preventative health initiatives.
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