Responsible Disposal of Prescription Drugs

The ever-increasing number of prescription drugs filled at U.S. retail pharmacies has surpassed 4 billion per year.[1] Although estimates vary, from 3 to 13 percent of drug prescriptions sold at retail pharmacies or dispensed in long-term-care homes go unused.[2]

Patients and their families end up with leftover medications for a variety of reasons: allergies or side effects related to the medication, stopping the drug after symptoms improve, a perceived lack of effectiveness of the medication, dosage changes or switches from one drug to another, drug expiration, or patient death.[3]

Regardless of the circumstances, the astounding number of prescription drugs that go unused highlights the importance of proper drug disposal.

Risks of keeping unused drugs

If you find it tempting to hang onto leftover medications, consider that the presence of unused drugs at home can put others at risk of taking the drugs accidentally. Each year, more than 70,000 emergency room visits result from unintentional drug poisoning among children.[4] Unused prescription drugs — particularly those used for pain relief, such as opioid pain relievers — also likely contribute to growing rates of prescription drug abuse among Americans, particularly teenagers.[5]

Additionally, all medications have expiration dates and degrade at varying rates. They should not be kept or used once they reach their expiration dates because afterward their composition may change and their potency may decrease.[6] For example, certain drugs used for life-threatening conditions, such as insulin for diabetes and nitroglycerin for angina (chest pain due to inadequate blood supply to the heart), have short shelf lives.

Drug take-back programs

The preferred way to properly dispose of expired or unused drugs is to transfer them into the hands of professionals through a community drug take-back program.[7] These programs collect and properly dispose of tons of unwanted or expired drugs. One such program, hosted periodically by the Drug Enforcement Administration (DEA), is called National Prescription Drug Take-Back Day.[8] On this day, collection sites are set up in communities nationwide to safely collect and dispose of prescription drugs and controlled substances.

Another option is to transfer these medications to DEA-authorized collection sites, which may be local retail pharmacies, hospital or clinic pharmacies, or law enforcement agencies.[9] Some authorized collection sites also may offer mail-back programs[10] or drop boxes.

When drug take-back or mail-back programs or DEA-authorized collectors are not available locally, federal guidelines recommend disposal of unused or expired drugs by household trash using the following steps:[11]

• Mix medications (do not crush tablets or capsules) with dirt, kitty litter or used coffee grounds to make it unlikely a pet or other animal will dig through the trash and eat the drug.
• Place the mixture in a sealed container such as a sealable plastic bag before throwing out.
• Be sure to mark out any personal information on the prescription label to make it unreadable.
• If a pill bottle is recyclable, remove the label and throw the bottle in the recycle bin.

Flushing: Recommended for only a few drugs

If a DEA-authorized collector or drug take-back program is not available, the Food and Drug Administration (FDA) recommends that a small number of medications can be disposed of by flushing down a toilet or sink as soon as they become no longer needed (see table).[12] These medications contain controlled substances and are especially harmful — or even fatal — to others if taken accidentally.[13] For example, the fentanyl patch (DURAGESIC, IONSYS), an adhesive patch that delivers a potent pain drug through the skin, can cause severe breathing problems and lead to death.[14]

According to the FDA, the risk associated with accidental exposure to these drugs outweighs any potential risk to the environment associated with disposal by flushing, because flushing completely eliminates the risk of harm to people in the home.[15]

Prescription Drugs Recommended for Disposal by Flushing[16]

Check the Food and Drug Administration website for updates to this list in the future. All listed medications are available in oral form (including tablets, capsules, liquid and sublingual) except where noted.
*Limited Use
**Do Not Use

What You Can Do

Check your drug label for instructions on disposing of unused medication. Additional instructions can be found on DailyMed, a website maintained by the National Library of Medicine. Search the drug name, then look under the “patients and caregivers” or “safety and handling”sections for instructions on drug disposal.

It is best to dispose of unused medications through your local drug take-back programs. Visit the DEA’s website at bit.do/drugdisposal for more information and to locate an authorized collector[17] in your area. You can call the DEA Office of Diversion Control’s Registration Call Center at 800-882-9539 to find an authorized collector in your community. You also can check with your local law enforcement agencies and your city or county government to find out if they sponsor drug take-back programs.

References

[1] IMS Health Incorporated. Total Number of Retail Prescription Drugs Filled at Pharmacies. 2015. http://kff.org/other/state-indicator/total-retail-rx-drugs/. Accessed February 12, 2016.

[2] Siler S, Duda S, Brown R, et al. Safe Disposal of Unused Controlled Substances: Current Challenges and Opportunities for Reform. Washington DC; 2008.

[3] Seehusen DA, Edwards J. Patient practices and beliefs concerning disposal of medications. Journal of the American Board of Family Medicine. 2006;19(6):542-547.

[4] Budnitz DS, Salis S. Preventing medication overdoses in young children: An opportunity for harm elimination. Pediatrics. 2011;127(6):e1597-e1599.

[5] Siler S, Duda S, Brown R, et al. Safe Disposal of Unused Controlled Substances: Current Challenges and Opportunities for Reform. Washington, DC; 2008.

[6] Food and Drug Administration. Don’t Be Tempted to Use Expired Medicines. http://www.fda.gov/Drugs/ResourcesForYou/SpecialFeatures/ucm481139.htm. Accessed February 12, 2016.

[7] Ibid.

[8] Drug Enforcement Administration. News Releases. http://www.deadiversion.usdoj.gov/drug_disposal/takeback/newsrelease.htm. Accessed February 15, 2016.

[9] Food and Drug Administration. How to Dispose of Unused Medicines. June 2015. http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm101653.htm. Accessed February 12, 2016.

[10] Glassmeyer ST, Hinchey EK, Boehme SE, et al. Disposal practices for unwanted residential medications in the United States. Environment International. 2009;35(3):566-572.

[11] Food and Drug Administration. Disposal of Unused Medicines: What You Should Know. December 2015. http://www.fda.gov/Drugs/ResourcesForYou/Consumers/BuyingUsingMedicineSafely/EnsuringSafeUseofMedicine/SafeDisposalofMedicines/ucm186187.htm. Accessed February 12, 2016.

[12] Ibid.

[13] Ibid.

[14] Food and Drug Administration. Fentanyl Patch Can Be Deadly to Children. September 2015. http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm300803.htm. Accessed February 15, 2016.

[15] Ibid.

[16] Food and Drug Administration. Disposal of Unused Medicines: What You Should Know. December 2015. http://www.fda.gov/Drugs/ResourcesForYou/Consumers/BuyingUsingMedicineSafely/EnsuringSafeUseofMedicine/SafeDisposalofMedicines/ucm186187.htm. Accessed February 12, 2016.

[17] Office of Diversion Control. https://www.deadiversion.usdoj.gov/pubdispsearch/spring/main?execution=e1s1. Accessed February 15, 2016.