How to Dispose of Unused Opioids and Other High-Risk Drugs Safely

Unused, unneeded or expired drugs in homes present a number of risks, including intentional or accidental overdose in humans (particularly young children), as well as toxic effects in pets. This is particularly true for prescription drugs that are controlled substances, incuding opioids — powerful medications such as morphine (EMBEDA, KADIAN, MORPHABOND ER, MS CONTIN) that are used to manage severe pain when other drugs are ineffective or cannot be taken. These drugs can cause serious risks, including abuse, addiction, overdose and death due to extreme sedation and slowed breathing.

Importantly, a 2017 systematic review showed that up to 71% of oral opioid tablets dispensed to surgical patients after their hospital discharges were ultimately unused, mainly because of pain resolution or due to opioid-induced adverse effects.[1] The review also found low rates of disposal of these unused opioids. Another study showed that some patients tended to keep their leftover opioid medications “just in case” they are needed in the future or because they planned on disposing of them after the expiration date.[2] Others kept these opioids because they were either unsure how to dispose of them or they had no further plans for disposing of them.

Given the serious risks of these medications, it is critical to dispose of any unused doses as soon as there is no longer a medical need for them. Learn how to do so safely by following the recommendations of the Food and Drug Administration (FDA).

FDA recommendations

The FDA advises that consumers should ideally dispose of all prescription and over-the-counter medications, particularly opioids, and dietary supplements by taking them to a drug take-back location authorized by the Drug Enforcement Administration (DEA).[3] These locations are usually located in certain retail pharmacies, hospital or clinic pharmacies, or law enforcement agencies.[4] If a take-back location is not readily available, the agency recommends that certain opioids and other drugs be flushed down the toilet (see Table below for a list of all of these drugs). The FDA-approved labeling and medication guides for these drugs also include these flushing instructions.

FDA scientists have found only negligible environmental (including surface and drinking water supplies) and human health risks associated with flushing these select medications.[5] Therefore, the agency determined that the known risk of harm to humans from accidental, and sometimes fatal, exposure to the drugs on this flush list far outweighs any potential public health risk to humans from flushing these unneeded drugs.

Like almost all other oral medications, if no take-back location is readily available and the oral drug is not on the FDA flush list, the agency recommends that consumers mix the drug with an unappealing substance (such as dirt or coffee grounds), place it in a sealed plastic bag and throw the bag in the trash.[6]

Prescription Drugs Recommended by Food and Drug Administration (FDA) for Disposal by Flushing†[7]

†Discontinued drugs were excluded. This list was last updated in April 2018. Check the FDA website for updates. All listed drugs are in oral or sublingual forms (including buccal film, capsules, solutions or tablets) except where noted.
‡Combination drugs that include other active ingredients
*Designated as Do Not Use
**Designated as Limited Use

What You Can Do

Dispose of any unused drugs, particularly opioids, in your home following the instructions on the labeling. If such instructions are unavailable, take the drug to a drug take-back location near you. Visit the DEA Diversion Control Division website or call 800-882-9539 to find a local location. If no local location is available and the drug is on the FDA flush list, flush it down your toilet or drain to remove the risks of these medications from your home. This is especially important to help limit the devastating opioid crisis affecting many American families.
 

References

[1] Bicket MC, Long JJ, Pronovost PJ, et al. Prescription opioid analgesics commonly unused after surgery: a systematic review. JAMA Surg. 2017;152(11):1066-1071.

[2] Neill LA, Kim HS, Cameron KA, et al. Who is keeping their unused opioids and why? Pain Med. 2019;March 21:1-8.

[3] Food and Drug Administration. Drug disposal: Flush potentially dangerous medicine. April 2018. https://www.fda.gov/drugs/disposal-unused-medicines-what-you-should-know/drug-disposal-flush-potentially-dangerous-medicine#FlushList. Accessed August 8, 2019.

[4] Food and Drug Administration. Drug disposal: Drug take back locations. December 18, 2018. https://www.fda.gov/drugs/disposal-unused-medicines-what-you-should-know/drug-disposal-drug-take-back-locations. Accessed August 8, 2019.

[5] Khan U, Bloom RA, Nicell JA, Laurenson JP. Risks associated with the environmental release of pharmaceuticals on the U.S. Food and Drug Administration "flush list." Sci Total Environ. 2017;609:1023-1040.

[6] Food and Drug Administration. Drug disposal: Dispose "non-flush list" medicine in trash. December 20, 2018. https://www.fda.gov/drugs/disposal-unused-medicines-what-you-should-know/drug-disposal-dispose-non-flush-list-medicine-trash. Accessed August 8, 2019.

[7] Food and Drug Administration. List of medicines recommended for disposal by flushing. April 2018. https://www.fda.gov/media/109643/download. Accessed August 8, 2019.