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

Unused, unneeded or expired drugs in homes present a number of risks, including intentional or accidental overdose in humans (particularly young children). This is particularly true for certain prescription drugs that are controlled substances, including most opioids — powerful medications such as fentanyl (ACTIQ, FENTORA) and oxycodone (OXAYDO, OXYCET, OXYCONTIN, PERCOCET, PERCODAN, ROXICET, ROXICODONE, XTAMPZA ER) that are used to manage severe pain when other analgesic drugs are ineffective or cannot be taken. These drugs have 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 opioid-induced adverse effects.[1] But the review also found low rates of disposal of these unused opioids. Another study published in 2020 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] Other patients kept these opioids because they were either unsure how to dispose of them or had no further plans for disposing of them.

The Food and Drug Administration (FDA) reported that data from U.S. poison control centers suggested that from 2015 to 2019, a variety of medications were implicated in the most common, and most severe, cases of accidental ingestion of household substances by children.[3]

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 FDA.

FDA recommendations

The FDA advises that the best way for consumers to dispose of most types of unused or expired prescription and over-the-counter medications is to drop them off at a drug take-back location authorized by the Drug Enforcement Administration (DEA).[4] These locations are usually located in certain retail pharmacies, hospital or clinic pharmacies, or law-enforcement agencies.

If a take-back location is not readily available, the agency recommends that certain opioids and other high-risk drugs be flushed down the toilet (see Table below for a list of all such drugs).[5] The FDA-approved labeling and medication guides for these drugs also include these flushing instructions.

The FDA acknowledges that its recommendation to flush certain medications down the toilet when a take-back program is not readily available raises concerns about the impact of medicines on the environment and potential contamination of surface- and drinking-water supplies.[6] However, agency scientists have found only negligible environmental (including surface- and drinking-water supplies) and human-health risks associated with flushing these select medications.[7] 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 when they are expired or no longer needed far outweighs any potential public health risk to humans from flushing these drugs.[8]

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.[9]

Prescription Drugs Recommended by FDA for Disposal by Flushing If Drug Take-Back Location Not Readily Available†

†This list was last updated in October 2020. Check the FDA website for updates. All listed brand-name drugs are in oral or sublingual forms (including buccal film, capsules, solutions or tablets) except where noted.
‡Combination brand-name drug that contains one or more other active ingredients
*Designated as Limited Use by Worst Pills, Best Pills News
**Designated as Do Not Use by Worst Pills, Best Pills News

What You Can Do

Dispose of any unused drug, particularly opioids, in your home following the instructions on its 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 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. 2020;21(1):84-91.

[3] Food and Drug Administration. FDA stresses critical importance of safe disposal of medications ahead of National Prescription Drug Take Back Day. April 22, 2021. https://www.fda.gov/news-events/fda-voices/fda-stresses-critical-importance-safe-disposal-medications-ahead-national-prescription-drug-take. Accessed October 16, 2022.

[4] Food and Drug Administration. Drug disposal: Drug take back locations. October 15, 2020. https://www.fda.gov/drugs/disposal-unused-medicines-what-you-should-know/drug-disposal-drug-take-back-locations. Accessed October 16, 2022.

[5] Food and Drug Administration. Drug disposal: FDA’s flush list for certain medicines. October 1, 2020. https://www.fda.gov/drugs/disposal-unused-medicines-what-you-should-know/drug-disposal-fdas-flush-list-certain-medicines#FlushList. Accessed October 16, 2022.

[6] Ibid.

[7] 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 Dec 31;609:1023-1040.

[8] Food and Drug Administration. Drug disposal: FDA’s flush list for certain medicines. October 1, 2020. https://www.fda.gov/drugs/disposal-unused-medicines-what-you-should-know/drug-disposal-fdas-flush-list-certain-medicines#FlushList. Accessed October 16, 2022.

[9] 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 October 16, 2022.