Proper Medication Disposal

Question:

What is the proper method by which to dispose of unused or expired medications?

Response from Darrell Hulisz, PharmD
Associate Professor of Family Medicine, Case Western Reserve University, School of Medicine, University Hospitals, Case Medical Center, Cleveland, Ohio

Patients often have medicine cabinets that are filled with unused and expired medications. Prescription drugs that accumulate at home may lead to sharing or theft of medications. The extent of unused prescription medications in US households and the reasons for nonuse have not been defined; however, one observational study estimated that about 2 out of 3 prescription medications were reportedly unused by patients.[1]

Questions arise about how to properly dispose of medications that are discontinued by a prescriber or are no longer used (eg, cured disease, patient death). The US Food and Drug Administration (FDA) has published guidelines for the proper disposal of unused medicine.[2-4] The guidelines are intended to decrease accidental exposure to harmful medications or unintentional misuse of unneeded medications.

The current guidelines encourage reading the patient information that is dispensed with prescriptions to determine any specific disposal instructions. The preferred way to safely dispose of unwanted medicines is through medication “take-back” days that allow the public to bring medications to be discarded to a specific location for disposal. The Drug Enforcement Administration (DEA) sponsors a National Prescription Drug Take-Back Day. Patients can visit the DEA’s website to learn of the next date.

Local law enforcement agencies or trash and recycling services also can provide advice about the local laws regarding medication disposal. Some retail and hospital pharmacies and police stations are DEA-authorized sites that offer drop boxes for unused medications. National organizations, such as the National Association of Drug Diversion Investigators, provide search engines and a growing list of drop box locations.

If there are no nearby medication take-back sites, the FDA recommends ways to properly dispose of medication in household trash. Generally, noncontrolled substances are to be dispersed into something that is undesirable, such as coffee grounds, dirt, or cat litter, to deter anyone from picking the medications out of the trash. Medications should not be crushed or altered before mixing. Medications should be sealed in a bag or container and placed alongside household trash.

In general, only controlled substances, such as opiates, benzodiazepines, and amphetamine derivatives, are recommended to be flushed down the toilet or sink. Although the FDA recognizes the risk for contamination of public water supplies by flushed medications, the agency considers the risk associated with minor water contamination to be less than the risk for drug diversion from household trash.[5,6] Some unavoidable contamination of water supplies also may result from drug residues entering water systems via the passage of drugs and/or metabolites in urine and feces.[7,8]

Patients should be instructed to scratch out personal information on prescription vials to protect personal health information.

Remind patients that leftover medications at the end of treatment should not be shared with family members or friends, or sold.

In general, it is not advisable for healthcare professionals to accommodate any patient requests to take possession of discontinued or unwanted prescription medications. If a healthcare provider accepts unused, unwanted, expired, or discontinued prescription medication from a patient, the medication becomes the property of the provider, with the corresponding responsibility for proper medication disposal. Healthcare providers can provide a community service by determining the best option for drug disposal and helping to publicize drug “take-back” days.

Patients should be encouraged to follow the preceding FDA guidelines for drug disposal. They also can contact the pharmacy that originally filled the prescription for specific advice.

The author wishes to acknowledge Jessica Wetshtein for providing technical assistance.

Retreived from Medscape.com

References

Law AV, Sakharkar P, Zargarzadeh A, et al. Taking stock of medication wastage: unused medications in US households. Res Social Adm Pharm. 2015;11:571-578.

US Food and Drug Administration. How to dispose of unused medications. June 4, 2015. http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm101653.htm Accessed October 31, 2016.

US Food and Drug Administration. Disposal of unused medicines: what you should know. October 12, 2016. http://www.fda.gov/Drugs/ResourcesForYou/Consumers/BuyingUsingMedicineSafely/EnsuringSafeUseofMedicine/SafeDisposalofMedicines/ucm186187.htm Accessed October 31, 2016.

US Food and Drug Administration. Medication disposal: question and answers. March 3, 2016. http://www.fda.gov/Drugs/ResourcesForYou/Consumers/BuyingUsingMedicineSafely/EnsuringSafeUseofMedicine/SafeDisposalofMedicines/ucm186188.htm Accessed October 31, 2016.

Glassmeyer ST, Hinchey EK, Boehme SE, et al. Disposal practices for unwanted residential medications in the United States. Environ Int. 2009;35:566-572.

Yanovitzky I. The American medicine chest challenge: evaluation of a drug take-back and disposal campaign. J Stud Alcohol Drugs. 2016;77:549-555.

Daughton CG, Ruhoy IS. Green pharmacy and pharmecovigilance: prescribing and the planet. Expert Rev Clin Pharmacol. 2011;4:211-232.

Kolpin DW, Furlong ET, Meyer MT, et al. Pharmaceuticals, hormones, and other organic wastewater contaminants in U.S. streams, 1999-2000: a national reconnaissance. Environ Sci Technol. 2002;36:1202-1211.

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