By Douglas Throckmorton, MD, deputy director for Regulatory Programs, Center for Drug Evaluation and Research, FDA
Each year, Americans fill several billion prescriptions, including those for strong pain medications, but some of them go unused or expire before being consumed. The bottles may get pushed to the back of the medicine cabinet and forgotten until that space is needed for something else. So what should be done with them?
Most patients know not to share medications with others. They know that their medications are prescribed based on individual symptoms and specific medical history. What works for one person could be dangerous for someone else. Certain medications, especially strong painkillers, are especially harmful if taken by someone other than the person for whom they were prescribed. If a prescription medication falls into the wrong hands—a child's, for instance—serious consequences, like hospitalization and possibly death, can result. In fact, there have been reports of tragic outcomes for children who were inadvertently exposed to fentanyl patches or other opioids. Pets are also at risk. Hanging on to certain medications—especially those with addictive properties—also increases the risk of prescription drug abuse.
The good news is that there are several ways to responsibly dispose of unwanted, unused and expired prescription medications. One is by participating in drug take-back programs. Since 2010, the Drug Enforcement Administration's (DEA's) National Prescription Drug Take-Back Initiative has organized events to help us clean out our medicine cabinets by collecting unneeded prescription drugs. The drugs are collected at many sites throughout the country and then safely incinerated. The DEA's efforts have been paying off, as the volume of drugs collected has grown exponentially. During its first drug take-back event in October 2010, the agency collected 242,000 pounds of prescription drugs from 4,000 sites. In April 2016, nearly 900,000 pounds of drugs were collected from 5,400 sites. The most recent drug take-back day was April 29, 2017.
Drug take-back events only happen twice a year, usually in the spring and fall. At other times of the year, there are alternative ways to safely dispose of drugs. First, check the drug's labeling; there might be specific instructions for disposal. If not, the best choice for disposal depends on the drug itself. Many prescription drugs can be thrown safely into the trash, provided these simple safety measures are taken:
First, mix medicines with an unpalatable substance such as dirt, kitty litter or used coffee grounds. Do not crush tablets or capsules, however.
Then, place the mixture in a container, such as a sealed plastic bag, and throw the container in the trash.
To protect medical privacy, labels containing personal information should be removed or scratched out before the empty pill bottle or medicine packaging is tossed.
A small number of prescription medications should never be thrown in the trash, and are better off being flushed down the toilet or sink. Generally, the FDA does not recommend flushing medication—we don't want pharmaceuticals unnecessarily ending up in our water supply—but the potential risks in the home associated with certain drugs outweigh the environmental risks. For example, opioids like fentanyl, oxycodone and other strong painkillers should be flushed and not left in the medicine cabinet. The FDA describes here what medicines should be flushed to avoid risks to people and pets in the home: Safe Disposal of Medicines
We all have a responsibility to make sure drugs are disposed of properly when they expire or are no longer needed. The DEA has more information about the National Prescription Drug Take-Back Initiative. Local authorities can also help identify medication disposal options in your area during the rest of the year.