Prescription drug misuse is a significant problem among Americans, particularly teenagers. Two thirds of teenagers who misuse prescription medications first obtain them from medicine cabinets. Americans fill an average of 4.3 billion prescriptions per year, but over 40% of these prescription medications are never used. This means unused medications are either stored indefinitely in medicine cabinets where they can be accidentally ingested or intentionally abused, or they are discarded in the trash, which carries the same risks of misuse plus environmental considerations. To reduce these risks, consumers and caregivers should discard unused medications as soon as possible following the most recent guidelines.
Flushing is one method of disposal that is not longer recommended for most drugs. Drugs that are poured down the sink or flushed may pass through wastewater treatment plants, ending up in rivers and lakes and eventually community water supplies. In houses with septic tanks, drugs can leak into the ground and into groundwater, and medications that are thrown out or flushed may harm wildlife. However, some drugs should be flushed due to their potential harm if misused or accidentally ingested. For example, fentanyl patches should be flushed immediately due to their increased risk for children. The FDA has a complete list of drugs that should be flushed online.
Medications that should not be flushed are often identified on the packaging. For example, some opioid patches, such as Butrans™, contain a caution statement against flushing. These medications come with packaging that encloses the used patch for disposal into household trash. Testosterone patches can also be thrown away. However, disposing of medications in the trash is not a preferred method and should only be used as a last resort. If trash is the only option, drugs should be removed from their original containers and mixed with cat litter, coffee grounds, or another undesirable substance, then placed in a sealed bag or container and thrown away.
The easiest way to ensure that unused drugs are disposed of safely is to utilize a take-back program. In the past 10 years, state and federal agencies have led efforts to educate the public on proper disposal of medications through take-back programs and drop boxes. The DEA hosts its National Drug Take Back Days twice per year, in the spring and fall. Each drug take-back event collects around half a million pounds of unwanted, unused, or expired medications. This is a free and anonymous collection event available to anyone who has access to a drop off location. Collection sites will take back prescriptions, over-the-counter medications, pet medications, medicated lotions and ointments, and pills in any packaging. Find the nearest drop off location online.
The state of Tennessee participates in National Drug Take Back Day in partnership with its statewide program called Count It! Lock It! Drop It! ™ (CLD). CLD is a community initiative that encourages people to count their pills once every two week to help identify and deter theft and ensure patients are taking their medications appropriately (Count It!). The next step is to lock up medications or secure them in an inconspicuous place (Lock It!). The last step in the initiative is to drop off unused or expired medication where they will be properly disposed of (Drop It!). The CLD program is available in 33 counties in Tennessee and growing.
Residents of rural areas may have difficulty finding collection sites or take-back events nearby. This is one of the factors that led to the Secure and Responsible Drug Disposal Act in 2010. Before this act was established, controlled substances, such as narcotics, stimulants and depressants, could only be collected by law enforcement officials. The Secure and Responsible Drug Disposal Act allows for public and private entities to develop methods of collection and disposal of controlled substances. Now that pharmacies and clinics have the option to be a drop off site for drug collection, the number and convenience of collection sites has increased. However, not all pharmacies and clinics have opted to be drop off sites, and some pharmacies require medications for disposal to be mailed in using purchased envelopes. This can be a hinderance for people who do not want or are unable to pay for this service.
There are also limitations to what can be collected at pharmacies, clinics, and National Take Back Day drop off sites. Asthma inhalers, sharps, needles, IV bags, bloody or infectious waste, blood sugar equipment, and illicit drugs are among the items that cannot be placed in the drop boxes.
Used sharps must be stored in FDA-approved containers. These can be purchased at pharmacies, through healthcare providers or online. Thick plastic household containers may also be used to hold sharps until they can be properly disposed of. Loose sharps should never be thrown away in the trash. Doing so endangers workers who may come into contact with them. Dangers of loose sharps include infections like Hepatitis B, Hepatitis C, and HIV. Find mail-in programs for sharps disposal as well as access to free containers online. The EPA also lists several options for proper sharps disposal.
Once medications are collected, they must be stored or transferred until rendered non-retrievable. This means the drugs cannot be resold, donated, repackaged, or re-dispensed. The most common method for rendering drugs as non-retrievable is incineration.
Properly disposing of unused prescription medications helps prevent misuse, abuse, and accidental ingestion by children and pets. The National Take Back Day website, your state government, or your local pharmacy can help identify a drop off location near you.