Drug Disposal Information
What should patients, care givers, and health care professionals do with unused drugs or with partially used units of drugs? Start by reviewing the Federal GuidelinesonProper Disposal of Prescription Drugs provided by the White House Office of Drug Policy. “Do not flush prescription drugs down the toilet or drain unless there is specific information to do so. For information on drugs that should be flushed, visit the FDA’s website .” Almost all medicines can be thrown away in the household trash after mixing them with some unpalatable substance such as coffee grounds or kitty litter and putting them in a sealable bag, empty can or container so the medication doesn’t leak out. The medications that the FDA recommends be disposed of by flushing are primarily opioid analgesics, the rationale being “that these medicines may be especially harmful and, in some cases, fatal in a single dose.” Disposing of these drugs down the sink or toilet, reduces the possibility that they will be accidentally used by children, pets or anyone else.
Federal agencies have slightly different policies on drug disposal; the US Fish and Wildlife Service cautions against flushing or pouring drugs down the drain; The Environmental Protection Agency stated that “it is important that the public understand that the toilet is not a trashcan for unused medications,” the DEA requires that controlled substances are flushed or delivered to law enforcement.
Take-back programs were motivated by concerns about drugs getting into water supplies, but are increasingly focused on keeping controlled substances out of the hands of persons who might abuse them. Take-back programs could involve your local pharmacy or police department. Georgia, Iowa, and most recently Oregon have implemented state-wide take-back programs. Bills to facilitate drug take-back have been introduced in the US Congress.
Transmucosal and transdermal delivery systems for fentanyl present unique disposal problems. Immediately upon removal from the skin, used transdermal systems should be folded so that the adhesive side of the system adheres to itself, then flushed down the toilet. If the gel from the drug reservoir accidentally contacts the skin, the area should be washed with clear water. Patients should dispose of any unused systems as soon as they are no longer needed. Unused systems should be removed from their pouch, folded and flushed down the toilet. Disposal of the oral transmucosal lozenge, ACTIQ, requires placing the handle under hot running water until the medicine is gone and then disposing of the handle so that is out of the reach of children and pets. Unused ACTIQ units should be disposed of one at a time: open the blister pack, cut the medicine end off so it falls into the toilet, and again throw the handle away. Flush the toilet twice after 5 ACTIQ units have been cut.
Many web sites are available to assist with disposal of unused medications; and we have a responsibility to provide guidance to patients and family members as they may be getting conflicting messages. It is critically important that patients and their caregivers understand how important it is to keep their medications secured in their homes, preferably in a lock box, so they can not be accessed and used with potentially fatal consequences by those for whom they were not prescribed. We must all work together to reduce diversion and abuse of opioid analgesics.