Discarding unused drugs? Don’t crush and flush

(Excerpt from Drug Topics Magazine by Reid Paul)

Following guidelines issued by the American Pharmacists Association in February, the federal government has also issued guidelines on the disposal of medications, which recommend against flushing unused or expired drugs in a toilet or down the sink. Consumers, doctors, and pharmacies are now urged to dispose of most drugs in the garbage.

A growing body of evidence indicates that many drugs are ending up in drinking water. The U.S. Geological Survey, for example, found traces of 22 pharmaceuticals ranging from acetaminophen to fluoxetine to warfarin in Boulder Creek in Boulder, Colo. Other studies have found that estrogen in the water supply is causing sexual abnormalities in fish.

The new guidelines direct consumers to first ensure that the medication cannot be reused. Consumers should crush solid medications or dissolve them in water and then combine them with cat litter, coffee grounds, or other kitchen materials. The medication should then be placed in a sealed bag in the trash. The Food & Drug Administration has ruled that some medications can still be flushed.

APhA and government officials hope that better disposal solutions will be developed down the line. Among them are:

• Establishment of take-back programs in which drugs are taken back to a central location. Three states already have take-back programs. Controlled drugs can only be taken back to the police in most instances.

• Use of reverse distributors, now employed in some small countries. These firms facilitate the return of drugs to manufacturers for credit.

“We must think toward the future to address the prescribing practices that led to this waste,” concluded Stevan Gressitt, M.D., a Maine physician who’s been actively lobbying on the issue. “There’s not way we can solve this problem without the concept of pollution prevention.”

You can help patients properly dispose of prescription drugs by encouraging them to follow new Federal guidelines intended to help with drug diversion while also protecting the environment. New guidelines issued in February by the White House Office of National Drug Control Policy (ONDCP), HHS, and the Environmental Protection Agency (EPA) address the proper disposal of unused, unneeded, or expired prescription drugs and went into effect immediately.

Patients should be advised to:

• Take unused, unneeded, or expired prescription drugs out of their original containers.
• Mix the prescription drugs with an undesirable substance, like used coffee grounds or kitty litter, and put them in impermeable, nondescript containers, such as empty cans or sealable bags, further ensuring that the drugs are not diverted or accidentally ingested by children or pets.
• Throw these containers in the trash.
• Flush prescription drugs down the toilet only if the accompanying patient information specifically instructs it is safe to do so.
• Return unused, unneeded, or expired prescription drugs to pharmaceutical take-back locations that allow the public to bring unused drugs to a central location for safe disposal.

The FDA advises that the following drugs be flushed down the toilet instead of thrown in the trash:

• Actiq (fentanyl citrate)
• Daytrana Transdermal Patch (methylphenidate)
• Duragesic Transdermal System (fentanyl)
• OxyContin Tablets (oxycodone)
• Avinza Capsules (morphine sulfate)
• Baraclude Tablets (entecavir)
• Reyataz Capsules (atazanavir sulfate)
• Tequin Tablets (gatifloxacin)
• Zerit for Oral Solution (stavudine)
• Meperidine HCI Tablets Percocet (oxycodone and acetaminophen)
• Xyrem (sodium oxybate)
• Fentora (fentanyl buccal tablet)