Sunday, September 8, 2013

Apple #651: Disposing of Prescription Drugs

How to dispose of expired prescription drugs came up in conversation not long ago -- don't ask me how; it just did.  I related a story about how I once tried to take an expired prescription back to the pharmacy.  It used to be they would dispose of old medications for me.  But on this most recent occasion, the pharmacist shook her head and said they didn't do that anymore.

She said, "Put the pills in an old bottle of laundry detergent, then throw out the whole bottle."

When I told my friends about this, they wondered if the laundry detergent makes the pills inactive [editor's note: it doesn't].  I said I didn't know; I hadn't tried it.  I never got rid of the old medication because I wasn't sure what's the best thing to do with it.  I know some people flush old pills down the toilet, but then you hear all those news stories about antibiotics and antidepressants showing up in our water supply, and fish and other water animals being affected by them, so I wasn't sure if flushing pills was the best thing to do either.

Everyone agreed that we needed the Apple Lady to look into this and find out what's the best way to dispose of expired medications.  So, here's the Apple Lady to the rescue.

What to do with those old red or blue pills after you've decided not to take them?
(Photo from the US VA Center for Medication Safety)

Expired Medications

  • First of all, if your medication has expired, don't use it.  This applies to everything from aspirin to cough syrup, from cold medicine to pain pills, from blood thinners to, I don't know, whatever a doctor may have prescribed.
  • Over time, the ingredients in the medicine may get changed by humidity or temperature, or they might lose their effectiveness, or they could become unsafe. It happens more often than you might think that people show up in emergency rooms or go to the doctor because of problems related to taking medications past their expiration date.
  • So the FDA says, "If your medication has expired, don't use it."
  • To find the expiration date, look for EXP on the label.

Sometimes there is no EXP, just a date.  If it's later than the date stamped on the package, don't take the medication.
(Photo from Brookside Associates)

Drug disposal

  • Here are the recommended ways to dispose of medications, in order of preference:
  • 1. Follow the instructions on the label, or in the patient information that came with the prescription.  That's the big sheet of small print that the pharmacist gives you.
    • Personally, I have never seen any information about disposal on the label of any medication, either prescribed or over the counter.  Maybe they're starting to include this more often now, or maybe it's included for more serious types of medication, I don't know. 

An example of a patient information sheet. This one is for Warfarin, a blood thinner. You probably can't read it, but I see nothing here about disposal.
(Photo from Consumer Reports)

  • 2. Bring the medication to your local Drug Take-Back Day.
    • National Prescription Take-Back Day is coordinated nationally by the DEA, but it will get organized locally.
    • For 2013, National Drug Take-Back Day is scheduled for October 23.
    • They don't yet have a list of local collection sites, but they promise that they will by October 1.  They say that a list will be made available on this page within the DEA website.
    • Various communities have held drug take-back days at other times too.  Check with your local county or city website to see if they have anything scheduled in the near future.  If you're not sure how to find information about local disposal guidelines, Google the name of your city or town or county + drug take back.

Some locations have receptacles available on an ongoing basis for the disposal of unused medication. This one happens to be at the University of North Texas in Fort Worth. Here is a list of locations around the country that have MedReturn drug collection units.
(Photo from UNT Health Science Center)

  • 3. If no disposal instructions are provided with the prescription and you can't make it to a Drug Take-Back Day, the best disposal method is to put the medications in the trash, but please follow these additional recommendations. 
    • Do not crush pills or capsules.
    • Mix expired or unused medications with some undesirable, icky trash such as kitty litter or used coffee grounds or liquid laundry soap.  This doesn't do anything about their effectiveness but it will make them extremely unpalatable to anyone -- children or adults -- who might be tempted to take them.
    • Put the pills and the icky stuff in a sealable container, such as a ziploc bag or maybe a plastic butter tub with a lid. This will keep them from leaking into the rest of the trash, and it will act as an additional deterrent or disguise. 
    • For prescription pills, don't throw them away in the original prescription container.  Use a different container instead.
    • On the (now empty) prescription containers, scratch off any identifying information such as your name and details about the (now absent) contents.
    • If you have used needles or syringes or sharps, put them in a rigid, sealable plastic container.  A special Sharps container works best, but if you don't have one of those, a big plastic laundry detergent bottle with a screw top is a very good alternative. Close the lid and seal it with tape, and put it in your regular trash. This is to keep the people who handle trash from getting accidentally stuck by needles.

Laundry detergent bottles make very good trash cans for used needles. The plastic is thick, leak-resistant, and the bottles have tight-fitting caps.
(Photo from the FDA)

    • In most communities, you can throw used inhalers in the trash as well.  
    • It should go without saying, throw all this stuff in the trash, not the recycling bin.
    • Some communities have varying definitions about what they consider hazardous materials.  Check with your local disposal company.  
    • If you're not sure how to find information about local disposal guidelines, Google the name of your city or town or county + drug disposal, or your location + hazardous waste.

Many police stations and sheriff's offices around the country are also placing prescription drop boxes outside their buildings. Personally, I don't think that's the most user-friendly location, but nobody asked me.  This one is outside the police station in Oceanside, CA.
(Photo from Oceanside Police)

  • 4. Flushing medications down the toilet is the least-preferred method of disposal.
    • Yes, it's true that trace levels of drugs of all kinds have been found in rivers and lakes and even in drinking water.  But the majority of those drugs didn't get there from people flushing old medications.  Those medications got there from people taking them, passing the drugs through their system, and using their bathrooms normally.  
    • Some amount of any medication you take will not be completely absorbed by your body; some of it is going to wind up in the toilet.  That's just how it is.  
    • I know some of you are very environmentally conscious, so please don't feel like you shouldn't take your medications because they may end up in the water supply.  You've been prescribed those medications for a reason.  You are precious and we want you around as long as possible.  We can't resurrect you, but we can figure out how to fix our water supply. 
    • But if you're done using those medications and you have some left over, there are better ways to dispose of expired medications besides flushing them down the toilet (see #3).

The rhyme is a little annoying, but it's accurate because while most drugs should not be flushed down the toilet, some should be disposed of by flushing.
(Image from the Connecticut Society of Medical Assistants)

    • Some medications, however, should be disposed of by flushing. Mainly, these are powerful pain medications such as morphine, methadone, and oxycodone.  The primary reason to flush these is to really make sure people -- babies, children, and even adults -- and pets don't come in contact with them by accident.  
    • One of them, fentanyl, a pain-delivery patch should absolutely be flushed because too much of this particular drug can cause breathing problems and even death, and it's too easy to come in contact with this patch and absorb the drug accidentally.


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