Drugs

Medication Disposal: Questions and Answers

For safety reasons, FDA recommends that a few, select medicines be disposed of by flushing down the sink or toilet. Accidental exposure to these medicines could harmful, and in some cases deadly in a single dose, if they are used by someone other than the person the medicine was prescribed for. Flushing these medicines down the sink or toilet completely removes this risk from the home. View a list of these medicines.

This question and answer page provides additional details on why FDA recommends flushing certain medicines.

Q: How does FDA recommend that unused medicines be disposed of from the home?

FDA supports the responsible disposal of medicines from the home. Almost all medicines can be safely disposed of by using medicine take-back programs, if available, or by throwing them away in the household trash. To dispose of acceptable medicines in your household trash, first mix the medicines (do NOT crush tablets or capsules) with an unpalatable substance such as kitty litter or used coffee grounds. Then place the mixture in a container such as a zip-top or sealable plastic bag, and throw the container in your household trash. Before throwing out your empty pill bottle or other empty medicine packaging remember to scratch out all personal information on the prescription label to make it unreadable. Drug take-back programs for disposal can be another good way to remove unwanted or expired medicines from the home and reduce the chance that someone may accidentally take the medicine.

There are, however, a few, select medicines (certain controlled substances) that are especially harmful (and possibly deadly in a single dose), if taken accidentally by someone other than the person the medicine was prescribed for. These medicines should not be thrown in the trash, given this method of disposal may still provide an opportunity for a child or pet to accidentally take the medicine. Although FDA endorses drug take-back programs, such programs may be unable to accept drugs that are controlled substances.

Therefore, FDA recommends that these particular medicines be disposed of by flushing because the risk of harm is completely eliminated from the home when the drug is flushed down the sink or toilet after it is no longer needed.

View the list of medicines which should be disposed of by flushing


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Q: Why do the medicines on this list have directions for disposal by flushing and other medicines do not? What is the rationale for this policy?

The medicines on this list of medicines recommended for disposal by flushing are safe and effective when used as prescribed, but they could be especially harmful to a child, pet, or anyone else if taken accidentally. Some of the possible harmful effects include breathing difficulties or heart problems, which could lead to death. For these reasons, FDA recommends that when it isn’t possible to return these medicines through a medicine take-back program, flushing them down the sink or toilet is the best way for you to immediately and permanently remove this risk from the home.

Reducing the risk of harm to people from accidental exposure to medicines is of utmost concern to FDA. FDA believes that the risk associated with accidental exposure to this small, select list of medicines far outweighs any potential risk associated with disposal by flushing. FDA continues to work with and encourage manufacturers of these medicines to develop alternative, safe disposal systems.

Q: How big of a problem is accidental exposure to medicine in the United States?

Accidental exposure to medicine in the home is a major source of unintentional poisonings in the United States.

  • In 2007, there were 255,732 cases of improper medicine use reported to Poison Control Centers in the United States. Approximately 9% of these cases (23,783) involved accidental exposure to another person’s medicine. Approximately 5,000 of these accidental exposure cases involved children 6 years and younger.1
  • Keeping medicines after they are no longer needed creates an unnecessary health risk in the home, especially if there are children present. Even child resistant containers cannot completely prevent a child from taking medicines that belong to someone else. In a study that looked at cases of accidental child exposure to a grandparent’s medicine, 45% of cases involved medicines stored in child-resistant containers.2

Cases of inadvertent exposure to some of these medicines were published in the American Association of Poison Control Centers’ 2007 annual report.1 A case of accidental exposure to one of these medicines has also been published in the literature.3 Below are summaries of some of these cases to illustrate how some medicines can result in fatality if they are accidentally taken by children.

  • A 2-year old male was found with an open bottle of methadone, an opioid drug that can be used for the management of pain. The child was taken to the emergency department and appropriate actions (e.g., activated charcoal) were taken to flush the medicine from his system. Following these interventions, the child was discharged from the hospital. Later that same day, he was found not breathing and without a heart beat. There was vomit around his mouth. Emergency services were called, but attempts at resuscitation were ineffective and the child died.1
  • A 4-year old female was found not breathing by her grandparents in their home. Resuscitation was attempted, but was ineffective and the child died. During the autopsy, a transdermal fentanyl patch, a strong opioid pain medicine, was found in the child’s gastrointestinal tract. Apparently, the child found a discarded patch in the trash and ingested it, resulting in a massive overdose of fentanyl.1
  • A 2-year old female was found in her home rubbing her mouth and staggering. Before entering the house, she had been playing outside and her parent, based on her behavior, believed that she had ingested something. Additional symptoms, including tiredness and abdominal pain, later emerged. She was brought to the emergency room and her physical examination revealed no remarkable signs of distress. The child was discharged to her parent’s care. The following morning, the child was found unresponsive. Emergency services were called and CPR was begun. The child was pronounced dead upon arrival to the hospital. A blood sample taken around the time of death was positive for oxycodone.3

Q: Does flushing the medicines on this list down the toilet or sink pose a risk to human health or the environment? How have considerations about medicines in the environment informed FDA’s recommendations about the disposal of medicines from the home?

FDA is aware of recent reports that have noted trace amounts of medicines in the water system. Disposal of these select few medicines by flushing contributes only a small fraction of the total amount of medicine found in the water. The majority of medicines found in the water system are a result of the body’s natural routes of drug elimination (in urine or feces).

Scientists to date have found no evidence of harmful effects to human health from medicines in the environment. Based on the available data, FDA believes that the known risk of harm to humans from accidental exposure to these medicines far outweighs any potential risk to humans or the environment from flushing them.

Q: Can the medicines that FDA recommends for disposal by flushing be eliminated from the home in some other manner; for example, by drug-take back programs or returning the medicine to the pharmacy?

Yes, the medicines that FDA recommends for disposal by flushing can be disposed of by other methods. However, these methods must agree with Federal and state laws. Since these medicines are controlled substances, current Federal and some state laws limit who can take these types of medicines back for disposal after they are dispensed by the pharmacy to the consumer. These legal limitations could prevent take-back programs or pharmacies from accepting medicines containing controlled substances. Therefore, these other methods of disposal may be infrequent or hard to find.

The U.S. Drug Enforcement Administration sponsors National Prescription Drug-Take Back Events that can accept medicines containing controlled substances. If there is not a timely take-back program in your area that accepts medicines containing controlled substances, the most effective way to immediately and completely eliminate the potential for harm is to remove these medicines from the home by flushing them down the sink or the toilet.

To find out whether there are alternative disposal options for medicines containing controlled substances in your community, contact your city or county government. You can also talk to your pharmacist to see if he or she knows of other disposal programs in your area.

FDA continues to work with and encourage the manufacturers of these products to develop alternative, safe disposal systems.


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Q: I live in an assisted living community and take my own medicines. I have prescription medicines that I no longer need. How can I safely dispose of them?

Check first with your community’s health care management team to learn the best way to dispose of your used or unneeded medicines.  If you learn that you are responsible for disposal of your own medicines, there are a few options that you can choose from:

  1. Medicine take-back programs for disposal are a good way to remove expired, unwanted, or unused medicines from the home and reduce the chance that others may accidentally take the medicine. Contact your city or county government's household trash and recycling service to see if there is a medicine take-back program in your community and to learn about any special rules regarding which medicines can be taken back for safe disposal. You may also visit the U.S. Drug Enforcement Administration’s website for more information on National Prescription Drug-Take Back Events.
  2. If no medicine take-back program is available in your area, you can dispose of most medicines in your household trash. Mix the medicines (do NOT crush tablets or capsules) with an unpalatable substance such as kitty litter or used coffee grounds. Place the mixture in a container such as a zip-top or sealable plastic bag, and throw the container in your household trash. Before throwing out your empty pill bottle or other empty medicine packaging, remember to scratch out all personal information on the prescription label to make it unreadable.
  3. A small number of medicines may be especially harmful, and in some cases are fatal with just one dose, if they are taken by someone other than the person for whom the medicine was prescribed. For this reason, a few medicines have specific disposal instructions telling you to flush them down the sink or toilet when they are no longer needed and when they cannot be disposed of through a medicine take-back program. For example, you should flush strong pain medicines such as Oxycontin® down the drain as soon as they are no longer needed. When you dispose of these medicines down the sink or toilet, they cannot be accidentally taken by children, pets, or anyone else. Click here for the list of medicines recommended for disposal by flushing.
  4. Some of these medicines recommended for disposal by flushing are available as adhesive skin patches. For example, fentanyl patches are used to treat patients in constant pain by releasing a continuous amount of drug from the patch over three days. Even a used patch that has been worn for three days still contains enough fentanyl to harm or cause death in a child.
    FDA recommends disposing of used patches immediately after taking them off of the skin. Fold the patch in half so that the sticky sides meet, and then flush it down the toilet. Used or unneeded fentanyl patches should NOT be placed in the household trash where children or pets can find them. You can read more about disposing of fentanyl patches in the product Medication Guide.

References

  1. Bronstein et al. 2007 Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 25th Annual Report. Clin Toxicol (Phila). 2008;46(10):927-1057.
  2. McFee RB, Caraccio TR. "Hang Up Your Pocketbook" -- an easy intervention for the granny syndrome: grandparents as a risk factor in unintentional pediatric exposures to pharmaceuticals. J Am Osteopath Assoc. 2006;106(7):405-11.
  3. Armstrong et al. 2004. An unusual fatality in a child due to oxycodone. Am J Forensic Med Pathol. 2004;25(4):338-41.

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Page Last Updated: 08/30/2013
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