This question and answer section provides additional details on drug disposal options and why FDA recommends flushing certain potentially dangerous medicines only when take back options are not readily available.
The best way to dispose of most types of unused or expired medicines (both prescription and over-the-counter) is to drop off the medicine at a drug take back site, location, or program immediately.
If you cannot get to a drug take back location promptly, or there is none near you, and your medicine is:
- on the FDA flush list, your next best option is to immediately flush this potentially dangerous medicine down the toilet.
- not on the flush list, you should follow these instructions to discard the medicine in your trash at home.
You can also check with your pharmacist. Some pharmacies offer mail-back programs and other ways to help you safely dispose your unused or expired medicines.
Follow this link to get information on the proper way to dispose of sharps (needles, syringes, and lancets).
First, check with the health care management team in your community or hospice to find out the best way to dispose of unused or expired medicines.
If you learn that you are responsible for disposal of these medicines, follow the directions below:
- The preferred method of medicine disposal is a drug take back option.
- If these options are not readily available, check to see if your medicine is on the flush list. If it is, you should dispose of your medicine by flushing it down the toilet. These flush list medications are potentially dangerous and should not be disposed of in the trash.
- If your medicine is not on the flush list, you can follow these instructions to dispose of your medicine in the trash at home.
Some opioid products with uncommon dosage forms (e.g., sprays, lozenges) have product-specific disposal instructions. Review the instructions that came with your prescription or contact your health care professional (e.g., pharmacist, doctor) to find out how to properly dispose of these medicines.
The few, select medicines recommended for disposal by flushing are safe and effective when used as prescribed. However, medicines on the flush list can result in death from one dose if inappropriately taken. These medicines are those sought-after for their misuse and abuse potential. If children, adults, or pets in your home accidentally or intentionally ingest, touch, misuse, or abuse a medicine on the flush list, they can suffer serious consequences including death.
For these reasons, FDA recommends that when it is not possible to immediately drop off these medicines at a drug take back program or a DEA authorized collector, consumers should flush them down the toilet to immediately and permanently remove this risk from their home.
We believe that the risk of harm from accidental exposure to these few select medicines far outweighs any potential risk to the environment that may come from disposal by flushing. FDA continues to work with and encourage manufacturers of these medicines to develop alternative, safe disposal systems as reducing this risk is of our utmost concern.
Accidental exposure to medicine in the home is a major source of unintentional pediatric poisonings in the United States. Each year in the United States, approximately 60,000 emergency department (ED) visits 1 ,2 and 450,000 calls to poison centers 3 are made after children under 6 years of age find and ingest medication without caregiver oversight. Over two-thirds of ED visits for accidental pediatric medication exposures involve 1- or 2- year old children and nearly 20% result in hospitalization 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 3 .
Cases of inadvertent exposure to some of these medicines were published in the American Association of Poison Control Centers’ 2018 annual report 4 . Below is a case summary to illustrate how some medicines can result in death if they are accidentally taken by children.
- A 2 year old boy was found lethargic by his mother with her methadone bottle open and 20 pills missing. She then put the child down for a nap and could not wake him 5 hours later. The child arrived to the emergency department (ED) in cardiac arrest, pupils were fixed and dilated. A heart ultrasound showed no cardiac activity after 30 minutes of resuscitation, and the boy was declared dead. The cause of death: methadone toxicity.
FDA is aware of reports of very low, but measurable levels of medicines in surface waters such as rivers and streams, and to a lesser extent in drinking water. To date, scientists have found no evidence of harmful effects to human health from these few, select medicines in the environment.
The majority of medicines found in water are a result of the body’s natural routes of drug elimination (in urine or feces). Disposal of these few, select medicines by flushing, which is encouraged only when drug take back options are not readily available, would only contribute a small fraction of the total amount of medicine found in our surface and drinking water.
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 human health or the environment from flushing these medicines.
FDA works with other agencies, including the U.S. Environmental Protection Agency (EPA), to better understand the human health and environmental risks from medicines in our water. In addition, FDA continues to work with and encourage manufacturers of these medicines to develop safe, alternative disposal systems.
This depends on which state you live in. There are some online resources that may help you determine whether pharmaceutical donation and reuse programs exist in your state. It should be noted that most state programs do not accept controlled substances.
Also, please note that FDA does have concerns regarding the donation of unused drugs and does not endorse this practice. This is because the ultimate end user would have no assurance that the medications were appropriately stored. For many medications appropriate storage is essential to maintain their strength and quality.
Here is a question and answer sheet about donating drugs for international humanitarian relief.
- 1 a b Lovegrove MC, Weidle NJ, Budnitz DS. Trends in Emergency Department Visits for Unsupervised Pediatric Medication Exposures, 2004-2013. Pediatrics. 2015;136(4):e821-829. Retrieved from https://doi.org/10.1542/peds.2015-2092
- 2Centers for Disease Control and Prevention. PROTECT Initiative: Advancing Children’s Medication Safety. Retrieved from https://www.cdc.gov/medicationsafety/protect/protect_initiative.html
- 3 a b 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 Jul;106(7):405-411. Retrieved from http://jaoa.org/article.aspx?articleid=2093323
- 4Gummin DD, Mowry JB, Spyker DA, Brooks DE, Fraser MO, Banner W. 2016 Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 34th Annual Report. Clin Toxicol (Phila). 2017;55(10):1072-1252. Retrieved from https://doi.org/10.1080/15563650.2017.1388087