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.
What are FDA's recommendations for removing unused or expired medicines (including prescription, over the counter (OTC), and dietary supplements) from the home?
Almost all medicines can be safely disposed of through drug take back programs or using U.S. Drug Enforcement Administration (DEA) authorized collectors.
When these options are not immediately available, consumers may also dispose of most unwanted medicine in their trash at home.
If the prescription medicine is on the flush list and a DEA authorized collector or drug take back program is not immediately available for drop off, FDA recommends that these medicines be disposed of by flushing.
The prescription medicines on the flush list contain controlled substances and are especially harmful if taken accidentally by someone other than the patient. These medicines should not be thrown in the trash because this method may still provide an opportunity for a child or pet to accidentally take the medicine.
How do I get rid of needles and syringes?
Follow this link to get information on the proper way to dispose of sharps (needles, syringes, and lancets).
‘I live in an assisted living community and take my own medicines’ or ‘My family member was in hospice and has since passed away.’ How can I safely dispose of medicines that are no longer needed?
First, check with the health care management team in your community or hospice to find out the best way to dispose of unused or unwanted 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 it 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 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.
Why are some medicines on the flush list while other medicines are not? What is the rationale for this policy?
The few, select medicines recommended for disposal by flushing are safe and effective when used as prescribed but they could be especially harmful to children, pets, or others 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 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 this small, select list of 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.
How big of a problem is accidental pediatric exposure to medicine in the United States?
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’ 2016 annual report 4. Below are two case summaries to illustrate how some medicines can result in death if they are accidentally taken by children.
- A 2 year old female was seen drinking an unknown liquid from a stray plastic bottle. The next day she was lethargic, later that day her parents found her unresponsive with labored breathing, and transported her to the emergency department (ED). The child arrived to the ED in cardiac arrest, pupils were fixed and dilated. Laboratory/diagnostic findings: Urine drug screen (UDS) was positive for methadone. Head CT was consistent with anoxic brain injury. She was determined to be brain dead after a 10 day clinical course.
- A 15 month old female was found with a buprenorphine/naloxone film wrapper in her mouth. Her mother removed it and took her to the ED where she remained asymptomatic for 4 hours. A UDS was negative for opiates and she was discharged. She was found at home, 5 hours later, in cardiac arrest. EMS began CPR and transported to the ED. In the ED, she was intubated and received naloxone and epinephrine. CPR was continued for 1 hour, but she died.
Does flushing medicines on the flush list pose a risk to human health or the environment? Does FDA’s recommendations about medicine disposal consider the effects of medicines in the environment?
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 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.
Can unused or unexpired medications be donated?
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.
Here is a question and answer sheet about donating drugs for international humanitarian relief.
Does FDA have a pamphlet on drug disposal I can print and hand out?
Yes, please see our Consumer Update: How to Dispose of Unused Medicines.
- 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
- 2. Centers 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
- 4. Gummin 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