By: Douglas C. Throckmorton, M.D., Deputy Center Director for Regulatory Programs, Center for Drug Evaluation and Research
Unused or expired medicines in the home have long been a major safety concern. For example, data from calls to U.S. poison control centers suggest that from 2015-2019 a variety of medications were implicated in some of the most common, and the most severe, cases of accidental ingestion of household substances by children. These data also indicate that calls to poison control centers during this time showed that pain medications were the single most frequent cause of pediatric fatalities. Drug take back programs offer a valuable opportunity for protection. For many years, the U.S. Food and Drug Administration has strongly supported work to expand the availability of drug take back programs. These programs, many of which are run in local communities, can help people dispose of unused or expired medicines that can be potentially lethal – such as fentanyl patches, which are so potent that even a used patch touched by a child can lead to death.
National Prescription Drug Take Back Day is April 24, 2021. During this annual event, authorized drug take back locations may be in retail pharmacies, hospital or clinic pharmacies, and law enforcement facilities. Some sites may also offer ongoing mail-back programs or permanent drop-boxes to assist patients in safe disposal.
With the COVID-19 pandemic keeping children at home more than before, now is an especially important time for avoiding threats from unused or expired medicines and other potentially dangerous substances found in the home. For example, according to the U.S. Centers for Disease Control and Prevention, during the early part of the COVID-19 pandemic, January through March 2020, calls to poison control centers regarding accidental disinfectant and cleaning exposures were 20% higher than the same period in 2019. While child-resistant containers can help prevent accidental access to medicines, research shows that even child-resistant containers cannot always prevent a child from taking medicines that aren’t meant for them.
Additionally, our nation’s ongoing opioid crisis underscores the importance of drug take back programs. In a number of instances, people who misuse medications, such as opioids, get their first dose from the home of other people who have been prescribed the drug, such as from the medicine cabinets of their parents, relatives, and friends. Removing prescription opioids from the home once they are no longer medically necessary is part of the solution to this crisis and can prevent accidental exposure or intentional misuse.
When someone is unable to access a drug take back site, the FDA recommends seeing whether a drug is on the “flush list”, and if it is, to immediately flush it down a toilet. Given the FDA’s focus on public health, we reserve this recommendation only for those drugs that can result in deaths of people from a single dose if taken inappropriately. Nonetheless, we’re seeking alternative solutions to flushing. For instance, a law known as the SUPPORT Act provides the FDA with new authorities over packaging and disposal of drugs that pose risks of abuse or overdose, such as opioid analgesics. We are exploring how we might best use these new authorities to develop new disposal options outside of flushing. While current data suggest that disposal of these drugs through flushing has no substantial environmental impact, we are also continuing to study the issues. Drugs that are not on the flush list can be discarded in household trash after taking safety precautions such as deleting all personal information on the containers and sealing the medicine in a bag mixed with an unpleasant substance such as dirt, coffee grounds, or kitty litter. With that in mind, the FDA strongly emphasizes that, when possible, the best way to dispose of these potentially dangerous drugs is to promptly bring them to a drug take back location, if one is readily available.
The FDA encourages all Americans to take advantage of the National Prescription Drug Take Back Day. Bring your unused and expired drugs to a drug take back location and protect your family, friends, and visitors to your home. However, if you are unable to get to a drug take back site, visit www.fda.gov/drugdisposal for information on how to safely dispose of unused or expired medicine on your own.
The FDA continues to support the critical work of drug take back programs. We continue to work with manufacturers to develop new formulations with reduced risk for accidental harm and with our federal partners to encourage the development of alternative, safe disposal systems.
For more information: Where and How to Dispose of Unused Medicines