Drug disposal is the act of throwing away medicines. People often get rid of medicines they no longer need after finishing their treatment. Hospitals and clinics also throw away medicines in larger amounts for many reasons, such as having leftover medicines after treating patients or getting rid of medicines that have passed their expiration date. Not properly disposing of medicines can allow others who are not meant to use them to take them in the wrong way. Improper disposal of medicines can also lead to drug pollution.
People throw away medicines in different ways; even experts who know a lot about medicines may give different advice to the public about how to dispose of them. Proper waste management systems that handle the distribution, control, and disposal of medicines help healthcare centers and also support environmental health.
Sources of drugs
Medication waste includes dangerous and non-dangerous waste, controlled medicines, and expired drugs.
Medication waste can occur at different stages of a drug's life. First, it can come from factories where drugs are made. This includes unused medicine ingredients and materials that can no longer be used in making drugs. Second, medication waste can come from healthcare places such as hospitals, clinics, and pharmacies. This type of waste may result from doctors prescribing too much medicine, expired drugs, opened containers, or medicines that are only partly used. It may also include items like syringes, bottles, IV bags, and tubes that hold leftover medicine or are contaminated during handling of dangerous drugs, such as chemotherapy medicines. Some states require healthcare places to destroy unused medicines. Lastly, medication waste can come from patients using too much over-the-counter medicine.
Sometimes, normal use of a drug can lead to waste. For example, when someone uses a skin patch, after it is used, it still has strong medicine left and must be disposed of safely.
Reasons for disposal of drugs
Medical experts recommend that people should not keep any medicine they do not currently need. Keeping medicines in a home increases the chance that someone might use them incorrectly and get hurt. Accidentally taking medicine that was prescribed for someone else is a common cause of poisoning in American homes. Poison Control Centers in the United States report that in 2007, about 23,783 out of 255,732 cases involving wrong use of medicine were linked to accidental exposure. Of these, 5,000 cases involved children younger than 6 years old. Because children's bodies process medicines differently, medicine poisoning in children can be very dangerous.
Methods for disposal
The most obvious way for people to get rid of drugs is through household trash services. Experts suggest checking other options first because throwing drugs away with regular trash could let someone find and use them, which could hurt them. Medical experts say people should not pass drugs to others for use.
The best place to find local advice is at a community pharmacy. Pharmacies handle drugs and can suggest the safest disposal method. Many pharmacies collect drugs and dispose of them for free. Some areas have government programs that take back drugs for proper disposal. Sometimes, pharmacies or government services allow people to mail drugs to special disposal centers. If no other options are available and drugs must be thrown away, mixing them with unappealing trash is a safer choice. Putting pills in the toilet can pollute water, but this might be used quickly to dispose of dangerous drugs.
In the United States, many efforts have been made to encourage people to bring leftover drugs to disposal centers. Examples include special events at community centers where people can bring drugs, or teaching individuals and groups about correct disposal methods. A study found these programs did not work well enough to reduce the amount of leftover drugs available in communities.
Disposing of large amounts of drugs can pollute the environment and harm it. Organizations may choose to return drugs to the manufacturer, put them in landfills, burn them, or dump them into sewers.
Disposal of controversial drugs
Drugs linked to substance abuse and illegal drugs require special care when being disposed of. Police may take these drugs as illegal items and must then destroy them. In other cases, some legal drugs can be misused and need more careful disposal than drugs that are not likely to be misused. Governments find it difficult to decide how to properly dispose of drugs that are controversial.
A small study in one region of the United States looked at the results of a public health program that collected unused opioid medications. The study found that people who returned opioids often gave back more than half of what they had been prescribed, which might suggest they had twice as much medication as they needed. The study was too small to draw general conclusions, but it provided information to help guide further discussions and research about whether people would take part in opioid return programs, which types of drugs are more likely to be returned, and how much people would return.
The U.S. Food and Drug Administration has a list of medications that should be flushed down the toilet if people cannot take them to a drug return program. These medications contain controlled substances that can be dangerous to pets and other people in the home and should be disposed of right away when no longer needed. Examples include Dilaudid (hydromorphone hydrochloride) tablets, fentanyl patches, and morphine sulfate oral solution. In 2016, a study by Harvard University found unsafe levels of poly-fluoroalkyl and perfluoroalkyl substances (PFASs) (industrial chemicals linked to cancer, hormone problems, and other health issues) in the drinking water of 6 million Americans. These products should immediately flush due to high potential for abuse and overdose.
Worldwide drug disposal practices
In 2001, the European Parliament created a rule about how medicines should be disposed of. This rule, called Directive 2001/83/EC, required that outer medication packaging include instructions for safe disposal. In 2004, the European Union issued another rule that explained the 2001 rule more clearly. This new rule required that medication collection plans be established, and that information about these plans for each country be included on medication packaging.
According to National Health Service SI 2014/349: The National Health Service (Pharmaceutical and Local Pharmaceutical Services) Regulations 2013, local pharmacies in the UK must accept unused or unwanted medicines from homes. These same rules state that pharmacies must sort the medicines and send them back to the NHS.
Canada does not have a single national policy for returning unused or expired medicines, but most provinces have their own plans. In most Canadian provinces, pharmacies can accept unused or expired medicines any day of the year.
In Australia, the Return Unwanted Medicines (RUM) project explains that most medicines can be placed directly into disposal bins. However, medicines containing opioids must be stored separately. Pharmacists are responsible for sorting medicines to ensure they are disposed of correctly.
In some Asian countries, such as Malaysia, Bangladesh, and Thailand, unused or expired medicines are often stored at home and then thrown in the trash or flushed down toilets.
National Regulations in the United States
In the United States, used prescription drugs are important safety issues because they can be accidentally swallowed, taken in dangerous amounts, or used illegally. To help solve these problems, the Drug Enforcement Administration (DEA) started the National Take Back Initiative. Drug Take-Back Days happen twice each year, in April and October. These events aim to create safe places for people to throw away medicines, stop the illegal use of prescription drugs, and teach the public about proper disposal. In April 2021, the program collected 420 short tons (380,000 kg) of drugs at 5,060 locations across the country. The National Association of Drug Diversion Investigators (NADDI) also runs a website that helps people find Rx Drug Drop Boxes for safe disposal outside of Take-Back Days.
In 2010, Congress passed a change to the Controlled Substances Act. This law allows the DEA to create a permanent way for people to safely and easily dispose of prescription drugs. President Barack Obama signed the Secure and Responsible Drug Disposal Act of 2010, and the DEA quickly began making rules for a long-term solution. The law says that controlled substances can only be thrown away if law enforcement has permission from the DEA to take and dispose of them. This rule prevents drug take-back programs from accepting and disposing of controlled medicines for the public, which could lead to misuse. Misuse of prescription drugs has become a serious problem, with deaths from opioids increasing four times since 1999. In 2006, about one-third of new prescription drug abusers were between the ages of 12 and 17. Because of these issues, Congress created the Secure and Responsible Drug Disposal Act of 2010 to give the Attorney General the power to make new policies that help people safely and easily throw away unwanted medicines. The goal of this law is to stop the illegal use of drugs and protect the environment from drug-related pollution.
Other national groups have also supported drug take-back programs. In 2011, the White House introduced the first national Prescription Abuse Prevention Plan. This plan helped increase support for drug disposal programs and reduced the number of unused prescription drugs. The U.S. Environmental Protection Agency (EPA) also supported these programs by providing guidelines for safely throwing away medicines at home and suggesting ways to burn household drugs. The American Pharmacist Association and Pharmaceutical Research and Manufacturers of America worked with the U.S. Fish and Wildlife Service to teach people how to properly dispose of medications. This effort encouraged people not to flush unused medicines down the toilet or pour them down the sink. It also highlighted the role of pharmacists in helping people learn about safe disposal methods and which medicines can be safely flushed.
Examples of State Regulations
Alameda County was the first county in the United States to require manufacturers to pay for the safe disposal of pharmaceutical waste. This rule required companies that make drugs sold in Alameda County to run and pay for a "Product Stewardship Program." These programs can include drug kiosks, mail-back systems, or volunteer collectors like law enforcement and pharmacies. Because of this program, eight other counties in California created similar programs, including San Mateo, Santa Barbara, Santa Clara, Marin, Los Angeles, Santa Cruz, Sonoma, Contra Costa, San Luis Obispo, and Tehama Counties.
In California, pharmacies in retail and hospital settings may host drug take-back programs if they follow rules in Article 9.1 of Division 17 of Title 16 of the California Code of Regulations. These pharmacies must register with the Drug Enforcement Administration (DEA) and inform the Board of Pharmacy and DEA within 30 days of starting or ending a program. They must place collection containers in approved locations with liners that meet standards set by a testing organization. Pharmacies must also follow rules such as accepting returned prescription drugs to be sent to approved DEA destruction sites. No employee can join the program if they have a criminal record related to controlled substances. Pharmacies cannot sort, count, or examine collected medications, and they must report any tampering with collection containers to the Board of Pharmacy within 14 days. It is important to note that these programs only accept prescription medications, not drug samples or medical waste.
On September 30, 2018, California passed SB 212: Solid waste: pharmaceutical and sharps waste stewardship. Like the Alameda County rule, this law creates a statewide program for drug and needle waste funded by manufacturers or distributors. The law requires these companies to create their own stewardship program or join one approved by CalRecycle. The law also requires at least five collection sites per county or one site for every 50,000 people in larger counties. Retail pharmacies must act as "authorized collectors." These collectors can operate in one location or 15% of their store locations in the county, whichever is greater. The law began in January 2019, with CalRecycle approvals completed by that time, and programs started in January 2021.