Posted by Dr. Jim Joyner
The FDA has updated its consumer oriented web-page with detailed instructions on disposal of unused medications. The FDA is concerned that unused medications be disposed of properly to avoid harm. Their web page states that most medications should be mixed with some unpalatable substance (coffee grounds, cat litter) and placed in a sealed container which is then thrown away with household garbage. The idea is to make the mixture as unappealing as possible and sealing it up in a ziplog bag or other container with a tight fitting lid.
The FDA has indicated that certain medications may be especially harmful and in some cases fatal if they are used by someone other than the person that the medication was prescribed for, such as children. For this reason they have published a list of medications that have "special" disposal instructions recommending flushing instead of being thrown out with regular trash. The updated guidelines contain a new list of 26 specific medications that the FDA has recommended for disposal by flushing down the toilet or sink. The list of medications includes all of the high-potency opioids, a couple of central nervous system stimulants, and one concentrated benzodiazepine rectal gel (Diastat). Many of these medications are commonly used in hospice and palliative care.
FDA's web page addresses concerns about contamination of the water supply with medications this way:
" We are aware of recent reports that have noted trace amounts of medicines in the water system. 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."
It is important for hospices to be aware that some individual states have rulings from their own Departments of Health or Environmental Services that are in disagreement with FDA on this point of water contamination. For example, it is illegal to flush any and all medication into the water system in California, no exceptions. It is important to stress that the FDA does not recommend routine flushing for all medication disposal, just those with potential for serious harm which are on the new list.
Hospices should have a policy in place regarding the disposal of unused medications for their patients. The FDA guidelines provide a good framework for developing a policy on drug disposal, however, each agency should determine if there are more strict laws or regulations in place within their particular State that may prohibit the flushing of medications into the water system. Some communities have drug-take back programs that can be another excellent way to dispose of unused drugs. Access to these programs may be obtained through one of the following:
- City or county government
- Residential trash company
- Residential recycling company
- Community hospital
Further information on the FDA medication disposal guidelines can be found on the FDA website at http://www.fda.gov/ or by calling (888) INFO-FDA.