The Hospice Clinician Blog

The FDA recently evaluated a series of 26 cases of pediatric accidental exposures to fentanyl patches reported over the past 15 years. Ten cases resulted in death and 12 in hospitalization. Sixteen of the 26 cases occurred in children 2 years of age or younger. This case review prompted the FDA to issue a reminder to healthcare professionals and patients about the proper disposal of fentanyl patches, recommending that the adhesive side of the patch be folded upon itself (so it sticks together) and that the patch then be flushed down the toilet. However, in certain states (such as California), flushing medications down the toilet is illegal, regardless of the FDA's recommendations. Be sure to know the law in your state before recommending that medications be flushed.

The FDA's reminder regarding appropriate disposal of fentanyl patches prompts a discussion of the proper disposal of unused medications. In hospice, we are often left with an unused medication supply when a patient passes, many of which are medications that pose particular risk of diversion or harm due to accidental exposure (such as opioids).

What are the options for medication disposal?

• Medicine Take-Back Programs: Contact your city or county government's household trash and recycling service to see if there is a medicine take-back program in your community and learn about any special rules regarding which medicines can be taken back. You can also talk to your local pharmacist to see if he or she knows of other medicine disposal programs in your area.
• Disposal in Household Trash: If no medicine take-back program is available in your area, you can also dispose of medicines by mixing them with an undesirable substance such as kitty litter or used coffee grounds (do NOT crush them first), placing the mixture in a sealed container such as a plastic bag, and throwing the container in the household trash. (Consumers are advised to check their local laws and ordinances to make sure medicines can legally be disposed of with their household trash.)
• Flushing of Certain Medicines: There is a small number of medicines (primarily the opioids) that, if they cannot be returned to a medicine take-back program, should be flushed down the sink or toilet (as long at it is legal in your state), because they could be especially harmful to a child, pet, or anyone else if taken accidentally. Flushing down the sink or toilet is currently the best way to immediately and permanently remove the risk of harm from the home. Many consumers have expressed concern about contamination of the water supply. Recent reports have noted trace amounts of medicines in the water system, but 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). Disposal of these select, few medicines by flushing contributes only a small fraction of the total amount of medicine found in the water. When a medicine take-back program isn’t available, the FDA believes that any potential risk to people and the environment from flushing this small, select list of medicines is outweighed by the real possibility of life-threatening risks from accidental ingestion of these medicines. Scientists, to date, have found no evidence of harmful effects to human health from medicines in the environment.

MEDICINES RECOMMENDED FOR DISPOSAL BY FLUSHING (IN STATES WHERE FLUSHING IS LEGAL)

As with the fentanyl patch, there may be specific recommendations regarding how to flush these medications. Always consult the Medication Guide for specific disposal instructions.

Posted on April 19, 2012

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