It is estimated that between 10 and 30 percent of medications prescribed to patients are not used. Physicians are rarely asked what to do with unused medications and, if asked, most physicians, myself included, would recommend disposing of them in the household trash. Pharmacies, with good reason, will not take back unused or partially used prescription bottles. Disposing of them in the toilet is not a good idea as the medications will wind up in our waterways where they may be harmful to marine life. Until recently the DEA and FDA both agreed trash disposal was a safe and environmentally friendly method of disposing of unused pills.
Unused medications often linger in medicine cabinets where unintended recipients may access them. Accidental ingestion of pharmaceuticals is on the rise, including an epidemic of opioid overdoses in adults and children. Recent studies, however, have found pharmaceuticals in environmental and ground water. This finding is due to the medications seeping out of landfills. So if medications cannot safely be disposed of in trash or in toilets, then where should they go? The answer can be found in Canada and Europe.
Environmental activists have been promoting pharmaceutical “take-back” programs where qualified entities like fire departments, police stations, and pharmacies set up kiosks where medications can be safely disposed of. Medications from these kiosks are then incinerated. Canada and Europe already have this system in place. The advocates of this program here in the U.S. have invoked the principle known as “Extended Producer Responsibility.” This principle provides that manufacturers of environmentally harmful products must assume responsibility for their safe disposal. So this principle places the responsibility for disposal in the hands of the pharmaceutical industry. Naturally the industry is balking at this, arguing that other supply-chain entities profit from the sale of their products. Holding the producers rather than the complex network of suppliers and retailers responsible has the advantage of simplicity. And thus far, the U.S. legal system, including the Supreme Court, has agreed.
Take-back programs remain a novel concept in the U.S., but this may be changing. Only this year the FDA and DEA have endorsed take-back programs as the preferred approach to disposing of pharmaceuticals. Just this spring Walgreens introduced take-back kiosks in some stores and other retail chains may follow suit. Additionally, a handful of municipalities, mostly on the west coast, have passed ordinances requiring manufacturers to develop and fund take-back programs. Passing and enforcing a national take-back program may have drawbacks and unintended consequences however. First of all, the vast majority of antibiotic usage in the U.S. is in livestock where a take-back program will be of no help. Secondly, a take-back program may inadvertently increase accidental ingestions as many people would undoubtedly stockpile unused medications until they had enough to warrant a trip to the take-back kiosk.
More studies and research are needed and so, for the time being, until take-back programs become locally available, trash disposal will remain the recommended method of medication disposal. Toilet disposal should remain a last-ditch disposal method and reserved for high-risk situations like disposal of opioids in a situation where a family member has a substance-abuse issue.
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