Medication Disposal: Questions and Answers

For safety reasons, FDA recommends that a few, select medicines be disposed of by flushing down the sink or toilet. Accidental exposure to these medicines could harmful, and in some cases deadly in a single dose, if they are used by someone other than the person the medicine was prescribed for. Flushing these medicines down the sink or toilet completely removes this risk from the home. View a list of these medicines.

This question and answer sheet provides additional details on why FDA recommends flushing certain medicines.

Q: How does FDA recommend that unused medicines be disposed of from the home?

FDA supports the Federal Guidelines calling for the responsible disposal of medicines from the home. Almost all medicines can be thrown away in the household trash after mixing them with some unpalatable substance (e.g., coffee grounds) and sealing them in a bag or other container. Drug take-back programs for disposal can be another good way to remove unwanted or expired medicines from the home and reduce the chance that someone may accidentally take the medicine.

There are, however, a few, select medicines (certain controlled substances) that are especially harmful (and possibly deadly in a single dose), if taken accidentally by someone other than the person the medicine was prescribed for. These medicines should not be thrown in the trash, given this method of disposal may still provide an opportunity for a child or pet to accidentally take the medicine. Although FDA endorses drug take-back programs, such programs may be unable to accept drugs that are controlled substances.

Therefore, FDA recommends that these specific, listed medicines be disposed of by flushing because the risk of harm is completely eliminated from the home if the drug is flushed down the sink or toilet after it is no longer needed.

View the list of medicines which should be disposed of by flushing. 

Q: What is the rationale for FDA’s policy on why some medicines should be disposed of by flushing?

Reducing the risk of harm to people from accidental exposure to medicines is of paramount concern to the FDA. The FDA believes that the risk associated with accidental exposure to this small, select list of medicines far outweighs any potential risk associated with disposal by flushing. Disposing of these medicines in the sink or toilet completely eliminates the risk of harm to people in the home.

Q: How big of a problem is accidental exposure to medicine in the United States?

Accidental exposure to medicine in the home is a major source of unintentional poisonings in the United States.

• In 2007, there were 255,732 cases of improper medicine use reported to Poison Control Centers in the United States. Approximately 9% of these cases (23,783) involved accidental exposure to another person’s medicine. Approximately 5 thousand of these accidental exposure cases involved children 6 years and younger.¹
• Keeping medicines after they are no longer needed creates an unnecessary health risk in the home, especially if there are children present. Even child resistant containers cannot completely prevent a child from taking medicines that belong to someone else. In a study that looked at cases of accidental child exposure to a grandparent’s medicine, 45% of cases involved medicines stored in child-resistant containers.²

Cases of inadvertent exposure to some of these medicines were recently published in the American Association of Poison Control Centers’ 2007 annual report.¹ A case of accidental exposure to one of these medicines has also been published in the literature.³ Below are summaries of some of these cases to illustrate how some medicines can result in fatality if they are accidentally taken by children.

• A 2-year old male was found with an open bottle of methadone, an opioid drug that can be used for the management of pain. The child was taken to the emergency department and appropriate actions (e.g., activated charcoal) were taken to flush the medicine from his system. Following these interventions, the child was discharged from the hospital. Later that same day, he was found not breathing and without a heart beat. There was vomit around his mouth. Emergency services were called, but attempts at resuscitation were ineffective and the child died.¹
• A 4-year old female was found not breathing by her grandparents in their home. Resuscitation was attempted, but was ineffective and the child died. During the autopsy, a transdermal fentanyl patch, a strong opioid pain medicine, was found in the child’s gastrointestinal tract. Apparently, the child found a discarded patch in the trash and ingested it, resulting in a massive overdose of fentanyl.¹
• A 2-year old female was found in her home rubbing her mouth and staggering. Before entering the house, she had been playing outside and her parent, based on her behavior, believed that she had ingested something. Additional symptoms, including tiredness and abdominal pain, later emerged. She was brought to the emergency room and her physical examination revealed no remarkable signs of distress. The child was discharged to her parent’s care. The following morning, the child was found unresponsive. Emergency services were called and CPR was begun. The child was pronounced dead upon arrival to the hospital. A blood sample taken around the time of death was positive for oxycodone.³

Q: How have considerations about medicines in the environment informed FDA’s recommendations about the disposal of medicines from the home?

Based on available data, FDA believes that the known risk of harm to humans from accidental exposure to these medicines far outweighs any potential risk to the environment from flushing them.

Disposal of these select, few medicines by flushing contributes only a small fraction of the total amount medicine found in the water, given that most medicine found in the water supply is a direct result of normal bodily elimination (in urine and feces) after patient use.

Q: Can the medicines that FDA recommends to flush for disposal be eliminated from the home in some other manner; for example, by drug-take back programs or returning the medicine to the pharmacy?

Yes, if federal and state laws permit. Since these medicines are controlled substances, current Federal and some state laws limit who can take these types of medicines back for disposal after they are dispensed by the pharmacy to the consumer. This legal limitation could prevent take-back programs or pharmacies from accepting medicines containing controlled substances and, therefore, these programs may be hard to find. If there is not a program in your area that accepts medicines containing controlled substances, the most effective way to completely eliminate potential for harm is to remove these medicines from the home by flushing them down the sink or the toilet.

To find out whether there are alternative disposal options for medicines containing controlled substances in your community, contact your city or county government. You can also talk to your pharmacist to see if he or she knows of other disposal programs in your area.

FDA continues to work with and encourage the manufacturers of these products to develop alternative, safe disposal systems.

References

1. Bronstein et al. 2007 Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 25th Annual Report. Clin Toxicol (Phila). 2008;46(10):927-1057.
2. McFee RB, Caraccio TR. "Hang Up Your Pocketbook" -- an easy intervention for the granny syndrome: grandparents as a risk factor in unintentional pediatric exposures to pharmaceuticals. J Am Osteopath Assoc. 2006;106(7):405-11.
3. Armstrong et al. 2004. An unusual fatality in a child due to oxycodone. Am J Forensic Med Pathol. 2004;25(4):338-41.