Medication Disposal - What to Do with Old or Unusable Medication

Medical Author: Benjamin C. Wedro, MD, FAAEM
Medical Editor: William C. Shiel, Jr., MD, FACP, FACR

There are many axioms that remind us about how unfair life can be. It always rains after you wash the car. The car noise disappears the moment you drive into the mechanic's bay. Your doctor always changes your prescription the day after you had it refilled.

When you look into your medicine cabinet, you see your medical history. The leftover pain medication from knee surgery, the few antibiotic pills you forgot to finish once you felt better, the cholesterol lowering medication that caused liver inflammation. Small bottles half-filled with potent medicine and elixirs no good to anybody - but what to do with them? Like nuclear waste, nobody wants the leftovers back. Have you ever tried returning pills to a pharmacy after you developed a side effect or an allergic reaction to the medication? What are you supposed to do with the 53 pills left in the bottle?

Most people toss them in the garbage or flush them down the toilet; but there is a problem with disposing of medication this way. These medicinal compounds filter into the groundwater and end up in our lakes and streams. The US Geological Survey studied water from 139 streams in 30 states and found that 80% contained traces of pharmaceuticals. The affect that those traces of pharmaceuticals may have on the environment, plants, and marine life is unknown. This unknown has created a research opportunity, which has been seized by scientists at the Great Lakes Water Institute. Studies are ongoing to determine the effects of fluoxetine (Prozac) and other anti-depressants on fish development. Other work is focused on the effects of atorvastatin (Lipitor), a cholesterol lowering drug, on fish reproduction.

Disposing of old or unused medication may get easier as pharmacies nationwide start programs to accept discarded medicine. An EPA mail back program has been started by the University of Maine; and La Crosse, Wisconsin has developed a return program as part of its household hazardous waste collection program.

Rivers and streams are increasingly being protected from a variety of runoff contaminants from farm waste to industrial toxins. It was only a matter of time that the amount of leftover medication flushed down the toilet would make a difference to the quality of our water.

Limiting the drugs we waste needs cooperation from both the doctor and patient. It may be cost effective to get a six month supply of prescription medication for high blood pressure, diabetes or high cholesterol. However, there is a good chance that the dose or drug will change in that time frame. Doctors need to be aware that constantly changing medications and dosage will lead to a medicine cabinet full of medications with no place to go.

Some doctors' offices have medication receptacles. You simply bring your old or unusable medication to the office and dispose of them in the receptacle. You may want to ask your physician if they have these available.

The problem with outhouses was that people were constantly reminded of what went down the hole. Indoor plumbing was a great invention with flushing confirming another axiom: out of sight, out of mind. But flushing didn't make the medicine go away; it just put it into somebody else's backyard.

References: United Sates Coast Guard, "Water-Quality Data fore Pharmaceuticals, Hormones, and Other Organic Wastewater Contaminants in U.S. Streams, 1999-2000" (http://toxics.usgs.gov/pubs/OFR-02-94/)

University of Wisconsin, Marine and Freshwater Biomedical Sciences Center, "Toxicology with the Zebrafish Model," (http://www.uwm.edu/Dept/MFB/research/res_grp3.html#Effects%20of%20Psychopharm).