FAQs about Unwanted Medicines and Secure Medicine Return
Have more questions? Email us at safemedicine @ zerowastewashington dot org.
Learn more about medicine abuse, poisonings, and pollution at Waste Medicines - The Problem
A commonly used estimate is that 30% of medicines sold to consumers go unused for various reasons. This is based on studies using different methodologies to estimate or measure the amount of medicines that go unused. Here’s some examples of survey results:
- A recently published survey of 238 residents in California found that 2 out of 3 prescription medicines were reported unused. Common reasons were: disease/condition improved (40.4%), forgetfulness (10.6%), and side effects (8.0%). Law et al. “Taking stock of medication wastage: Unused medications in US household”. 2015. Research in Social and Administrative Pharmacy 11; 571-578.
- The Los Angeles County Department of Public Health conducted a survey of 1,062 residents from December 2015 to January 2016, and found:
- 59% of respondents had medicines in their homes that were expired or no longer needed. 45% of these people said they did not know what to do with them.
- When asked about drop-off or mail-back options for medicine disposal, 87% said pharmacy drop-off is a “good approach” and 69% chose a pharmacy drop-off bin as the preferred method. “Los Angeles County Medicines & Sharps Disposal Consumer Survey Results”. Los Angeles County Department of Public Health. April 8, 2016.
- A 2009 survey of WA residents found similar results:
- Over half of respondents had six or more medication containers in the home, and 39% of those people had at least one container that had expired or would not be used for some other reason.
- 25% of respondents said there were unused narcotics or other medications following a death or major illness of somebody they knew.
- 72% of respondents said that they or a household member would either drop-off unused or expired medicines at a free, convenient location or use a free mailer. “Medication Disposal: 2009 Survey of Attitudes and Preferences Among Oregon and Washington State Residents”. The Gilmore Research Group. December 2009.
Large amounts of leftover and expired medicines have been collected in recent years by voluntary medicine take-back programs in Washington State.
- Snohomish County residents have returned 45,274 poundsof medicines in 6 years to secure drop boxes at the Sheriff's Office and Police Departments. With only word-of-mouth advertising. Collection amounts have been rapidly increasing each year.
- In Pierce County, law enforcement agencies have collected 29,000 of medicines from 2010-2015.
- From 2010 to 2016, DEA-coordinated drug take-back events have collected more than 160,000 pounds of medicines.
See more on about medicine collection amounts and public demand for medicine take-back here: Drug Take Back Works.
There are many reasons why our prescription and over-the-counter medicines go unused. Some waste can be reduced by changes in prescribing practices, dispensing practices, and changes in consumer demand. Even when the health care system and patients do everything right, some medicines are leftover and need secure disposal. Reasons for leftover medicines include:
- Lots of medicines are needed during a serious illness, but when the individual recovers there are leftovers.
- Lots of medicines, including strong pain relievers, are needed for end-of-life care and are leftover for family members to deal with when the patient dies.
- Medicine is not finished if the patient has an allergic reaction, can’t tolerate the drug, or other side effects develop.
- Different medications are prescribed in the search for the right treatment. This is particularly common in treatment for depression and other common psychological conditions.
- Medicines expire before they are fully used. This is common with prescription drugs that patients take only “as needed” for a recurring condition, and with over-the-counter medicines that consumers purchase to have on hand if needed.
- Drugs are overprescribed in some situations. There is increasing awareness in the medical community about the problem of overprescribing, especially for pain pills. WA has adopted strong opioid prescribing and pain management guidelines. This is a complex issue. Responsible practitioners must balance limiting the size of a prescription with a patient’s legitimate need for appropriate pain management, or other treatment.
- Consumers buy more over-the-counter medicines than they will need. This is encouraged by advertising that prompts consumers to “stock up” their medicine cabinets.
- Sometimes people stop taking their prescription medicines before they should, sometimes because they feel better. While physicians stress the importance of medication adherence to patients, this is an ongoing area of emphasis to ensure patients complete drug treatments.
Survey responses from 2,041 Maine residents who returned unwanted medicines in a pilot mail-back program found the following reasons why medicines were returned:
- 47.4 % medicine expired
- 31.1% doctor said to stop taking it
- 27.3% doctor ordered a new medicine
- 24.2% other reason
- 18.0% felt better
- 12.2% side effects
- 11.9% negative reaction or allergy
- 7.2% didn’t want to take it
Respondents could select multiple reasons.
Source: Kaye, Crittenden, Gressitt, Sorg, LaBrie and Chase. Safe Medicine Disposal for ME: A Handbook and Summary Report April 2010. Page 47. Available online from this site: http://umaine.edu/safemeddisposal/resource-library/
Medicine take-back programs are the secure and environmentally sound way to dispose of leftover prescription and over-the-counter medicines. Secure medicine take-back is recommended as the safest medicine disposal method by the FDA, the DEA, the EPA, and local agencies.
- FDA – How To Dispose of Unused Medicines “Is your medicine cabinet full of expired drugs or medications you no longer use? How should you dispose of them? Many community-based drug “take-back” programs offer the best option.”
- DEA Drug Disposal Information provides resources on the DEA’s Rule for take-back of controlled substances and locations of Authorized Collectors for take-back of controlled substances. Flyers for the DEA’s National Drug Take-back Initiative state: “Unused prescription drugs thrown in the trash can be retrieved and abused or illegally sold. Unused drugs that are flushed contaminate the water supply. Proper disposal of unused drugs saves lives and protects the environment. Take-back programs are the best way to dispose of old drugs.”
- EPA - Collecting and Disposing of Unwanted Medicines “EPA encourages the public to take advantage of pharmaceutical take-back collection programs that accept prescription or over-the-counter drugs, as these programs offer a safe and environmentally-conscious way to dispose of unwanted medicines.”
- WA State Department of Health’s TakeAsDirected guidance to reduce teen misuse of medicines.
In areas where there are no drug take-back programs, federal and local agencies are having to advise people to throw medicines in the trash as an interim, or last resort measure. However, some local governments prohibit disposal of waste household medicines down the sewer or in the solid waste stream. In WA, this includes Kitsap County, Snohomish County, and the City of Tacoma.
Disposing of potentially dangerous unused medicines in the household garbage is not secure, not recommended for controlled substances by the DEA, and does not ensure the pharmaceuticals won’t be released into the environment.
- The FDA, DEA, and EPA all recommend medicine take-back programs as the best method for safe disposal of unused medicines, and only suggest putting medicines in the trash if there is no drug take-back program available. See FDA’s How To Dispose of Unused Medicines.
- Trash disposal, or “in home disposal”, methods ask residents to mix leftover pills with kitty litter or coffee grounds as an attempt to reduce risks of diversion from the trash. This can be messy, and puts residents at risk of exposure to pill dust and residues, especially if residents crush up the pills or dissolve them in liquids. These methods can be difficult for large volumes of pills. There is no evidence that residents are willing to follow these procedures to hide medicines in the trash. Secure medicine take-back is safer.
- The DEA wants leftover medicines that are controlled substances collected and destroyed so that they are non-retrievable by those who are addicted. DEA has stated “sewering (disposal by flushing down a toilet or drain) and landfill disposal (mixing controlled substances with undesirable items such as kitty litter or coffee grounds and depositing them in a garbage collection) are examples of current methods of disposal that do not meet the non-retrievable standard.” Federal Register 79 (174): page 53547. September, 2014.
- Pharmaceuticals are commonly found in landfill leachate according to U.S.G.S. sampling and peer-reviewed research studies. These chemicals are released into waterways when leachate is pumped out of a landfill and sent to wastewater treatment facilities because pharmaceuticals are not effectively removed or degraded by those facilities.
- Some local governments in WA State prohibit disposal of household medicines in the garbage because of these problems. In WA, this includes Kitsap County, Snohomish County, and the City of Tacoma. They recommend using a secure medicine take-back program.
Why is medicine take-back an important prevention strategy to reduce abuse, poisonings, and pollution?
Public health leaders, substance abuse professionals, health professionals and law enforcement agencies support medicine take-back as part of a comprehensive prevention strategy for medicine abuse, addiction, and overdoses. The home medicine cabinet is the most common source of medicines that are abused. Safe storage of medicines in the home and secure disposal of medicines when they are no longer needed reduces the supply of medicines that could be misused.
Secure medicine take-back is part of 4 "pillars" of a comprehensive prevention approach for reducing medicine abuse. WA State has taken action on opioid prescribing and pain management, has a prescription drug monitoring program, and continually enforces against illegal "pill mills". But medicine take-back programs are not available in every community and are underfunded and underpromoted.
Pillar 1: Education - Educate Health Care Providers About Opioid Pain Medicine Prescribing
Pillar 2: Monitoring - Enhance Prescription Drug Monitoring Programs
Pillar 3: Disposal - Increase Medicine Return/Take-Back and Disposal Programs
Pillar 4: Enforcement - Address Diversion and Pill Mills
National Drug Control Strategy. 2015. White House Office of National Drug Control Policy. Pages 87-101.
Wastewater, water quality, and solid waste agencies also support medicine take-back as a prevention strategy for pharmaceutical pollution. With about 30% of medicines sold going unused, medicine take-back keeps those waste medicines from contributing to pharmaceutical pollution in our environment.
Actions are also needed to address the many other sources of pharmaceutical pollution. Human excretion is a problematic source that cannot be eliminated at this time without telling people to stop taking medicines. But more actions can be taken to reduce pharmaceutical pollution from manufacturing facilities, agricultural uses of medicines, and improper disposal from healthcare facilities and businesses.
No, the programs currently operating at some pharmacies and some law enforcement offices are successfully complying with all regulations. Medicine take-back programs must follow federal and state regulations for handling and disposal of household medicines, in particular for medicines that are controlled substances. The DEA’s Rule, issued in October 2014, defined security protocols for take-back of prescription drugs that are controlled substances, like narcotics and stimulants, by pharmacies, hospitals and other authorized collector. The DEA Rule also authorized new and easier options for transport of collected medicines, including use of reverse distributors or common carriers to disposal facilities. A number of companies now provide turnkey systems for residential medicine take-back services for collection, shipping, and disposal of medicines including controlled substances, such as Sharps Compliance.
The estimated annual cost of a statewide medicine take-back program is only about 0.1% of annual medicine sales of $5.7 billion in WA State. Actual program costs will depend on details of the program design and on the amount of medicines collected. The ongoing costs of a comprehensive medicine take-back program includes costs of secure drop boxes, collection supplies, pre-paid mailers, collection events, transportation, disposal, promotion, and administration.
Here’s how our estimate was made from cost projections of county pharmaceutical stewardship programs:
- ~ $1.2 million per year for an Alameda County, CA program (pop. ~ 1.6 million in 2013) was the program cost estimate stated by PhRMA, BIO and GPhA in 2013 in their unsuccessful legal motion against Alameda County’s Safe Drug Disposal ordinance.
- This is in the same ballpark as a program cost estimate of ~$1 million per year for a King County, WA program (pop. ~ 2 million in 2013) in a Board of Health Staff Report in June 2013.
- ~$1 million per year is the rough average of a low and a high estimate in the report:
- Estimate 1: ~ $600,000 annually, assuming 85 drop-off sites and 50,000 pounds medicines collected per year.
- Estimate 2: ~ $1.3 million annually, assuming 400 drop-off sites and 300,000 pounds medicines collected per year.
- Note: Both estimates assume pharmacy drop-off sites participate voluntarily without staff time compensation.
- Extrapolating the industry’s higher cost estimate for Alameda County to WA State’s population of 7.2 million yields: $5.4 million per year estimated cost of statewide pharmaceutical stewardship program.
- Total pharmaceutical sales into WA State were about $5.7 billion per year in 2015.
- Retail pharmacy sales of prescription medicines in WA State in 2015 were $5,008,376,790 and 92,928,952 units. Does not include mail-order prescriptions which represent about 11% of total prescriptions dispensed in U.S. Source: Kaiser Family Foundation
- Over-the-counter medicine data based on sales at all outlets in U.S. in 2015, extrapolated for WA State which is 2.22% of U.S. population, were $712,620,000 and 128,760,000. Source: Consumer Healthcare Products Association
- Total = $5,720,996,790 and 221,688,952 units.
The estimated $5.4 million cost of a statewide medicine take-back program is less than 0.1% of the $5.7 billion of annual pharmaceutical sales in WA State.
- Update: some pharmaceutical industry representatives are stating that the MED-Project program for King County is $2 million per year to the more than 350 participating manufacturers. This amount probably includes start-up costs of arranging the secure drop-off sites at pharmacies, hospitals, and law enforcement offices.
Using this amount, a statewide cost projection would be about $7 million, which is 0.12% of teh $5.7 billion in annual pharmaceutical sales in WA State.
As another comparison to an estimated $5.4 million cost of statewide medicine take-back program, the pharmaceutical industry spends the following on marketing in WA State:
- $532 million on total pharmaceutical marketing in WA in 2014. This amount was extrapolated per capita from total pharmaceutical marketing spending of $24 billion in the U.S. WA is 2.22% of U.S. population. The Pew Charitable Trusts. “Persuading the Prescribers: Pharmaceutical Industry Marketing and its Influence on Physicians and Patients” Nov. 2013
- $115 million on direct-to-consumer ads in WA in 2015. This amount was extrapolated per capita from total direct-to-consumer ad spending of $5.2 billion in the U.S. WA is 2.22% of U.S. population. STAT (Boston Globe Media). “Drug makers now spend $5 billion a year on advertising. Here’s what that buys.” March 9, 2016
The Drug Enforcement Administration (DEA)’s Rule for Disposal of Controlled Substances went into effect on October 9, 2014 to implement the federal Secure and Responsible Drug Disposal Act of 2010. The Rule defines protocols for take-back of leftover controlled substances from any person the drug is prescribed to, any member of that person’s household, and from individuals lawfully entitled to dispose of a deceased person’s property. Controlled drugs for pets can also be disposed of by household members.
Allowed Collection Methods:
- Secure collection receptacle locations (i.e., permanent drop-off boxes) – operated by authorized drug manufacturers, distributors, reverse distributors, retail pharmacies, hospitals/clinics with an on-site pharmacy, narcotic treatment centers, or law enforcement agencies. Certain types of long-term care facilities may also have a secure drop box operated by an authorized retail pharmacy or by an authorized hospital/clinic with an on-site pharmacy.
- Take-back events – conducted by law enforcement agencies only, but other entities may partner with law enforcement to promote and coordinate the take-back event.
- Mail-back programs – operated by authorized drug manufacturers, distributors, reverse distributors, retail pharmacies, hospitals/clinics with an on-site pharmacy, narcotic treatment centers, or law enforcement agencies that can meet specific requirements of the Rule.
Comingling of medicines allowed: By any of the approved collection methods, controlled substances may be co-mingled with other consumer medications. Consumers can place all leftover medicines into one collection box or one mail-back envelope without having to attempt to identify and separate different medications.
Transportation and final destruction options: The proposed rule makes it simpler for authorized collectors to send drugs away to final destruction through existing providers of pharmaceutical waste disposal. Reverse distributors, drug distributors, and common carriers may be used. The Rule does not limit the specific destruction method, but requires that drugs must be rendered non-retrievable and the disposal method must comply with federal, tribal, state, local laws. DEA specifically says flushing and trash disposal do not meet the non-retrievable standard for collected medicines.
See the Rule and the DEA Drug Disposal Information webpage for additional information.
Prior to this Rule, leftover prescribed controlled substances - such as prescription narcotics and stimulants - could only be legally collected from residents by law enforcement, at take-back events or drop-off programs. The Secure and Responsible Drug Disposal Act, effective October 2010, amended the Controlled Substances Act and authorized the DEA to develop the Rule, but the federal law does not mandate the creation of any medicine take-back programs, nor does it provide any funding for those programs.
Why do over-the-counter medicines need to be collected by take-back programs? Isn’t the problem only with prescription drugs?
Some over-the-counter medicines are commonly abused, especially by teens. And over-the-counter medicines are a common cause of preventable poisonings in the home. Improper disposal of over-the-counter medicines through flushing or trash disposal contributes to pharmaceutical pollution in our environment. The regulatory distinction between prescription and over-the-counter drugs reflects whether the FDA deems the drug safe for self-medication when used as instructed, not whether the drug poses a risk of poisoning or abuse if accidentally or intentionally misused. And not whether the drug is safe in our environment. Sometimes the same medicine that is available in over-the-counter form, is also prescribed in a higher dosage or are purchased as a prescription under certain health plans.
- OTC cough medicines, antihistamines, decongestants, and diet pills are often abused, especially by teenagers. See https://www.drugabuse.gov/publications/drugfacts/cough-cold-medicine-abuse and http://abovetheinfluence.com/drugs/over-the-counter/
- Loperamide – an anti-diarrhea medicine sold under the brand name Imodium – is being abused by opioid addicts. Loperamide is now available over-the-counter, but it used to be regulated as a prescription drug and a controlled substance. See http://nyti.ms/1UR8BTo
- Drugs are often shifted from prescription status to over-the-counter. The pharmaceutical industry is working to convert a large number of drugs currently sold as prescription to over-the-counter status, including drugs for chronic conditions like hypertension, lipid-lowering, osteoporosis, arthritis. See www.chpa.org/Switch.aspx
- An example is nicotine patches for smoking cessation. These patches were initially prescription only, but are now available over-the-counter. Nicotine is toxic, and exposure to even small amounts can be fatal to children. Nicotine patches designate as federal hazardous waste for disposal.
- Several over-the-counter medicines, e.g., ibuprofen, Tylenol, and antihistamines, are among the top ten causes of poisonings in Washington homes, especially for children. WA Poison Center’s 2014 Top Ten List
- One study found that 34% of ER visits for children poisoned by medicines in the home were a result of over-the-counter medicines. Schillie et al. “Medication overdoses leading to emergency department visits among children” 2009. Am J Prev Med 37: 181-187.
- 26% of child poisoning deaths in Washington were caused by someone else’s over-the-counter medications and 32% were caused by someone else’s prescription medications. Sabel, J. (2004). Washington State Childhood Injury Report – Poisoning Chapter. WA DOH.
Also, as a practical matter, most consumers do not know the difference between prescription medicines and over-the-counter medicines, so it is unrealistic to expect consumers to separate the types of drugs. It would burden authorized collectors to have to try to exclude over-the-counter medicines from being deposited in a secure drop box. The effective and convenient approach is to encourage consumers to return any unused or expired medicine used in the home to a secure and safe medicine take-back program.
Medicines that have been used or stored in someone’s home are typically not appropriate for donation or redispensing because the packaging has been opened and/or it is not possible to verify that the medicines have been safely stored and not tampered with. Medicine take-back programs collect and dispose of such waste medicines that are not appropriate for reuse.
Since 2014, Washington’s “Access to Prescription Drugs” law (69.70 RCW) has allowed drug donations under specific conditions to increase access to medicines for uninsured and low income individuals. Health practitioners, pharmacists, medical facilities, drug manufacturers, and drug wholesalers may donate unused prescription drugs and supplies to a pharmacy for redistribution. Drugs must be in original sealed packaging, must be at least six months from their expiration date, and must be inspected by a pharmacist. Beginning in January 2017, a patient can also donate unopened, sealed medications equipped with a time-temperature indicator device to a pharmacy that verifies the drug’s safety. This program was authorized by the Legislature without dedicated funding, so we are not aware of how many medicine donations have occurred.
Pharmaceutical pollution is the result of many sources including human excretion, agricultural sources, manufacturing releases, and improper disposal of unused medicines. Scientific analyses that measure drugs in our waterways cannot distinguish between these sources; therefore, the relative contribution of each source is unknown. Human excretion is a problematic source that cannot be eliminated at this time without telling people to stop taking medicines. However, it’s estimated that 30% of medicines sold to consumers go unused. It’s smart and simple to keep all those leftover medicines out of our waterways by proper disposal at a medicine take-back program.
Scientists and credible environmental and health organizations are concerned, even about these low concentrations of pharmaceutical pollution. Research is demonstrating harm to fish and other aquatic species from exposure to the low levels of pharmaceuticals commonly found in the environment.
- Learn more on these websites:
- A recently reported study in Puget Sound found more than 80 common medicines, such as Prozac, Advil, Lipitor, Valium, Flonase, Oxycontin, and Benadryl, some at higher than expected levels. Sources appear to be effluent from wastewater treatment plants, as well as septic systems. Juvenile chinook salmon from the waters also tested positive for medicines. See Seattle Times, Feb. 23, 2016: http://www.seattletimes.com/seattle-news/environment/drugs-flooding-into-puget-sound-and-its-salmon/
- Even some members of the pharmaceutical industry admit there’s a problem, like this scientist at Merck: "There's no doubt about it, pharmaceuticals are being detected in the environment and there is genuine concern that these compounds, in the small concentrations that they're at, could be causing impacts to human health or to aquatic organisms." - Mary Buzby, director of environmental technology for Merck & Co. Inc, in USA Today, March 10, 2008. “AP: Drugs found in drinking water”.
- Contamination of municipal drinking water supplies by low levels of a complex mixture of pharmaceuticals is a growing concern. Learn more from this Associated Press investigative series: http://hosted.ap.org/specials/interactives/pharmawater_site/day1_01.html
Levels of pharmaceutical compounds detected in some drinking water supplies are low, below therapeutic doses, and potential health effects are not known. However, the presence of a mixture of drugs in some drinking water supplies suggests the need to reduce environmental contamination through safer disposal of waste medicines. Some drinking water supplies, such as Seattle’s and Spokane’s, have tested negative for pharmaceuticals because their water sources are from pristine watersheds. This result is expected for any water supply which is protected from human activities. Municipalities that use water sources downstream of wastewater treatment facilities are those which might detect pharmaceuticals.
- Harvard Health Letter. June 2011. “Drugs in the water. Pharmaceutical pollution doesn't seem to be harming humans yet, but disturbing clues from aquatic life suggest now is the time for preventive action.” http://www.health.harvard.edu/newsletter_article/drugs-in-the-water
- Journal of the American Medical Association review article: Traces of Drugs Found in Drinking Water: Health Effects Unknown, Safer Disposal Urged. Bridget M. Kuehn JAMA. 2008;299 (17):2011-2013
- A 2008 Associated Press series published the results of a nationwide study that found medicines in the drinking water of 24 major metropolitan areas serving 41 million Americans. Some frequently detected compounds were atenolol (heart medication), carbamazepine (mood-stabilizer), gemfibrozil (anti-cholesterol), meprobamate (tranquilizer), naproxen (pain-killer), phenytoin (anti-seizure medication), sulfamethoxazole and trimethoprinm (antibiotics).
- AP Investigation: Pharmaceuticals Found in Drinking Water. (2008) Web site with complete series of articles
- “Top 11 compounds in US drinking water”, New Scientist, January 12, 2009
- “AP Probe Finds Drugs in Drinking Water”, Seattle Times, March 12, 2008
- A World Health Organization report recommends the use of medicine take-back programs and finds that "Inappropriate disposal practices, such as flushing unwanted or excess drugs down toilets and sinks and discarding them into household waste, are common and may be the main contributors to pharmaceuticals in wastewater and other environmental media, such as surface waters and landfill leachate.” World Health Organization. (2011) “Pharmaceuticals in Drinking-Water”. Technical Report WHO/HSE/WSH/11.05.
Last Updated (Sunday, 05 March 2017 15:17)