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Flush it or Crush it? Advising Patients on Disposal of Unused Medications

An Associated Press probe reported that trace levels of prescription and OTC drugs are detectable in drinking water nationwide. Waste water contains consumed drugs that are excreted as well as unused drugs that are flushed down the toilet. After treatment, some waste water enters the drinking water supply. The AP investigation detected trace amounts of various drugs - including hormones, antibiotics, anxiolytics, anti-convulsants, cholesterol-lowering drugs, and others - in the drinking water supply of several major metropolitan areas.

Proper Disposal of Prescription Drugs

In order to avoid misuse, abuse, or diversion of discarded drugs, most unused drugs should be placed into household trash as follows:

• Remove drugs from their original container.
• Mix or crush with an unappetizing substance (coffee grounds, kitty litter, dust) and place into an impermeable container, such as a jar with a lid or a sealable plastic bag.
• Place in household trash.

The only drugs that should be flushed down the toilet are those whose label or accompanying patient information explicitly specifies flushing. Patients should refer to printed material accompanying each medication for specific instructions.

The FDA advises that the following drugs should be flushed into the toilet rather than thrown into the trash:

• Actiq (fentanyl citrate)
• Daytrana Transdermal Patch (methylphenidate)
• Duragesic Transdermal System (fentanyl)
• OxyContin Tablets (oxycodone)
• Avinza Capsules (morphine sulfate)
• Baraclude Tablets (entecavir)
• Reyataz Capsules (atazanavir sulfate)
• Tequin Tablets (gatifloxacin)
• Zerit for Oral Solution (stavudine)
• Meperidine HCl Tablets
• Percocet (Oxycodone and Acetaminophen)
• Xyrem (Sodium Oxybate)
• Fentora (fentanyl buccal tablet)

Some communities host pharmaceutical take-back programs that encourage the public to bring unused drugs to a location for appropriate disposal. Where available, these programs are a good way to dispose of unused drugs.

Source: Federal Guidelines from the Office of National Drug Control Policy, Last Updated: March 20, 2007.