To Flush Or Not To Flush Unused Medications?

It Depends On Who You Ask

The FDA is concerned about those expired or unused medications that may still have a potent toxic effect, even though they are out of date.

More than 250,000 cases of accidental poisoning were reported to poison control centers in 2007 and many involved children.

The agency cites the example of a two-year-old boy who was found with an open bottle of methadone, an opioid drug that can be used for the management of pain, reports the FDA.

The child was taken to the emergency room and the medication flushed from his system. Later the same day he was found not breathing and without a heartbeat. The child died.

Then there was the case of a four-year-old girl who was found not breathing by her grandparents. The child died, the FDA reports.

An autopsy reveals a transdermal fentanyl patch, a strong opioid pain medication, in her gastrointestinal tract. The child had apparently found a discarded patch in the trash and ingested it. She died in a massive overdose of fentanyl.

Children are most likely to ingest adult medications. There were approximately 5,000 cases of accident exposure to children six years and younger in 2007.

So the agency is issuing new consumer guidelines for disposal, the second time in as many years.

FDA Guidelines- Flush Some

Most leftover medications can be mixed with something unpalatable such as coffee grounds or cat litter, sealed in a container and thrown away in household trash.

For controlled substances such as high-potency opioids, the FDA says dispose of them by flushing down a sink or toilet. A list of medications safe for flushing includes Demerol, Dilaudid, Methadone, Morphine Sulfate, Percodan, among others.

The FDA says, "it is aware of recent reports that trace amounts of medications have been found in waterways but the agency believes that any potential risk to people and the environment from flushing this small, select list of medicine is outweighed by the real possibility of life-threatening risks from accidental ingestion of these medicines.”

Fish & Wildlife- Don't Flush

The U.S. Fish and Wildlife Service (FWS) disagrees about the flushing option.

FWS, the American Pharmacists Association, and the Pharmaceutical Research and Manufacturers of America group have come up with their own “SMARxT DISPOSAL” program to protect the nation’s fish and aquatic resources from disposed medicines.

It reports that 80 percent of the male smallmouth bass in the Potomac River are growing eggs. The reason is still a mystery, but pharmaceutical or agricultural pollutants that contain hormones are strongly suggested. Hormones are used in farm animals to produce bigger animals faster and residue ends up in farm manure and runoff.

The Potomac River supplies drinking water for the Washington metropolitan area and surrounding communities, though there is no indication humans are being affected by flushed medications.

Unlike the FDA, it says DO NOT flush unused medication or pour them down a sink or drain. Instead, it suggests mixing them with sawdust or coffee grounds seal the bag, breaking down capsules or liquid, and put it in the trash. Remove the address and prescription labels.

This also applies to pet medications.

Both parents and grandparents medication may be available to young children. For older children, medication in friend’s medicine cabinets can be misused. Don’t rely on child-resistant caps.

For the even more conscientious, there may be a drug take-back program that is offered in some municipal trash disposal agencies, though because of the risk of misuse, these programs may be tough to find through your city or county government. A pharmacist may be knowledgeable about disposal programs in your area.

Call your recycler to see what, if any is available. #