Should you be flushing your old prescription drugs down the toilet?

Illuminating answers to environmental questions.
Dec. 1 2009 12:05 PM

Should You Flush Your Drugs Down the Toilet?          

The greenest way to get rid of old prescription meds.

Medicine. Click image to expand.
How green is your medicine cabinet?

I've been hearing a lot about how prescription medications and the other drugs we take end up in the water supply. It got me wondering: What's the most environmentally responsible way to dispose of old pills and cough syrups?

It's true: A wide range of pharmaceuticals have been found in our lakes, streams, and drinking water. Scientists are trying to puzzle out what effects these drugs might have on people and wildlife, but there's still a lot we don't know. Even without hard evidence on the impacts of long-term exposure to trace contamination from our water, most government organizations now recommend that you dispose of old medications in the trash, rather than the toilet. (Of course, that doesn't address the fact that, according to most estimates, the vast majority of pharmaceutical pollution comes through our bodily excretions.)

Sometimes, however, broad environmental risks have to be balanced against more immediate hazards—like the danger that a child or a pet might accidentally consume a toxic drug that's lying in a trash can or that someone might steal a medication and use it illicitly. In that case, flushing may be preferable, since the drug is immediately removed from the home and rendered unusable.

In 2007, the Office of National Drug Control Policy, the EPA, and the Department of Health and Human Services issued the first set of federal guidelines for proper disposal of prescription drugs. For the vast majority of medications, the government suggests taking them out of their original containers, mixing them with an "undesirable substance" (such as kitty litter or used coffee grounds), putting the mixture in a Ziploc bag or a container with a lid, then throwing the whole package in the trash.

The guidelines do recommend flushing in a few select cases—such as Demerol, OxyContin, and Percocet—where the risk from accidental ingestion or the potential for abuse is very high. The FDA maintains an ever-evolving list of drugs that should be sent down the toilet.

These federal guidelines aren't binding, and your state or local authority may have somewhat different advice. For example, several states caution patients never to flush any medications, dangerous or otherwise. (Connecticut suggests taking extra steps to keep your meds out of unwanted paws or hands, such as dissolving pills and capsules in water, wrapping blister packs in duct tape, and adding flour, salt, or mustard powder to liquid medications to make "a pungent, unsightly mixture.")

Many organizations also recommend keeping medications in their original containers—after blacking out personal information with a permanent marker or duct tape—in case someone accidentally ingests the contents and the drugs need to be identified. Placing the original container insider another container (like a margarine tub) that's taped shut is sometimes advocated as a further precaution.

"Take-back" programs—in which unused drugs are collected for disposal by pharmacies, community organizations, or government groups—are starting to pop up throughout the United States, though they're often expensive to operate. A law enforcement officer must supervise the collection sites if "controlled substances" (such as Ambien, Vicodin, and codeine) are involved. To see if there's a facility in your area, search the database at Earth911.com for "unwanted or expired medications," or check out this map from the Product Stewardship Institute's Drug Take-Back Network. Sharps Compliance, a Houston-based medical waste company, also operates a mail-in program for unused medications. Drugs collected through take-back programs are generally incinerated.

Finally, there are limited opportunities to donate your unused medications to charity. According to a recent report from the National Conference of State Legislatures, 15 states have enacted laws allowing individuals to donate various kinds of prescription drugs, typically provided that they're not expired, that the packaging is unopened, and that the person donating can provide proper documentation. These programs are a source of concern for some physicians and pharmacists, who worry about the pedigrees of donated drugs (PDF).

When you finish all your pills, what should you do with your empties? Pharmaceutical packaging—like bottles, caps, and blister packs—uses a fair amount of plastic: 1.2 billion pounds in the United States in 2007, according to industry research firm the Freedonia Group. And this plastic is often difficult to recycle.

Most over-the-counter bottles are made of high-density polyethylene (that's No. 2 plastic), though some may be made of polyethylene terephalate (No. 1). Both types are widely recyclable, but many local curbside programs won't take them, because they're small and can jam up equipment. Meanwhile, amber prescription bottles are usually polypropylene (No. 5), which is rarely accepted by recyclers. The design company Preserve collects No. 5 plastics at many Whole Foods, though, and you can also mail your polypropylene empties directly to the company. Some shelters, clinics, and veterinarians' offices also collect prescription vials and reuse them, so if you've got a whole bunch of them on your hands, it might be worth looking for such a facility in your area. The Lantern likes to use hers as coin containers or carrying cases for earrings and safety pins while she travels.

Meanwhile, if you want to reduce the footprint of your personal pharmaceutical habit, you should also spare a thought at the beginning of the process. Buying in bulk usually makes a lot of environmental sense, but those benefits are undercut if you have to throw away an unused product because it's gone bad. If you know you're not going to consume 500 Advil capsules before the expiration date, go for the smaller bottle.

Is there an environmental quandary that's been keeping you up at night? Send it to ask.the.lantern@gmail.com, and check this space every Tuesday.

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