This article originally appeared in the January 2006 Harvard Heart Letter and is provided courtesy of Harvard Health Publications.

Leftover drugs pose prescription for trouble

Few programs exist for environmentally safe drug disposal. Flushing them is a no-no.

This year, you’ve resolved, will be the year you finally clean out your medicine cabinet. No more half-full vials of blood pressure pills dating back to the 1990s. Out with the crusted tubes of salve, bottles of crystallizing cough syrup, and assorted containers of mystery medicine.

It’s a good idea. Hanging onto a slew of unused medications can increase the chances of taking the wrong one, and old drugs can lose their potency.

But before making a clean sweep, take a moment to think about where that medicine will likely end up — our water supplies. Armed with increasingly sensitive measuring devices, geologists, limnologists, and other scientists are finding everything from aspirin to Zoloft in streams, rivers, and lakes. No one yet knows what effect these substances are having on fish, other critters, and humans.

Much of this drug pollution comes from us. Anyone who takes a drug excretes it — the body absorbs or breaks down only a portion of most drugs, the rest ends up in the toilet. Tossing unused or unwanted medications in the trash or flushing them down the toilet adds to the problem. Other sources include hospitals, nursing homes, and animal feedlots.

No such thing as “away”
Unused drugs pile up for a variety of reasons. It’s not uncommon to get a new prescription for a stronger dose or different drug before finishing the old one. Forgetfulness, side effects, and mistrust cause pills to pile up. Medications are also left over when people get better, or die.

There are two main reasons why people tend to hold on to unused or expired medications: They don’t know what to do with them and/or feel it is a shame to toss out perfectly good — and often expensive — medicine.

The traditional advice has been to flush old drugs down the toilet or put them in the trash. Neither one is a good method. Flushing unused medications down the toilet can kill helpful bacteria in septic systems, and they pass largely untouched through sewage treatment plants. Children and animals can get into drugs tossed in the trash, and as they sit in landfills, drugs can trickle into groundwater.

What about recycling? After all, there are programs to donate used eyeglasses and hearing aids. Why not medicines? A tangle of regulations from the Food and Drug Administration, Drug Enforcement Administration, Environmental Protection Agency, Department of Transportation, and even the U.S. Post Office make it difficult to recycle medicines. There aren’t any bad guys here. The rules were established to ensure that the drugs people get are safe and effective, something that is hard to do once they have left the control of a pharmacy.

A few innovative programs are tackling the problem of drug disposal. In Clark County, Washington, and LaPorte County, Indiana, residents can drop off unused or expired medications during household hazardous waste collection days. The state of Maine has embarked on a program that would create drug turn-in days and allow Mainers to mail unused drugs to the state Drug Enforcement Agency. Programs getting off the ground in Louisiana, Oklahoma, and a handful of other states are distributing unused drugs to the needy.

Lesser of two evils
What can you do now if you’re itching to clean out that cabinet? See if you have any environmentally sound options first. Ask your doctor or pharmacist if he or she can take back unused or expired medications. Call your city or state to see if they have disposal programs.

If you come up empty, don’t flush your drugs. A better, though still not perfect, alternative is to put them in the trash, according to Christian Daughton, an EPA scientist who has energized interest in this area.

Here are a few tips for safe drug disposal:

Keep medications in their original containers. Most drug vials or bottles are childproof and watertight. Leave the label on, but scratch out your name to protect your privacy.
Add some water to pills or capsules and flour or cat litter to liquids.
Put bottles or vials in an empty margarine tub, yogurt container, or paper bag so it ’s tough to see what’s inside.