To flush or not to flush, that is the question
For a variety of reasons, many of us have leftover or expired medications lying around at home. Nearly 40% of folks say they keep them around for future use, according to a 2019 report by the company Stericycle.1
The pharmaceutical industry has previously overlooked the fact that people have legitimate reasons to get rid of unused meds, says Kristin Fitzgerald, a specialist at the U.S. Environmental Protection Agency’s Office of Land and Emergency Management. Someone, for example, might have a negative reaction to a drug or need to adjust their dose.
Though the industry has recently begun to acknowledge the need for safe disposal procedures—since 2014, drug manufacturers have worked via a nonprofit organization to coordinate responsible drug disposal—she says they can work to promote take-back programs over leaving patients to trash meds themselves.
For the sake of space and safety, it’s crucial to handle medication disposal responsibly. But patients often lack the proper education on medicine disposal,2 even though there are plenty of convenient options available to remove them from your home without risking the health of loved ones and the environment.
Importance of proper disposal of medicines
Without knowing how to properly dispose of unneeded or expired medicine, many people simply chuck pills and other prescription drugs. When these substances aren’t properly contained, they risk flowing out into ecosystems and the water supply.
The impact of pharmaceuticals on wildlife and ecosystems
Flushing extra meds can be common practice in many households, but doing so can have significant environmental impacts once they head down the drain.3 Our sewage travels from the toilet to water-treatment plants. The filtration technologies at these facilities vary widely in their ability to clear water of pharmaceuticals.4 So the drugs may keep flowing until they dissolve in bodies of water like lakes and streams, ultimately causing harm to wildlife.5
Flushing extra meds can be common practice in many households, but doing so can have significant environmental impacts.
Certain medications, such as antidepressants, birth control, and hormones, can alter the growth and reproduction of aquatic species like fish and frogs.6,7 Another common drug, beta blockers, can also impair critters’ development and overall wellbeing in the wild.8 “There are demonstrated negative effects on the environment, especially aquatic ecosystems,” says Fitzgerald.
The impact of flushing drugs on the water supply
Even when flushed meds reach our taps, scientists think short-term health impacts are unlikely,9 though that could change as prescription drug consumption increases in the U.S.10 “When it comes to humans, I think the jury’s still out,” Fitzgerald says. “There’s no demonstrated acute effects on humans but [as for] chronic, long-term exposure to a myriad of pharmaceuticals—that research is very difficult and ongoing.”
Risks of hanging on to unused medications
Beyond harm to our planet, leaving pills lying around can pose risks for other members of the household. Amid the growing U.S. opioid overdose epidemic, a 2015 survey found that more than 60% of respondents kept leftover opioid medications at home.11 Meanwhile, more than half of people who misuse pain relieving drugs report receiving them from friends or relatives.12
In additional to potential misuse by family members, leftover drugs can cause accidental poisoning or contribute to suicide attempts among children and adolescents. “Having them in an unsecured location in the home can obviously be very dangerous,” Fitzgerald says.
How to use drug take-back programs for disposal of unused meds
Instead of tossing old medications and risking both the environment and the people who might access drugs in the trash, you can participate in a drug take-back program. These typically accept both expired and unexpired medications given in person, but some allow you to mail items in.
DEA National Prescription Drug Take-back Day
You can find a variety of programs that will accept your unused or expired medications. These include the U.S. DEA’s National Prescription Drug take-back Day, which falls on April 27 this year. While it has prescription in the name, the program also accepts over-the-counter medications. Check here to find a Take-back Day collection site near you.
Last year, the DEA’s Take-back Day collected nearly 600,000 pounds’ worth of medications. This service is free and anonymous, with no questions asked about the drugs you deposit. “We recommend strongly towards any of the take-back methods the DEA has provided for,” Fitzgerald says.
After these medications get collected on Take-back Day, they’re usually destroyed by chemical digestion or incineration. Incineration is not a perfect solution. It can use a lot of energy and release harmful pollutants, like heavy metals. However, it is important to keep medications out of waste and water.13
Local take-back programs and authorized collectors
As for the rest of the year, you can search for authorized collectors registered with the DEA on the agency’s website. In your area, these may include hospitals, pharmacies, and law enforcement facilities.
What should I do if there’s no take-back program in my area?
If you can’t find any take-back programs near you, you may be able to find a mail-back program online via your state or purchase pre-labelled envelopes online. These mail programs are typically run by private companies, nonprofit organizations, or police departments. Medications they receive are usually destroyed by medical waste incineration. The company American RX Group, meanwhile, sends mailed-in medications to a waste-to-energy facility.
How to dispose of unused meds at home
You have several options to do away with the bottles sitting in your cabinets, like donation, disposal, and drop-box sites, depending on the type of drug and the programs available near you.
Can I donate my unused medicine?
You can donate unused medicine to those in need through organizations like SIRUM and SafeNetRx, as long as they meet the conditions required. For example, SIRUM requires that medications remain sealed, have at least 5 months until expiration, and stay non-refrigerated.
Flushing medicines: When is it safe?
While experts like the EPA’s Fitzgerald highly discourage flushing medications, the FDA says flushing can serve as a last resort for disposal of medications with high potential for misuse and/or abuse or whose ingestion may result in death from one inappropriately taken dose. These include drugs that contain fentanyl. Here is a list of medications on FDA’s flush list.
Disposal of expired medicine in household trash
If your medication has expired and you can’t find a take-back program near you, it’s possible to dispose of most drugs in the trash (as long as they aren’t on the FDA’s flush list). Make sure to remove the drugs from their original containers, mix them with something yucky like dirt or cat litter, and put the mix in a closed container to prevent spillage or leakage. Don’t forget to scratch out personal information on the packaging and throw it out as well (or recycle, if applicable).
You can also mix drugs you’re trashing with packets of DisposeRx, a solution that turns medications into a biodegradable gel so they can be safely thrown out without risking others.
How do I dispose of sharps or needles?
Make sure to place all needles and other sharps into a proper disposal container right after they’ve been used, according to guidance from the FDA. Be careful not to overfill the container and never reuse it. “We discourage sharps from going loose into the trash,” Fitzgerald says. “That’s a very dangerous situation—all sorts of people along the way can get exposed to the needle and potential infectious agents.”
Disposal guidelines vary by community, but you can find local drop-box sites, hazardous waste collection sites, mail-back programs, or special waste pick-up services. SafeNeedleDisposal.org maintains a searchable database of these sites.
How to dispose of medicine bottles?
Certain medicine bottles can be recycled, depending on the type of bottle and the plastic it’s made of. The see-through orange containers are typically made from a type of plastic called polypropylene that’s marked #5; this type of plastic is recyclable in some areas, but these bottles may prove a challenge for recycling machinery due to their small size. You can check with your local recycling program to see whether they accept certain pill bottles.
Some organizations accept old pill bottles. Matthew 25: Ministries, for instance, uses donations in medical supply shipments to developing nations. You can mail them your clean bottles by following these instructions.
You can also reuse old bottles after washing them thoroughly—they can make for a handy container for mini household items like nails, screws, or even vegetable seeds.
How to dispose of liquid medicine?
If you can’t return your liquid medicines to a local take-back program or mail them, mix them with something unappealing, like cat litter. Next, place the mixture in a closed container. Finally, throw it away with your regular household trash.
Then, put the mixture in a closed container and throw it away with your other household garbage. As for the packaging, scratch off any personal details and check if you can recycle it locally.
Specific instructions for the disposal of unused medicines by type
Fentanyl patches
Because used fentanyl patches can pose significant dangers for those not prescribed them, the FDA recommends quickly folding them in half after use with the sticky sides together, flushing them down the toilet and washing your hands thoroughly with water.
Inhaler products
Read the handling instructions on your inhaler product for proper disposal. These meds contain gases that can become dangerous if they’re thrown into a fire or incinerator, releasing toxic fumes. You can contact local facilities like pharmacies, health departments, and trash and recycling centers to see if they accept used inhalers.
Safe storage of medicines
It’s crucial to store medications properly to ensure they work effectively. Keep meds in a cool, dry place in their original containers. Bathroom cabinets may damage medication due to heat and moisture from the shower and sink. Make sure to ask your pharmacist for any specific storage instructions. If you live with children or adolescents, secure your medication in a cabinet with a child-proof latch or lock.
Additional recycling and disposal tips
What do I do with old electronics?
Between 2010 and 2022, the amount of e-waste made per year jumped by 82%, reaching nearly 70 million tons, according to a recent United Nations report. When devices like old laptops, phones, and even cables get dumped into landfills or littered, heavy metals like lead and arsenic, along with flame retardants, can contaminate soil, water, and crops. Several states have gone so far as to ban sending any electronics to the dump. What are you supposed to do instead? Explore the best options to recycle your electronics.
What do I do with old clothes and fabric?
Trends come and go with dizzying speed these days, and even the most sustainable shoppers aren’t immune to needing a white t-shirt refresh every now and again. It’s no wonder that textile waste adds up: The U.S. chucks around 68 pounds’ worth per person every year, according to the latest data from the EPA. Luckily, there’s plenty we can do with fabric and clothes we no longer need. Reputable donation and take-back programs are an excellent first step for items in good condition. For stuff that’s hanging on by a thread, consider upcycling it at home or, as a last resort, taking them to a recycler. See our guide about how to recycle textile.
What do I do with old batteries?
Like e-waste, batteries hitting the bin can lead to serious problems. The materials that power our gadgets and gizmos can leach heavy metals into groundwater and soil after a trip to the landfill. Sometimes they can even spark water-resistant fires. The good news is that most batteries—from the single-use AAs in your remote to the rechargeable lithium power pack on your drill—can be recycled. You’ve just gotta know where to take them. See our guide about how to recyle old batteries.
What do I do with old cleaning products?
Getting rid of cleaning products can be quite messy. Some have the potential to rip through metal, burn skin, catch fire, and react violently to each other or just water and air. The key things to remember when getting rid of old cleaning supplies: read the labels carefully, never (ever) mix bleach and acid, and avoid dumping things down the drain. In many cases, household cleaners are considered hazardous waste, so if you find yourself with any excess, it’s important to understand how to dispose of cleaning products responsibly.
- The Opioid Epidemic and Unused Prescriptions, Stericycle, Mar. 2019 ↩︎
- Medication Disposal Practices: Increasing Patient and Clinician Education on Safe Methods, Journal of International Medical Research, Jan. 2018 ↩︎
- Ibid ↩︎
- Assessing Pharmaceutical Removal and Reduction in Toxicity Provided by Advanced Wastewater Treatment Systems, Environmental Science: Water Research & Technology, 2020 ↩︎
- Pharmaceuticals in Water, U.S. Geological Survey, Jun. 2018 ↩︎
- Effects of Antidepressants in the Reproduction of Aquatic Organisms: A Meta-Analysis, Aquatic Toxicology, Oct. 2020 ↩︎
- Risks of Hormonally Active Pharmaceuticals to Amphibians: A Growing Concern Regarding Progestagens, Philosophical Transactions of the Royal Society, Nov. 2014 ↩︎
- A Comprehensive Aquatic Risk Assessment of the Beta-Blocker Propranolol, Based on the Results of Over 600 Research Papers, Science of the Total Environment, Nov. 2021 ↩︎
- Pharmaceuticals Market, Consumption Trends and Disease Incidence Are Not Driving the Pharmaceutical Research on Water and Wastewater, International Journal of Environmental Research and Public Health, Mar. 2021 ↩︎
- Life Course Patterns of Prescription Drug Use in the United States, HHS Public Access, Oct. 2023 ↩︎
- Medication Sharing, Storage, and Disposal Practices for Opioid Medications Among US Adults, JAMA Internal Medicine, Jul. 2016 ↩︎
- Prescription Drug Use and Misuse in the United States: Results from the 2015 National Survey on Drug Use and Health, Substance Abuse and Mental Health Services Administration, Sep. 2016 ↩︎
- A Review of the Impact That Healthcare Risk Waste Treatment Technologies Have on the Environment, International Journal of Environmental Research and Public Health, Oct. 2022 ↩︎