Year-End Clearance…in Aging Medicine Chests

Most likely, to confront commercialism during this gift-giving time of year, I often think about having a bit less ‘stuff’ around me. [A funny thought for a mild hoarder such as I am.] Thus, similarly to when spring-cleaning is in the air, at the end of the year I consider a clearance, such as cleaning out my closets. Maybe ‘clean’ is the wrong word – more like de-clutter. Of course, winnowing out clothes can be emotional and carry its own weight (accidental pun there about weight and clothing). We’re all different in the apparel we like, what we feel comfortable wearing, or sentimentally want to keep. That means certain items could stay in our closet for 50 years. [I already admitted I can be a hoarder.] No harm in the decades-old favorite shirt. That got me to thinking that we can’t resort to the same game plan for the medicine ‘closet’.

Such a cupboard-clear-out endeavor sounded alarm signals in my head. Not because of my own cabinet but because of a general concern -– doing it without causing harm. To be totally candid, I am lucky enough at this point in my life to have a clean medicine cabinet. Clean when it comes to medicine anyway. I have no prescriptions to check, let alone toss, but other folks aren’t as fortunate. Especially at holiday times when inquisitive youngsters (or experimental teens) are visiting, drug-dumping may be a proactive step. And for those with pets, the medicine cabinet might be safe – but not the garbage pail.

Frankly, the ‘WHEN’ to discard is important. Drugs lose effectiveness or potency with time, heat and fluctuating temperatures, light or humidity. But I am ignoring that question in this post. I am not writing about WHEN, but only HOW we ditch (and maybe why).

FDA Catching up with the Times?

It was not long ago that the FDA indicated that flushing some medications down the toilet or pouring them down the sink helped prevent accidental ingestion. Their guidelines recommended consulting one’s physician, medicine leaflet or the FDA’s own list of drugs okay to flush. This has been walked-back a bit. If they don’t revert to older ways (less-care-for safety regulations), they will continue to discourage flushing. You can guess the major reason why – water supplies.

Drugs in Our Water

If you don’t take part in regular household recycling programs (for paper, plastics, glass etc.) because you don’t think your small role in ‘reduce-reuse-recycle’ makes a difference, then you might lean the same here. [No, I am not suggesting anyone ‘reuse’ their drugs.] Still, there could be health issues and the collective overview is disturbing.

Water-Water Everywhere. Numerous nationwide studies repeated since 2000 (conducted in 30 states by the US Geological Survey – USGS) have found at least 80% of our lakes, rivers and streams have tested for low (or higher) levels of drugs. These include an interesting assortment: steroids, hormones, antibiotics, contraceptives, anti-depressives, beta-blockers, anti-convulsants, and mood stabilizers. More recently, with opioids on everyone’s lips (so to speak) they too have become a major concern. An example was a small town not far from me that made the news. Just north of Medford Oregon, the level of opioids in the community water was alarmingly high after a 2017 testing. Even as early as 2000, the Associated Press reported a “vast array of pharmaceuticals” had been “found in the drinking water supplies of at least 41 million Americans.”

To be clear, the amount of any one drug in the waters is hundreds of times lower than the original full strength drug. Because of this, agreement has been unclear as how this contaminated water affects humans. [Studies evaluating the combination of these drugs or synergistic interactions with people do not seem available.] The Citizens Campaign Fund for the Environment (CCFE), most active in the northeast, emphasizes public awareness and healthier alternatives. They point out that long-term exposure to low-level antibiotics may result in “Superbugs” – evolved (or re-emerging), drug-resistant microbes and bacteria. Thus, putting humans at risk in a roundabout way. But we aren’t the only ones in the loop.

Fishermen & Environmentalists Concerned

The potential harm to humans at this point is (as reported) unclear. The same is not true for animals and fish that live with, or in, these tested waters. The Florida Department of Environmental Protection has researched this and states “Although this method of disposal [flushing] prevents immediate accidental ingestion, it can cause contamination in our aquatic environment because wastewater treatment systems, including septic tanks, are not designed to remove many of these medications.” The US Fish and Wildlife Service reaches further, with worry about general environs. They explain, “the improper disposal of unused medications by flushing them or pouring them down the drain may be harmful to fish, wildlife and their habitats.” Thus, it is of great concern to environmentalists, fishermen, and those who eat fish or drink most waters.

Three (3) Causes – not all under our control

1. — All professionals suspect that the foremost reason drugs are in the water is due to a natural process of contaminated urine or stool flushed down the toilet.

“The main way drug residues enter water systems is by people taking medicines
and then naturally passing them through their bodies.
Many drugs are not completely absorbed or metabolized by the body
and can enter the environment after passing through wastewater treatment plants.”
— Raanan Bloom, Ph.D., an environmental assessment expert at the FDA.

Other than not succumbing to over-medicating ourselves, there is little we can do to prevent this source of contamination.

2. — Improper or illegal disposal from medical, veterinary clinics, pharmaceutical companies and long-term care facilities as well as other non-medical sources.

“In many hospitals and clinics, the standard procedure for disposal of
numerous unused pharmaceuticals has been simply to pour them down the drain.
That is a critical public health issue, so both federal and state regulations have been developed
prohibiting this with respect to dangerous drugs.
But there remains a lack of awareness on the part of many healthcare professionals
of the laws and best practices.”

— Russell F. Mankes, Ph.D., a chemical hygiene officer at
the Albany Medical Center, NY;
studied risks associated with health facility waste disposal systems.

Hopefully with increased awareness and the “Secure and Responsible Drug Disposal Act” of 2010 (signed into public law October 2010) we will witness positive impact on disposal process. It is difficult to know how the fines will be levied and with what degree of fairness or justice. Certainly penalties don’t always contribute enough to compensate for the problem. Still, even in 2004 (long before the act), a $214,420 fine to NY Memorial Sloan-Kettering Cancer Center was noticed. Such penalties may act as a deterrent, especially as proper procedures become easier and less costly to implement.

I imagine most of us aren’t interested in reading details of such medical practices. However, if I am in error, you can consult the Institute for Safe Medical Practices’ (ISMP) 2017 report on “best practices” – here simply as a reference.

Helpful tip from drb. One new product, generally marketed to hospitals and medical facilities is available in smaller quantiles for home use. If disposal is a common need in your household, look into this product called RxDestroyer. There may be others of which I am unfamiliar. Additionally, I don’t know enough about the new product, its use, or benefits. Particularly I wonder about their claims to protect water, but it is worth examining. They caught my attention. You can start your search with their YouTube video.

3. — Flushing or Dumping old or unwanted pharmaceuticals and drugs. It’s one of the noted causes, and the one-word solution is easy – don’t.

Helpful tip from drb. To limit effort and costs, when possible, and especially for a first time experience with a drug, ask the doc for a sample or a smaller prescription amount. It may be less costly and less to dispose of, particularly if it doesn’t work for you – not a rare scenario.

Options when Choosing to Avoid the Flush?

Not everyone wants to deal with drug disposal outside their house. I will address home-disposal shortly: the 2^nd best method. First, the preferred method is some type of a Take-Back program, of which there are several stripes.

The Drop Box or Collection Sites

A friend, who professionally worked for a hospital, casually mentioned to me that he “wasn’t likely to walk into a police station with a bag of drugs in hand.” I know others who would relate to that hesitation. This may be the reason that in some states, new ‘Pharma-disposal’ drop boxes (and online tools to locate them) have been developed. Folks may simply feel too exposed in the police station. And from watching TV, they don’t believe in the possibility of anonymity there. Yet, the police stations (according to what I have read) don’t require forms, questions and answers or even your name to drop off medications. Their goal is to get the stuff out of circulation. Some areas have special collection sites sponsored by the federal of local government to do the same drop off. Unfortunately, they’re often not scheduled regularly and may have some restrictions. [Realize that ‘Household Hazardous Waste’ day collections generally do not accept drugs or meds.] Additionally, more hospitals – a logical site – have installed drug boxes. Regrettably, liability has remained a concern for many places.

For state-by-state info, check out the Safe Drug Disposal Portal developed by the Product Stewardship Institute. Click on it here and use the drop down menu at “more in this section” for a reference to your own state.

Mail Back & Special Waste Pick Up

Some pharmaceutical companies are now providing special disposal bags inside the prescription boxes, some are ‘mail back’ containers. Special disposal bags are also for sale online or in drug stores. For a fee, pre-paid mailers for OTC and prescription medicines are available at certain chains like Walgreens, RiteAid and CVS. Individual pharmacies can explain their restrictions. Needles or “Sharps” should not be mailed in home-made containers or those for other medications. However, selected mail-back programs do provide for disposal of Sharps (so, check into this if you regularly self-inject). Without specifically designed mail-back parcels, sharps need special attention (see home disposal in chart) or preferably a “waste pick-up service.”

DEA Take-Back Program

If the police station makes you nervous, the federal Drug Enforcement Administration (DEA) may create an unwelcomed tingling in your boots. Still, since 2010 when the DEA started their Take-Back program (and National Take-Back Days), the response has been unpredictably successful. Last year for the efforts sowed, they reaped over 366 tons of prescription medications. And since the inception of the program, it has collected a dumbfounding 7.1 million pounds of drugs in their more than 5,200 collection sites. In the words of the DEA:

“Take back programs offer a safe, simple, and anonymous
way to keep dangerous prescription drugs out of the wrong hands
and prevent substance abuse.”

A place near you? You can put in your zip code and find the nearest authorized public disposal location through the DEA site.

Second Best Method

We can see that disposing of expired, unwanted, or unused medicines through a drug take back program or collection site is perhaps best. However, if we are going to do it at home, there are certain steps to follow that make it at least the second best method.

Final thought

I realize that this may not be the ultimate in fun or exciting posts. Still, think of it this way – the responsibility is a minor effort in exchange for the accessibility of medications. Proper disposal is a gift to others during this gift-giving season, and beyond.

In some states, like Oregon, the situation may be special.
If someone was disposing incorrectly, or
if someone was selling drugs,
weed know.  

—

Additional Sources

DEA Drug Disposal Information.  National Take-Back Initiative. DEA website.
Best practices for a hospital/medical facility http://www.ismp.org/tools/bestpractices/TMSBP-for-Hospitals.pdf
Disposal Act Fact Sheet.

Picture Credit: Gellinger. 1729443_1280 via Pixabay

 

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