Dear Michelle,
Many healthcare practitioners will tell you to flush unused or expired medications down the toilet or the drain. But as you suspect, Michelle, that's not quite consistent with the "first do no harm" medical ethic-for us or for our finned friends. They no doubt give this advice because they're in a tough spot for a good answer.as are perky recycling columnists. There is no perfect answer, since this material falls into that gray zone of unusual items for which our society has not yet developed a good enough solution.
So first, it's important to know what NOT to do: don't flush it, no matter whether the medication is a liquid or a solid. The US EPA has deemed flushing expired medications-otherwise known as PPCPs (pharmaceuticals and personal care products) in domestic sewage systems as the "least desirable way to dispose of any drug." According to the EPA, "If you throw your PPCPs down the drain or flush them down the toilet, and if your home is connected to a municipal sewage system, some of the PPCPs would typically be discharged into lakes, rivers, or oceans, because most waste water treatment plants are not designed to remove or destroy PPCPs from wastewater." Studies indicate that domestic septic systems do not destroy PPCPs either. Here in Boulder County , a recent study performed by the US Geological Survey confirmed that prescription and nonprescription drugs were not removed by our water treatment plant.
Research on the effects of PPCPs in our water has focused on hormone disruption in fish and increased resistance to antibiotics due to an abundance of estrogen and antibiotics in the water. The risks posed by other PPCPs are largely unknown and unstudied. The environmental issues could be as varied and diverse as the number of chemicals in use.
So what's the "better than flushing" advice? Local pharmacies tell me state law prohibits them from taking back unused meds for redistribution, so reuse is not an option with them. The best solution, of course, is to avoid waste medications whenever possible, by buying only what you can use or need. The second best option, according to the EPA, is to take medications back to the pharmacy for "safe" disposal. Not all pharmacies are able to accept this material, but I discovered a few, including Kaiser Permanente who will accept unused or outdated prescriptions from their members. Unfortunately, "safe" disposal means incineration, which is not without its serious health concerns.
The Boulder County Household Hazardous Waste Facility will not accept medical waste of any kind, but they and the County Health Dept. suggest a third option, which is to throw away your medications but first render them unusable by putting glue (such as Elmer's) in with the pills and throwing them out in a sealed container.
The EPA asserts that the best alternative for the future might include reworking existing regulations that prevent local pharmacies from taking back consumer medications and that currently prevent local hazardous waste facilities from collecting unwanted medications. Healthcare Without Harm, an international coalition of hospitals and health care providers working towards an ecologically-responsible healthcare industry, advocates for the adoption of non-incinerator specialized treatment for this waste. Clearly it's an important question for us to be asking and important that we find real solutions.
Having to suggest that anything should be thrown away is making me need pain medication. But one thing that would make me feel better is to confirm rumors I've heard of programs that redistribute reusable medications to other countries. If you are aware of such programs, please let me know and I'll gladly spread the word.
