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Medication Disposal

Different bottles of prescription medications

It is important for both patients and clinicians to dispose of unused medications in a way that keeps these substances out of the environment and prevents others from harm.

Medication Disposal for Patients

It is recommended that patients know how to safely dispose of unwanted or unused medications. Keeping leftover prescriptions, including controlled substances, may increase the risk of accidental poisonings and may lead to misuse or abuse of medications. Take-back programs for medication disposal are a safe, responsible way to remove expired, unwanted, or unused medicines, especially controlled substances, from one's possession or home. Proper disposal will help protect the environment and reduces the chance that others may find and accidentally or intentionally use the medication.

There are various options to consider when disposing of unwanted or unnecessary medications. Consider checking with your local pharmacy to determine what options are available in your community and for assistance in selecting the best disposal method.

This service is provided by law enforcement agencies to collect unwanted medications and is usually arranged once in the spring and once in the fall. Community members are encouraged to bring unnecessary medications to a specific drop-off location for disposal in an environmentally safe manner. It is important to pay attention to the types of items accepted during these events. If interested in participating in a take-back event or searching for locations with ongoing services, visit the DEA Diversion Drug Disposal Information Exit Disclaimer: You Are Leaving  page to locate the closest authorized collector. Take back events at tribal locations may not be listed so it is important to check with local law enforcement agencies as well.

Many law enforcement facilities and pharmacies have permanently secured medication drop boxes within or near their location. Some drop boxes are only available during business hours and others are available 24 hours a day. In addition, each location may restrict the type of substances accepted for disposal. The types of medications accepted include prescription and OTC medications including ointments, creams, liquids, lotions, patches, and vitamins. Items that are not accepted include: needles, inhalers, aerosol cans, hydrogen peroxide, thermometers, and illicit substances. MedSafe is one example of a medication disposal cabinet. Visit the DEA’s Controlled Substance Public Disposal Locations Exit Disclaimer: You Are Leaving  finder to locate the closest authorized collector.

This program allows the patient to send unwanted medications to a medication destruction facility via the U.S. mail. Patients use a special sealed, tamper-evident envelope that is handed to a postal carrier or dropped off at a U.S. Post Office for delivery. This program is typically coordinated through a medical facility that can purchase the special pre-addressed mailing envelopes with prepaid postage. Once medications are received by the destruction facilities, they are incinerated. This type of program is convenient and allows for safe disposal of medications at any time.

Another option for patients to dispose of unwanted medications from their own home is through the use of disposal pouches. Disposal pouches contain active carbon which deactivates the medications and allows for its safe disposal in a household garbage. After medications are added to the pouch, water must be added to start the deactivation process. The carbon binds to the active ingredient and breaks down the medication making it unusable if the pouch were to be reopened. The pouches come in different sizes, a small pouch (15 pills), medium pouch (45 pills), large pouch (90 pills), and an extra-large pouch (450 pills). Mallinckrodt provides a complimentary box of six pouches to physician’s offices, which can be ordered from their website.Exit Disclaimer: You Are Leaving 

The safest way to dispose of medications is via take-back events or by using a registered collector drop box. Another Option is to use drug deactivation bags for in-home Rx disposal, keeping medications off the streets and out of children's hands. These pouches deactivate drugs (narcotics, antibiotics and transdermal patches). Deterra Exit Disclaimer: You Are Leaving  and Element MDS Exit Disclaimer: You Are Leaving  are examples of drug deactivation bags.

Steps to follow:

  1. Place unused medications in pouch.
  2. Fill halfway with warm tap water and wait 30 seconds.
  3. Seal and gently shake pouch and dispose with normal trash.

If unable to use these methods, follow the recommendations below for environmentally safe disposal.

Check the FDA website for a list of medications that are safe to flush down the toilet Exit Disclaimer: You Are Leaving , and if the item is on the list, flush accordingly.

Steps to follow if medications are not on the "safe flush" list:

  1. Remove medication from original container
  2. Mix tablets or capsules that are not crushed or opened with an undesirable substance, such as cat litter, used coffee grounds, dirt, or sawdust
  3. For liquid medications, mix with an absorbent material such as flour or cat litter
  4. Put the mixture into a disposable container with lid or a sealable bag
  5. Remove personal information from medication bottles, including the Rx number, by covering it with black permanent marker, duct tape or scratching it off
  6. Place the sealed container or bag with the unwanted medications and the empty medicine containers in the trash

For more information on these methods, please visit the FDA website on using medicine safely.Exit Disclaimer: You Are Leaving 

Medication Disposal for Clinicians

The Drug Disposal Act of 2010 was passed to reduce harm from unwanted medications and to create accessible opportunities for simple, secure disposal from an ultimate user. The DEA defines an ultimate user as "a person who has lawfully obtained, and possesses, a controlled substance for their own use or for the use of a member of their household or for an animal owned by them or a member of their household." The drug disposal act provides a framework for collection and disposal strategies while keeping a focus on the needs of patients and their families or friends. The Indian Health Service understands the benefit of safe disposal services, and has outlined various methods for facilities and pharmacy programs to consider below.

Facility Medication Disposal Policy

Facilities should consider implementing a drug disposal policy in accordance with the Drug Disposal Act of 2010. The policy should utilize the best practice guidelines from the Environmental Protection Agency and Food and Drug Administration for proper disposal from the ultimate user. This disposal strategy is referring to the disposal of medications from the ultimate user and does not include waste from other health care operations such as medication administration, expired medications, and hazardous waste. Facility policy should be customized to local program processes. Key aspects of the policy may include: defining the purpose for a mechanism of disposal, defining the mechanism of disposal (i.e.: mail-back programs, take-back events), defining the management of the mechanism of disposal. The following is an example medication disposal policy:

Registering as a DEA collector allows facilities to become legally authorized to accept controlled substances for the purpose of destruction by the ultimate user. Defined by the DEA, an ultimate user is "a person who has lawfully obtained, and who possesses, a controlled substance for his own use or for the use of a member of his household or for an animal owned by him or a member of his household." Patients are able to dispose of unused and unwanted medications, including controlled substances, in a safe and private manner at locations they frequently visit. This can decrease the amount of obsolete medication in homes and may reduce unintentional patient harm from the non-medical use of prescription medications. This method creates a process that is simple and private, while providing patients open access to ongoing disposal services.

Manufacturers, distributors, reverse distributors, narcotic treatment programs, retail pharmacies, and hospitals or clinics with on-site pharmacy may modify their DEA registration to obtain authorization to become a collector. The collection mechanism needs to be identified before registration. Once registered, a site can obtain a secure receptacle to collect and store unwanted patient medications in a secure disposal cabinet. Collector sites accept prescription and OTC medications including ointments, creams, liquids, lotions, patches, and vitamins. Certain medications and medication supplies that are not included are: needles, inhalers, aerosol cans, hydrogen peroxide, thermometers, and illicit substances.

Costs related to establishing this solution are minimal, which includes start-up fees for the collection receptacle at registration and for replacement liners when the receptacle is full. Pharmacy staff remove the receptacle liner when full and follow the provided instructions to prepare the liner for transport to a reclamation facility. The reclamation facility destroys the unwanted medications in a manner to render them non-retrievable. Incineration and chemical digestion are DEA approved methods to achieve the non-retrievable standard. Different from the reverse distributor where unwanted medications are simply collected, a reclamation facility destroys the medications making them unusable. The DEA defines a reverse distributor as "a person who receives controlled substances acquired from another DEA registrant for the purpose of returning unwanted, unusable, or outdated controlled substances to the manufacturer or the manufacturer's agent, or, where necessary, processing such substances or arranging for processing such substances for disposal."

To register as a collector:

  1. Review state law to determine whether collector registration is lawful in your area. If it is not, consider submitting a request to the State Board of Pharmacy to proceed at your federal facility as special accommodations are possible.
  2. The DEA defines eligible collectors as any of the following:
    • Manufacturers
    • Distributors
    • Reverse distributors
    • Retail pharmacies
    • Registered narcotic treatment programs
    • Long term care facilities
    • Hospitals or clinics with an on-site pharmacy - Collection receptacles must be placed in the immediate proximity of where controlled substances are stored where an employee is present. This ensures appropriate security of the area and is required for lawful registration. The DEA also prohibits collectors from placing receptacles in an area where emergency or urgent care services are provided due to the chaotic nature of traffic flow near them.
  3. When ready to register, visit the DEA CSA Collector Status Request/Update page. Exit Disclaimer: You Are Leaving 
  4. Complete the brief form to create a login. Please note, you will need information from your registration certificate in order to login.
  5. Proceed with the remaining steps as directed via the DEA website.

Permanent collection receptacles are locked cabinets that are placed inside a facility where a patient may deposit unwanted medications in a drop box at their convenience. They combine a stainless-steel collection container with a removable prepaid ship-back inner liner. The cabinets are fastened to a permanent structure to prevent diversion and theft of collected substances. When the inner liner is full, authorized personnel should safely remove the liner from the collection receptacle, seal it and return it through a common carrier. The liners are waterproof, tamper-evident, and tear resistant. The internal contents are not viewable from the outside when sealed. The liners have a prepaid return label which includes a unique identification number that is trackable. Upon removal the inter liner must be stored in a securely locked, substantially constructed cabinet or a securely locked room with controlled access until transferred. The full liners may only be stored for a maximum of three business days.

Once sealed, a common carrier transports the package to a reclamation facility. The inner liners are then disposed of by using the DEA preferred method of disposal, incineration, rendering the pharmaceuticals non-retrievable. Permanent collection receptacles accept prescription and OTC controlled, non-controlled and over the counter medications; consult each program for a comprehensive list of accepted substances. MedSafe, American Security Cabinets, MedReturn, and RxDrugDropBox are examples of permanent collector receptacles.

During National Safety Month, IHS Highlights Collaborative Effort to Dispose of Drugs Safely and Properly Exit Disclaimer: You Are Leaving  - IHS Blog Post

Diversion attempts may occur during any part of the disposal process; quality controls need to be put into place to prevent diversion. The disposal cabinet shall be securely fastened to a permanent structure to prevent cabinet displacement. The cabinet should have two different locks to access the content of the cabinet, and the keys shall be placed in a secure location only accessible to authorized staff. Two employees shall be present every time the cabinet is opened. When the cabinet is full and the liner needs to be replaced two employees shall remove the contents and seal the liner immediately. Upon removal the inner liner may only be stored for a maximum of three business days in a securely locked, substantially constructed cabinet or a securely locked room with controlled access until transferred to the common carrier.

Mail-Back programs provide mailing envelopes for patient use. Unwanted medications are placed in prepaid envelopes and sent via designated mail carriers for disposal. Patients are able to privately use these from the convenience of their own home, but they may not be able to dispose of all substances as it will vary by program. A facility may purchase prepaid envelopes and boxes to provide to their patients. They are also sold in pharmacies and may be provided by other entities for consumers to prepare and mail directly from their home. The envelopes are designed to be tamper evident with unique serialization for tracking and destruction. Costs are highly variable based on the number of envelopes used and patients may not understand which medications are eligible. Takeaway Medication Recovery System Exit Disclaimer: You Are Leaving  is an example of a mail-back program.

A take-back event is a scheduled day in cooperation with local law enforcement where community members are encouraged to bring their unwanted medications to a specific drop-off location. Registered collectors are not authorized to conduct take-back events. Law enforcement may conduct take-back events at any time. Any person or community group, registrant or non-registrant, may partner with law enforcement to conduct take-back events. Medications are then disposed of in accordance with the Code of Federal Regulations Title 21 part 1317.05. Attention must be given to the types of items accepted, as illicit substances are not accepted. Law enforcement facilities may have permanent drop boxes, but must restrict the type of substances accepted for disposal. If you are interested in participating in a take-back event or searching for locations with ongoing services visit the links below. Be aware that take back events and locations offered by tribal law enforcement may not be listed, so it is important to check locally as well.