Optimizing Pill Disposal Programs

The best practices for pill disposal are always being updated and policies vary from state to state. Opioids, in particular, are a concern and pharmacists are being called upon to educate their patients on optimal disposal practices.

Community pharmacist Elizabeth Skoy, PharmD, an associate professor at North Dakota State University School of Pharmacy in Fargo, said consumers can look for medication take-back events or drop off unused or expired medications at their local law enforcement office. Some pharmacies provide products that patients can mix with medications before disposing of them, or envelopes they can use to mail a medication to a facility for incineration. “There often is a cost to the patient for these options. There are also states that allow consumers to bring unused or expired medication to kiosks located near their local pharmacy. North Dakota allows for kiosks at the pharmacy, and tons of medication have already been collected and disposed of within the state,” Skoy told Drug Topics®.

This issue is now at the forefront because it is estimated that more than half of individuals using prescription pain relievers for nonmedical purposes obtain the medications from a friend or relative.¹ Skoy said children or pets can access medications left in medicine cabinets or trash cans, which can cause unwanted, even life-threatening adverse effects. She noted that individuals looking to obtain medication for nonmedical purposes often check these areas, making proper disposal paramount.

What About Opioids?

Policies for opioid disposal vary by state. Community pharmacists should contact their state board of pharmacy to identify disposal options and what may be available for their particular pharmacy location. The FDA has a flush list, which includes opioids and other medications that the agency has identified as being suitable to flush as a method of disposal.²

According to the FDA, the known risks from accidental exposure to these medications far outweigh any potential risk to humans or the environment that may arise by flushing them. “If someone is unable to properly dispose of unwanted medications through any of the above disposal options, and the medication is not on the FDA flush list, the last [option] is to dispose of [it] at home. To do this, you can mix the medication with cat litter, coffee grounds, or dirt and then place the mixture in a sealed plastic bag before discarding in the trash can,” said Skoy.

Lisa Schwartz, PharmD, who is the senior director of professional affairs at the National Community Pharmacists Association (NCPA) in Alexandria, Virginia, advises pharmacists to counsel each patient to do what works best for them to keep their household safe and to explain the importance of this issue.

“By disposing of medications in a secure drop-off bin, usually at a pharmacy or law enforcement agency, or using a prepaid medication disposal mailer, you also help protect the environment, especially the lakes and rivers,” Schwartz said.

Amy Tiemeier, an associate professor of pharmacy practice at St. Louis College of Pharmacy at University of Health Sciences and Pharmacy in St Louis, Missouri, said the best way for a consumer to get rid of unused or expired medications would be to dispose of them in a medication drop box or at a take-back event that destroys medications in an EPA-certified incinerator. “Drop boxes can be found throughout the country and the DEA [Drug Enforcement Agency] National Prescription Drug Take Back Days use this method of destruction. The National Association of Boards of Pharmacy has an online search tool where consumers can search for a drop box near them,” she said.³

The policies on opioid disposal have changed over the past 5 years and are likely to change again. The FDA has not always recommended medication disposal drop boxes. According to Tiemeier, the federal law allowing medication disposal boxes in pharmacies, hospitals, and long-term care facilities didn’t go into effect until October 2013. “It was at least 6 months after that before any large chains started putting drop boxes in some of their locations, and some states had laws that still didn’t permit it. With the addition of more medication drop boxes that were more widely available to the general public, the recommendation changed to using that method first if available instead of flushing,” she explained.

References:

1. List of medicines recommended for disposal by flushing. FDA. Updated April 2018. Accessed November 10, 2020. https://www.fda.gov/media/109643/download
2. Jones CM, Paulozzi LJ, Mack KA. Sources of prescription opioid pain relievers by frequency of past-year nonmedical use: United States, 2008-2011. JAMA Intern Med. 2014;174(5):802-803. doi:10.1001/jamainternmed.2013.12809
3. Drug disposal. National Association of Boards of Pharmacy. Accessed November 10, 2020. https://safe.pharmacy/drug-disposal/