Proper drug disposal programs

Evidence Rating  
Expert Opinion
Evidence rating: Expert Opinion

Strategies with this rating are recommended by credible, impartial experts but have limited research documenting effects; further research, often with stronger designs, is needed to confirm effects.

Health Factors  

Proper drug disposal programs accept expired, unwanted, or unused medicines from designated users and dispose of them responsibly. Programs can use in-person drop-offs, mail-in efforts, or permanent secure collection receptacles and can be administered by state or local governments, municipal trash and recycling services, pharmacies, hospitals, clinics, or community organizations partnered with law enforcement. A 2014 amendment to the federal Controlled Substances Act allows the US Drug Enforcement Administration (DEA) to register authorized collectors of controlled substances, allowing collection of pharmaceutical controlled and non-controlled substances, but not illicit drugs1

Expected Beneficial Outcomes (Rated)

  • Reduced illicit drug use

  • Reduced unintentional poisoning

  • Reduced water pollution

  • Improved water quality

Other Potential Beneficial Outcomes

  • Increased appropriate drug disposal

Evidence of Effectiveness

Proper drug disposal programs are a suggested strategy to reduce illicit drug use and unintentional poisoning234, reduce pharmaceutical contamination of fresh water, and improve water quality56789. Available evidence suggests that drug disposal programs increase collection and proper disposal of unused prescription drugs10, 11, 12, 13, 14, 15 and reduce pharmaceuticals in the environment16. However, additional evidence is needed to confirm effects on drug use and water quality.

Ongoing statewide drug disposal programs with permanent collection receptacles may more effectively prevent drug abuse and accidental poisoning than temporary, one day take-back events73. Surveys suggest that community campaigns to raise awareness about drug take-back events increase use of disposal programs and conversations with children about the dangers of prescription drug abuse17. Overall, the US Food and Drug Administration (FDA) suggests disposing of unneeded medicine through organized programs or take-back events; however, the FDA also suggests flushing specific harmful drugs to prevent accidental ingestion or misuse4.

Many federal agencies and experts suggest that individual households, hospitals, and health care facilities avoid flushing any pharmaceuticals to preserve water quality and protect aquatic life and ecosystems1819. Active pharmaceutical ingredients (APIs) released into the environment via improper disposal (e.g., flushing or landfill leaching) can adversely affect aquatic life, contaminate freshwater resources, and promote drug resistance in bacteria20219. Flushing unused pharmaceuticals can cause spikes in APIs in the environment7; flushed pharmaceuticals may also break down into compounds that have different toxicity levels than the original drug5. Over 80% of sampled US streams have evidence of pharmaceuticals in the water822.

Patient and pharmacist education may be needed to reduce improper drug disposal and increase use of proper disposal programs2324. Benefit cost analysis suggests that establishing a proper drug disposal program would yield positive net social benefits25; ongoing bin-based programs appear to be more cost-effective than mail-in programs or one day events26

Impact on Disparities

No impact on disparities likely

Implementation Examples

Several states have legislation that authorizes and guides proper drug disposal programs for consumers such as Maine27, Ohio28, and Washington29. Some states have legislation that prohibits health care institutions from flushing unused medications into public wastewater as in Illinois30. Other states provide public guidelines and educational materials about proper drug disposal such as Connecticut31, Florida32, New York33, and New Jersey34.

The DEA has two drug take-back events each year; since 2010, the DEA has collected 4.8 million pounds of prescription drugs on only 9 days35. In 2016, at the most recent take-back event, the DEA set a new record, collecting about 447 tons at almost 5,400 sites in all 50 states36. Sheriff’s offices also host regularly scheduled drug take-back programs for the public. Operation Medicine Cabinet in Broward County, Florida is one example37.

October 22nd is National Prescription Drug Take-Back Day; in 2016, more than 5,000 collection sites nationwide participated. Private organizations have also established permanent drug disposal receptacles. For example, Walgreen’s pharmacy has over 500 collection kiosks at pharmacies in 35 states and Washington DC38.

Implementation Resources

US DEA-Drug take-back - US Drug Enforcement Agency (US DEA). National prescription drug take-back day.

CDC-Drug take-back - Centers for Disease Control and Prevention (CDC). Prescription drug take-back day.

PDFK-Safe drug disposal guide - Partnership for Drug-Free Kids (PDFK). Safe drug disposal: A guide for communities seeking solutions. Washington, DC: Office of Community Oriented Policing Services (COPS); 2015.

AMCC-Rx drop - The American Medicine Chest Challenge (AMCC). Use the search tool to find the drop off location closest to you!

Dispose my meds - Dispose My Meds. Safe disposal of medications: Pharmacy locator.

Take back your meds - Take Back Your Meds. Washington needs a statewide medicine take-back program: Protect our kids, families, and environment.

Footnotes

* Journal subscription may be required for access.

1 US DEA-Disposal regulations 2014 - US Drug Enforcement Administration (US DEA). Disposal regulations: Registrant fact sheet. 2014.

2 TFAH-Levi 2013 - Levi J, Segal LM, Miller AF. Prescription drug abuse: strategies to stop the epidemic. Trust for America’s Health (TFAH). 2013.

3 Simons 2010 - Simons TE. Drug take-back programs: Safe disposal of unused, expired, or unwanted medications in North Carolina. Coastal Coalition for Substance Abuse Prevention. 2010:1-17.

4 US FDA-Unused medicines - US Food and Drug Administration (US FDA). Disposal of unused medicines: What you should know.

5 Lubick 2010* - Lubick N. Drugs in the environment: Do pharmaceutical take-back programs make a difference. Environmental Health Perspectives. 2010;118(5):A210-A214.

6 Glassmeyer 2009* - Glassmeyer ST, Hinchey EK, Boehme SE, et al. Disposal practices for unwanted residential medications in the United States. Environment International. 2009;35(3):566-572.

7 Ruhoy 2008* - Ruhoy IS, Daughton CG. Beyond the medicine cabinet: An analysis of where and why medications accumulate. Environment International. 2008;34:1157-1169.

8 Becker 2010 - Becker J. Minding the gap: Research priorities to address pharmaceuticals in the environment. Health Care Research Collaborative. 2010:1-24.

9 US EPA-PPCPs - US Environmental Protection Agency (US EPA). Contaminants of emerging concern including pharmaceuticals and personal care products (PPCPs).

10 Fleming 2016 - Fleming E, Proescholdbell S, Sachdeva N, et al. North Carolina’s Operation Medicine Drop: Results from one of the nation’s largest drug disposal programs. North Carolina Medical Journal. 2016;77(1):59-62.

11 Gray 2015 - Gray J, Hagemeier N, Brooks B, Alamian A. Prescription disposal practices: A 2-year ecological study of drug drop box donations in Appalachia. American Journal of Public Health. 2015;105(9):e89-e94.

12 Yang 2015a - Yang CHJ, Doshi M, Mason NA. Analysis of medications returned during a medication take-back event. Pharmacy. 2015;3(3):79-88.

13 Stewart 2015* - Stewart H, Malinowski A, Ochs L, et al. Inside Maine’s medicine cabinet: Findings from the Drug Enforcement Administration’s medication take-back events. American Journal of Public Health. 2015;105(1):e65-e71.

14 Perry 2014a* - Perry LA, Shinn BW, Stanovich J. Quantification of an ongoing community-based medication take-back program. Journal of the American Pharmacists Association. 2014;54(3):275-279.

15 Welham 2015 - Welham GC, Mount JK, Gilson AM. Type and frequency of opioid pain medications returned for disposal. Drugs - Real World Outcomes. 2015;2(2):129-135.

16 Stoddard 2015* - Stoddard KI, Huggett DB. Wastewater effluent hydrocodone concentrations as an indicator of drug disposal program success. Bulletin of Environmental Contamination and Toxicology. 2015;95(2):139-144.

17 Yanovitzky 2016* - Yanovitzky I. The American Medicine Chest Challenge: Evaluation of a drug take-back and disposal campaign. Journal of Studies on Alcohol and Drugs. 2016;77(4):549-555.

18 Mankes 2013* - Mankes RF, Silver CD. Quantitative study of controlled substance bedside wasting, disposal and evaluation of potential ecologic effects. The Science of the Total Environment. 2013;444:298-310.

19 US EPA-Medicine disposal - US Environmental Protection Agency (US EPA). Dispose of medicines, vitamins and other supplements properly.

20 Kessler 2010 - Kessler R. Pharmaceutical factories as a source of drugs in water. Environmental Health Perspectives. 2010;118(9):382-385.

21 Pal 2010* - Pal A, Gin KYH, Lin AYC, Reinhard M. Impacts of emerging organic contaminants on freshwater resources: Review of recent occurrences, sources, fate and effects. The Science of the Total Environment. 2010;408(24):6062-6069.

22 USGS-Emerging contaminants - US Department of the Interior, US Geological Survey (USGS). Environmental health toxic substances: Emerging contaminants in the environment.

23 Seehusen 2006 - Seehusen DA, Edwards J. Patient practices and beliefs concerning disposal of medications. The Journal of the American Board of Family Medicine. 2006;19(6):542-547.

24 Jarvis 2009 - Jarvis CI, Seed SM, Silva M, Sullivan KM. Educational campaign for proper medication disposal. Journal of the American Pharmacists Association (JAPhA). 2009;49(1):65-68.

25 Kotchen 2009* - Kotchen M, Kallaos J, Wheeler K, Wong C, Zahller M. Pharmaceuticals in wastewater: Behavior, preferences, and willingness to pay for a disposal program. Journal of Environmental Management. 2009;90(3):1476-1482.

26 Carnevale-Drug takeback 2012 - Research and Policy Analysis Group of Carnevale Associates, LLC. Prescription drug takeback programs and substance abuse prevention: A policy brief. Gaithersburg: Carnevale Associates, LLC; 2012.

27 ME Statutes 22 604 - State of Maine. Disposal of unused pharmaceuticals. Public Laws of Maine: Second Special Session of the 121st; Chapter 679 S.P. 671-L.D. 1926.

28 OH HB 93 - Ohio 129th General Assembly. Revised code to establish and modify laws regarding the prevention of prescription drug abuse. Amended Substitute House Bill Number 93.

29 WA HB 2600 - Washington State 60th Legislature. An act relating to providing safe collection and disposal of unwanted drugs. 2008 Regular Session: House Bill 2600; 2008:1-15.

30 IL SB 1919 - Illinois 96th General Assembly. Safe Pharmaceutical Disposal Act: Senate Bill 1919.

31 CT-Medicine disposal - State of Connecticut Department of Energy & Environmental Protection. Disposing of prescription medicines and over-the-counter (OTC) products.

32 FL-Unwanted medications - Florida Department of Environmental Protection. How to dispose of unwanted medications.

33 NY-Proper drug disposal* - New York State Department of Environmental Conservation. Safe medication disposal for households.

34 NJ DEP-Medication disposal - State of New Jersey Department of Environmental Protection (NJ DEP). Guidelines for proper disposal of household medication.

35 US DEA Public affairs 2014 - US Drug Enforcement Administration (US DEA). DEA public affairs: DEA and partners collect 309 tons of pills on ninth prescription drug take-back day. 2014.

36 US DEA Public affairs 2016 - US Drug Enforcement Administration (US DEA). DEA public affairs: DEA collects record-setting amount of meds at latest national Rx take-back day. 2016.

37 Broward Sheriff-OMC - Broward County Sheriff's Office. Operation medicine cabinet (OMC).

38 White House-Botticelli 2016 - Botticelli M. October 22nd is national prescription drug take-back day. The White House Blog, President Barack Obama. 2016.

Date Last Updated