How you should dispose of unused or expired medications

If you have a stash of unwanted, unused, or expired medicines in a cabinet or drawer somewhere in your home and you don’t know the best way to get rid of them, you’re not alone.

A 2021 survey conducted on behalf of Covanta, a New Jersey-based waste management company, found that 53 percent of the 2,000 Americans polled had no idea what to do with their old medications. Pill hoarding is a common outcome, and many people eventually toss these drugs into household trash or flush them down the toilet or sink—none of which may be a good idea.

Unused or expired medicines lying around at home can get into the wrong hands, leading to accidental poisoning or drug overdose. One study found that between 2000 and 2015, U.S. Poison Control Centers received roughly 32 calls a day about children accidently ingesting opioids that had either been stored or disposed of incorrectly.

When drugs are flushed or sent to landfill, the pharmaceuticals can contaminate our groundwater, lakes, rivers, and streams, threatening human and aquatic life, although our urine and feces that contain remnants of consumed medication are bigger sources of pollution. Wastewater treatment plants aren’t designed to remove these pharmaceuticals, Tim Carroll, a spokesperson for the U.S. Environmental Protection Agency, says in an email. “EPA’s first message to everyone is do NOT put leftover, unused drugs down the drain.”

So how does one dispose of unneeded over-the-counter and prescription medications accumulating in our homes? There are a few options.

Drug take-back programs

In an effort to find a solution to drugs languishing in medicine cabinets or lurking in waterways, the U.S. Drug Enforcement Administration launched its first National Take-Back Day in September 2010. More than 4,000 sites across 50 states collected nearly 250,000 pounds of pharmaceuticals that people returned. Since then, DEA has hosted this single-day event biannually; in April this year, more than 5,000 sites collected about 721,000 pounds of pharmaceuticals.

People can also use mail-back envelopes or drop off their unwanted medications year-round at DEA-registered collection kiosks in police stations, pharmacies, community health centers, and hospitals. These returned drugs are then sent to medical waste incinerators.

In 2021 Stericycle, the largest medical waste incinerator company in the U.S., burned 40 million pounds of unused and expired pharmaceuticals, says Jim Anderson, the company’s vice president for product management and innovation. Incineration produces an inert ash that’s sent to landfills. However, one downside of this disposal method is that transporting and burning such waste and its packaging can release greenhouse gas emissions that can be potentially greater than those generated if the drugs were dumped in landfill, according to one study estimate.

But take-back programs are preferred as they reduce the risk of drug misuse and the incineration “effectively eliminates the entrance of these pharmaceuticals into our nation’s waters,” Carroll says.

However, Steve Skerlos, a mechanical, civil, and environmental engineer at the University of Michigan argues that take-back programs could still result in medicines piling up in homes—a problem such programs were designed to address in the first place. “The question is, if I have extra, unused medication, am I going to leave my house in the next day, or week, even a month, to return that,” he says, especially in rural settings where take-back sites may not be as easily accessible. “A reasonable person may consider landfill to get it out of the house fast.”

In such cases, the DEA suggests mixing medicinal tablets and capsules with undesirable substances like coffee grounds or kitty litter and tossing the mixture into the trash inside a sealed bag or container. (Don’t crush the drugs though.)

And while the EPA advises against flushing pharmaceuticals down the drain, the U.S. Food and Drug Administration maintains a list of limited medications that have the potential to be misused or result in death if taken inappropriately and so can be flushed when safer disposal alternatives are lacking.

Pharmacies also sell drug destroyers such as DisposeRx that can work with pills, tablets, capsules, liquids, and powders. “It’s about the size of a packet of sugar,” says Thomas Menighan, former CEO of the American Pharmacists Association. “You open it, put it in a bottle of unused opioids, or any medicine, for example, you pour a little water in and shake it up, it turns into a white slurry,” which can then be tossed into the trash.

But it’s unclear if these products permanently bind or inactivate the medicinal compounds so that they don’t end up in the landfill liquid, which is released into wastewater treatment plants, and can eventually contaminate our waterways.

Recycling pharmaceuticals

Perhaps surprisingly, not all unused medications need to be thrown away.

Every year five billion dollars’ worth of unexpired medicine ends up being discarded in the U.S. That could happen because a patient dies, their condition improves and they no longer need their prescribed medication, there’s a dose change, or they experience side effects and are put on new drugs. In such cases these unexpired medications—worth an estimated $700 million—can be recycled.

“We’re wasting a lot of medication which is already paid for,” says Anandi Law, a patient engagement specialist at the Western University of Health Sciences in California. “We could have somebody else who needs it have it.”

Millions of U.S. adults skip or delay getting their prescriptions filled due to high costs. Hence, at least 40 states have passed legislation to establish medication repository programs that allow pharmacies, drug manufactures, medical and long-term care facilities, and sometimes individuals to donate their unused drugs in original sealed containers or tamper-evident packaging.

A licensed pharmacist then inspects the donated medication to check the expiry date and look for signs of tampering, misbranding, or any indication that the drug could be compromised. Once approved, the drugs can be dispensed to uninsured or underinsured individuals via state-approved pharmacies, hospitals, charitable clinics, or community health centers.

Since its inception in 2007, Iowa’s drug donation program, SafeNetRx, has served more than 117,000 patients and redistributed nearly $54-million worth of medication and supplies. Georgia’s program formally launched in 2018, and it has already filled prescriptions worth over $50 million.

“Even though over 40 states have these drug donation laws, a lot of people don’t know that they exist,” says Kiah Williams, co-founder of SIRUM, a nonprofit organization that works with pharmacies and health facilities across the country to assist with drug donation.

Donating unused medications or using take-back programs are voluntary for households, but experts hope more people will use these options instead of disposing of their leftover drugs in the trash or down the drain, which tends to be more convenient.

“All of these efforts are still relatively new,” Carroll says. “We expect we have a long way to go until households change their habits.”