Hailey Tran
Hospitals and doctor's offices must dispose of expired medications with services that comply with medical waste regulations. The process can be confusing, as not all expired medications are required to be stored, packaged, or treated in the same way. Some medications are deemed hazardous due to their toxicity, flammability, corrosivity, or reactivity, and improper disposal can result in serious environmental contamination. In the US, the FDA and EPA have expressed concern about flushing certain medicines, but there has been no evidence of environmental effects caused by flushing recommended drugs. The best way to dispose of most types of unused or expired medicines is through a drug take-back program, where they can be dropped off at a location or mailed in using a prepaid envelope.
| Characteristics | Values |
|---|---|
| Best way to dispose of expired drugs | Drop off at a drug take-back location, mail using a prepaid drug mail-back envelope, flush down the toilet (if on the FDA flush list), dispose in household trash (if not on the FDA flush list) |
| Drug take-back locations | Retail, hospital, or clinic pharmacies, law enforcement facilities |
| Drug mail-back envelopes | Available for purchase at retail pharmacies or online, may be offered for free by some pharmacies |
| Concerns with flushing medicines | Environmental concerns due to drug residues entering water systems, potential for harm if consumed |
| Disposing of medicines in household trash | Mix with an unappealing substance such as dirt, cat litter, or used coffee grounds, place the mixture in a sealed plastic bag, scratch out personal information from prescription labels |
| Disposing of needles and syringes | Refer to the FDA's Medication Disposal Q&A page |
| Disposing of medications with uncommon dosage forms | Refer to product-specific disposal instructions or contact a healthcare professional |
| Disposing of hazardous medications | Incineration may be required to properly denature the medications |
What You'll Learn
Hospitals must comply with medical waste regulations
The first step in complying with medical waste regulations is to identify the difference between hazardous and non-hazardous medications. Hazardous wastes are often identified by their characteristics, such as toxicity, flammability, corrosivity, or reactivity. For example, chemotherapy drugs are considered hazardous due to their toxic nature. Hospitals must be aware of the medications they handle that are classified as hazardous under RCRA standards.
Once the hazardous medications have been identified, hospitals must ensure they are properly disposed of. Hazardous medications cannot be thrown into regular office waste or red bag waste. The autoclave process, which kills harmful or potentially infectious components in red bag waste, is not sufficient for denaturing medications. Instead, hazardous medications must be incinerated to comply with federal regulations.
Non-hazardous medications can be disposed of through drug take-back programs or mail-back programs. These programs are often sponsored by the DEA or local law enforcement agencies and provide secure drop-off locations or mail-back envelopes for safe disposal. Hospitals can also utilize safe medication disposal kiosks or drug disposal boxes for this purpose.
Additionally, hospitals should follow specific disposal instructions for certain dosage forms, such as sprays and lozenges, by reviewing the instructions that came with the prescription or contacting healthcare professionals. Overall, by adhering to these guidelines, hospitals can ensure they are complying with medical waste regulations and safely disposing of expired drugs.
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Hazardous and non-hazardous medications
The EPA regulates the disposal of hazardous waste pharmaceuticals through the Resource Conservation and Recovery Act (RCRA). Under RCRA, healthcare facilities are classified as very small quantity generators (VSQG), small quantity generators (SQG), or large quantity generators (LQG), which determines how the EPA regulates the facility. The EPA requires hazardous pharmaceutical waste to be treated at a permitted treatment facility before disposal. Most pharmaceutical waste is incinerated through a licensed medical incineration site.
Non-hazardous pharmaceutical waste does not require the same level of treatment as hazardous waste. However, it still needs to be disposed of properly. Non-hazardous pharmaceutical waste is typically collected in blue containers, whereas hazardous waste pharmaceuticals are collected in black containers labelled "hazardous waste pharmaceuticals". Hospitals and other healthcare facilities cannot use take-back programs or mail-back envelopes to dispose of their pharmaceuticals. Instead, they must contract a licensed company to perform commercial waste disposal. While awaiting removal, waste must be held in a secure area in covered, labelled drums with plastic liners.
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Drug take-back programs
These drug take-back locations may offer on-site medicine kiosks or drop-off boxes, mail-back programs, or other in-home disposal methods. To find an authorized drug take-back location, you can use Google Maps and search for "drug disposal near me" or "medication disposal near me". You can also contact your local waste management authorities or check with your pharmacist to see if they offer drug mail-back envelopes.
If you are unable to locate a nearby drug take-back location or cannot access one, there are alternative methods for disposing of medicines. One option is to check the FDA's Flush List to see if your medicine is on it. Medicines on this list can be flushed down the toilet, as they may be especially dangerous if accidentally ingested by children, pets, or others. However, it is important to note that flushing medicines is generally not recommended due to potential environmental concerns.
Another option for disposing of medicines, if they are not on the FDA's Flush List, is to throw them away in the household trash. The FDA recommends mixing them with an unappealing substance such as dirt, cat litter, or used coffee grounds, and then placing the mixture in a sealed plastic bag before disposal. It is also important to scratch out personal information from prescription labels and empty packaging to protect your privacy.
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Mail-back programs
Here's how mail-back programs work:
- Obtaining Mail-Back Envelopes: Hospitals can purchase prepaid drug mail-back envelopes from various places, including retail pharmacies, online websites, or directly from the pharmacist. Some pharmacies may even offer these envelopes at no cost.
- Filling and Sealing the Envelope: Hospitals collect all the expired drugs and securely seal them inside the mail-back envelope. It is important to follow any specific instructions provided with the envelope to ensure safe handling and disposal.
- Mailing the Envelope: Once sealed, the envelope can be mailed via the U.S. Postal Service. Hospitals can drop off the sealed envelope at any United States Postal Service office or U.S. Postal Service drop box.
It is important to note that some medications, such as sharps, liquids, or medications with specific disposal instructions, may not be suitable for mail-back programs. Hospitals should always refer to the specific guidelines provided by the mail-back program and follow any product-specific disposal instructions for unusual dosage forms, such as sprays or lozenges.
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Flushing medications
The FDA and the U.S. Environmental Protection Agency recognize the concerns regarding the flushing of medications and its impact on the environment. However, they have concluded that flushing recommended drugs poses a negligible risk to the environment. The FDA's Flush List contains medications that are considered especially dangerous if taken accidentally, particularly by children, adults, or pets, and are recommended to be flushed only when a take-back option is unavailable.
The FDA and the EPA strongly discourage flushing medications unless they are on the FDA Flush List. This list includes medications that are sought-after for misuse or abuse and can result in death or serious harm from a single dose if taken inappropriately. Flushing these medications helps to prevent accidental or intentional misuse, reducing the risk of serious harm.
To determine if a medication should be flushed, individuals should check the label, patient information leaflet, or consult the FDA Flush List. It is important to follow the specific disposal instructions provided by healthcare providers or included with the medication. The FDA's Medication Disposal Q&A page also provides additional information on proper disposal methods for medications with uncommon dosage forms, such as sprays and lozenges.
While flushing medications can be a safe disposal method in certain cases, it is generally recommended to prioritize take-back programs or mail-back envelopes as the primary options for disposing of unused or expired medications. These programs ensure that medications are properly handled and do not pose a risk to the environment or public health.
In the absence of take-back or mail-back options, and for medications not on the FDA Flush List, alternative disposal methods can be considered, such as disposing of medications in the household trash after mixing them with unappealing substances like dirt or used coffee grounds. This helps to prevent accidental consumption from trash scavenging. Ultimately, the recommended disposal method may vary depending on the specific medication and local regulations, so it is always advisable to consult official guidelines or healthcare professionals for proper disposal instructions.
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Frequently asked questions
Hospitals can dispose of expired drugs by incinerating them, or by using drug take-back programs.
Drug take-back programs are locations where people can drop off their unused or expired medications. These locations are often retail, hospital, or clinic pharmacies, and law enforcement facilities. Some programs also offer mail-back services.
All the medicines dropped off at the take-back locations are destroyed.
To dispose of drugs via mail, you need to purchase a drug mail-back envelope from a pharmacy or online. Fill the envelope with the unused or expired medicines, seal it, and take it to a post office or drop it in a postal drop box.
Depending on the type of drug, some medications can be disposed of at home. Some drugs can be flushed down the toilet, while others can be thrown into the household trash. However, it is important to check the FDA's flush list to ensure the medication is safe to be flushed.
