Comments on: Drug Disposal

Question: Drug Disposal

sandraregina — Mon, 26 Jan 2009 09:46:35 -0800

I know that when medicine expires or is no longer needed, the best way to dispose of it is to take it to a local pharmacy with a disposal program and hand it off to them to take care of it. But that gets me to wondering - then what?

How do pharmacies dispose of unwanted or expired medication? I can't see the little pharmacy in the local strip mall having an incinerator, for example (though hey, they might). Does it go to a medical waste disposal company? What about medications that fall on the floor, or get mixed up, or never picked up at the counter? What kind of tracking systems are in place to ensure the pharmacists don't sweep a couple pills under their shirt when counting them and walk out and sell them? Especially if its already been logged as 'disposed of' (or however its tracked)?

This isn't for any particular, pressing need. I'm just curious. Can anyone shed some light on what happens after I take my meds to the pharmacy to be disposed?

By: bitterkitten

bitterkitten — Mon, 26 Jan 2009 10:20:12 -0800

IANAPharmacist, but when I asked the pharmacy last time I brought a bunch of old pills there, they said "eventually, it's all going straight to the regular trash anyway."

gah

By: csw

csw — Mon, 26 Jan 2009 10:30:57 -0800

There was a radio program in the seattle market just yesterday that asked this very same question.

The discussion centered around a recent finding that detectable levels of pharmaceuticals were found in puget sound from all the people disposing of drugs by flushing them down the toilet. The new preferred method to dispose of expired drugs is to take them back to the pharmacy.

Then a caller who claimed to have worked for a major drug chain called in to say that their explicit corporate policy for dealing with expired medicines turned in by the public was to...flush them down the toilet.

By: penchant

penchant — Mon, 26 Jan 2009 10:32:29 -0800

I thought the radio program mentioned that they are incinerated at very high temperatures.

By: kimdog

kimdog — Mon, 26 Jan 2009 10:45:14 -0800

At least some of the drugs get (at least ones that expire while at the store) get returned to the manufacturer. In the 80's and 90's, my mother worked for one of the mega-pharma companies in the return processing division. They would get cases of expired meds from stores and pharmacies, and they would be reprocessed. I am not sure what all that entailed, but some things were incinerated, and I think some packaging could be recycled.

By: charmcityblues

charmcityblues — Mon, 26 Jan 2009 10:47:49 -0800

IANAP, but I did work at an inpatient pharmacy in a large hospital for a while.

Drug disposal: Returned or dropped drugs went into the medical waste bin to be incinerated. Scheduled drugs (narcotics, etc.) were locked up and specially disposed of on a less-frequent basis. It was very rare to get narcotics and other "fun" stuff back, for obvious reasons. [Drugs that come in blister packs or are otherwise tamper-evident and unused can often be donated; ask your pharmacist]

Drug control: As the staff member lowest on the totem pole (I was in high school at the time) one of my jobs was to crawl under the counting and collect all of the drops. These then went into the medical waste. I could have easily taken a handful, but what would I really want with a bunch of antibiotics, diuretics, and a disturbing number of anti-fungals and de-wormers? Again, the scheduled drugs were treated more carefully, though their "lock box" was seldom locked. Only a few people were authorized to handle them.

On a related note, it's always a good idea to count your pills when you receive a prescription. We had a system of checks, but I'm sure we were off sometimes.

As for disposal: taking the drugs back to the pharmacy works, but the state of Missouri recommends doing the following:

* To destroy liquid medications: Open the container and pour the medication over/into an absorbent material such as kitty litter or paper products and dispose of in the regular trash just prior to pick-up.
* To destroy tablets and capsules: Pour a small amount of cleaning fluid, such as liquid detergent, ammonia or bleach in the bottles with the medication and then dispose of in the regular trash just prior to pick-up.
* Remove the patient name from any medicine containers. Place all containers in a sealed outer bag or box with no label.

By: electroboy

electroboy — Mon, 26 Jan 2009 10:55:13 -0800

The discussion centered around a recent finding that detectable levels of pharmaceuticals were found in puget sound from all the people disposing of drugs by flushing them down the toilet.

It's not just people flushing them down the toilet, a lot of pharmaceuticals are excreted, enter the sewer system and are untreated by the wastewater treatment plant. Wastewater operators are looking at addressing this, but as with most upgrades, it costs money and the health effects are as of yet undetermined.

By: sandraregina

sandraregina — Mon, 26 Jan 2009 11:16:26 -0800

charmcityblues - so, there was a log to go with the lockbox? So people knew who had been in it and handled things?

Crawling around on the floor after dropped anti-fungal pills couldn't have been much fun.

By: misanthropicsarah

misanthropicsarah — Mon, 26 Jan 2009 11:55:03 -0800

interesting. of the three pharmacies i've asked (cvs, walgreens, and riteaid) none of them will take back drugs. they said to just toss 'em.

i also asked my doctor, and she said she used to take certain ones back if patients couldn't use them (like if i had to switch a doseage or was allergic or something) and give them to "at need" patients, but had stopped for risk of getting in trouble.

By: charmcityblues

charmcityblues — Mon, 26 Jan 2009 12:23:24 -0800

Yes, there was a log. I'm a little fuzzy on the details, because I was nowhere near authorized to dispense them, but I believe that more than one person had to sign off. There were certainly meticulous records kept.

In retrospect, the lock-box may have been kept unlocked in the interest of staff safety in the event of a robbery. I looked in there once and saw a pretty large vial of medical cocaine- turns out it's used in very small quantities as anesthetic for ENT procedures.

The crawling around wasn't too terrible, but I did get accidentally kicked a number of times!

Also, I just realized that you're in Canada, so YMMV with some of the government recommendations and procedures.

By: selfmedicating

selfmedicating — Mon, 26 Jan 2009 14:25:46 -0800

I'm a pharmacist. Because of HIPAA, pharmacies generate a ridiculous amount of protected information that needs to be destroyed somehow - such as the labels that go on pill bottles and show the customer's name and drug name. Lots of places incinerate those. At most pharmacies, when you give them old drugs, they get tossed into the bins with all the stuff going to be incinerated. At the CVS where I most recently worked, these were the bins with the blue trash bag liners. Drugs that have been out of the pharmacy's possession can't be returned to the manufacturer or resold, so that doesn't happen.

By: selfmedicating

selfmedicating — Mon, 26 Jan 2009 15:03:42 -0800

Oops, hit post too soon. If the little pharmacy in the local strip mall is part of a chain, the materials go to some central place for incineration. If not, the pharmacy probably contracts with a company that incinerates the waste.

If the prescription is never picked up, it hasn't been out of possession of the pharmacy, and the tablets can go back for resale. Most stores check their bins every week or so.

In the US, laws vary by state and pharmacists have to take a law exam to get licensed, as well as the pharmacy board exam that has to do with drugs. Some states have their own law exam, about half use a more general one (the MJPE).

Regulations to make sure a pharmacy employee doesn't take home "free samples" are in place. I'm in the US, so of course regulations involving controlled substances are in-freaking-sane. In Virginia where I live, controlled substances get counted every single day. Even the suppositories. Only a licensed pharmacist (as opposed to a pharmacy technician) can sign out controlled substances where I work. Ordering controlled substances requires a special form from the DEA and that whole process is highly regulated. If you waste a drug (throw it out b/c it's damaged, expired, etc), you need a witness to sign off.

By: sandraregina

sandraregina — Tue, 27 Jan 2009 16:12:04 -0800

I'm still curious as to differences between Canada and the US in terms of stringency - but I have a much clearer picture of what happens 'behind the scenes'. I'm a sucker for that kind of thing. Thanks