Trends in Medication Disposal

Proper medication administration receives frequent attention while the issue of medication disposal seems to lurk quietly in the shadows of its more famous counterpart.

The lack of attention and proactive measures taken to ensure proper medication disposal is equally if not more important—especially when dealing with drug diversion. All too often, people toss their medications in the trash or flush them down the toilet without realizing that they may be putting themselves, others, and the environment at risk.

In fact, the majority of unused or unwanted medications receive improper disposal, according to a review article on the topic published by the National Academies of Medicine in 2017. The careless or inadvertent discarding of medications not only makes it easier for controlled substances and other medications to get into the wrong hands; it increases soil and groundwater pollution, meaning that humans and animals alike may be ingesting pharmaceuticals for which they have no clinical need. Because of their frequent patient contact and access, community and independent pharmacies are in prime positions to help mitigate these risks by taking more active roles in patient education and medication disposal.

In efforts to help curtail medication safety risks, federal and state governments are taking proactive measures to ensure appropriate medication disposal while mitigating the risk for potential abuse. The Drug Enforcement Agency (DEA) sponsors a semiannual event that allows people to discard of their unused, unwanted, and expired medications and vaping products. Known as National Prescription Drug Takeback Day, the program is a collaboration between the DEA, state and local law enforcement agencies, pharmacies, and other participating parties who accept discarded drugs for disposal. The event occurs on designated days in April and October each year and has experienced tremendous response from its participants in the 10 years since its inception.

Last October, Americans discarded nearly 883,000 pounds of medication during the DEA’s last medication takeback event. The next National Prescription Drug Takeback Day is scheduled to take place on April 25, 2020. The DEA’s efforts are definitely a step in the right direction, but these semiannual medication takeback initiatives barely knock a dent in the solving the medication disposal problem. So now, many states are taking more aggressive steps to improve safe disposals of medications, some of which may allow for additional options to dispose of medications more frequently than twice a year.

Within the last year, several states have passed new laws to help track, improve, and increase medication disposal.

For example, on January 21, 2020, New Jersey passed “Charlie’s Law,” which requires pharmacy practice sites to supply their patients with information and resources that allow for safe disposal of unused drugs. In December of 2019, New Mexico proposed a bill regarding shipping requirements for controlled substances. The new law includes controlled substance stipulations such as applications, registration, prescribing and disposals. Other states are seeking to tighten the reins on manufacturers of opiates.

Ohio passed two new laws addressing drug disposal that will go into effect on March 1, 2020. One law outlines recordkeeping requirements for pain management clinic for documenting the tracking of drugs through the patient care process beginning from receipt of the medication, through administration, disposal, and inventory. The other law details secure handling of dangerous drugs including controlled substances in clinics and prescribers offices. Last September, Texas law began requiring the party dispensing a schedule II controlled substance to provide written information regarding safe disposal unless a few exceptions were met.

Numerous laws related to drug disposal are in the pipeline, as well. For example, both New York and Colorado have proposed legislation that allow for state-administered take-back programs. In Virginia and Hawaii, lawmakers are considering implementing rules regarding disposal. The proposed Hawaiian bill takes the idea one step further by including OTC as well as prescription drugs into its bill and charging the state’s attorney general with the task of overseeing the proposal.  

In addition to disposal efforts made by state governments, some big box and independent pharmacists are also stepping up their involvement. Community pharmacies have famously served as sites for medication disposal; however, not all such pharmacies accept unwanted medications on a routine basis or in collaboration with the DEA’s program.

Pharmacies that routinely accept discarded drugs are more likely to only accept over-the-counter and prescriptions drugs that are not controlled substances. For a pharmacy to accept discarded controlled substance is a violation of federal law unless the pharmacy has received authorization to do so. As one community pharmacist who wants to remain anonymous noted, the decision to participate in these programs and determining which pharmacies will apply to become authorized collectors of discarded medications is a decision made at corporate levels. Some pharmacies may not accept medications; however, these and participating pharmacies may still facilitate disposal by offering their patients an envelope to mail their unused medications to a third party for destruction.

Slowly but surely, America is making strides in keeping patients safe—one pill at a time.

Written by Frieda Wiley, PharmD