Health Care in The Home

Advances in medicine now allow us to monitor and treat some elements of our health and the health of our family at home. These advances can save us costly and frequent visits to health care professionals for such health monitoring and treatment as blood glucose, common colds and some allergic reactions, and kidney functions/dialysis.

An increasing challenge that comes with these medical advances is the proper management of the waste generated. These wastes include:
 

Used needles, syringes, and lancets
Medicine - unused or outdated
Broken thermometers
Contaminated dressings/Dialysis filter material
 

While used needles, syringes, lancets and other sharp implements may be safely disposed with the other solid wastes from the home, it is important to exercise care in packaging needles, syringes, and lancets for disposal. The safe packaging of these wastes may be accomplished very simply in the home. Use a rigid plastic bottle with a tight fitting cap, such as empty laundry detergent or fabric softeners bottles to store and dispose "sharps." Do not put sharp objects in any container that will be recycled or returned to a store. Needles and syringes need not be recapped. The rigid bottle will minimize the potential for needle sticks. When the bottle is full, add plaster of Paris to the level of the neck of the container, cap it tightly, and place it with your other solid waste for disposal.

Unused and outdated medicines stored in the home provide a considerable risk to children as well as individuals with vision or mental impairment.  Sharps Compliance, Inc. www.sharpsinc.com/locations can help find a pharmacy that participates in the unused or expired medication disposal program.

 

Pharmaceutical disposal practices: 
Trace amounts of pharmaceuticals and other personal care products (also known as PPCPs) are being detected in our nation’s water and drinking water systems. These substances, such as antibiotics, caffeine, or aspirin, may end up in the environment through human or animal waste, runoff from animal feeding operations, or by improper disposal from flushing medicines down the toilet. Much information exists on these substances for therapeutic doses, but little data exists on the potential effects on public health or aquatic life in the low doses that are now being recognized in our waterways.
Currently, the Environmental Protection Agency has not set maximum contaminant levels (MCLs) for these substances in drinking water. However, environmental and health agencies are concerned and believe that more work needs to be done to evaluate the health and environmental impacts of these substances. For more information on this topic, refer to the Environmental Protection Agency, the US Geological Survey, the American Waterworks Association, and the US Senate Committee on Environment and Public Works, Subcommittee on Transportation, Infrastructure, Security, and Water Quality.
 
The Office of National Drug Control Policy recommends the following guidelines for proper disposal of prescription drugs:
•          Take unused, unneeded, or expired prescription drugs out of their original containers and throw them in the trash.
•          Mix prescription drugs with an undesirable substance, such as used coffee grounds or kitty litter, and put them in impermeable, non-descript containers, such as empty cans or sealable bags.
•          Flush prescription drugs down the toilet only if the label or accompanying patient information specifically instructs doing so (see right column).

•          Take advantage of community pharmaceutical take-back programs that allow the public to bring unused drugs to a central location for proper disposal. These programs are a good way to dispose of unused pharmaceuticals.  

 

However, certain medicines may be especially harmful and, in some cases, fatal in a single dose if they are used by someone other than the person the medicine was prescribed for.  For this reason, a few medicines have special disposal directions that indicate they should be flushed down the sink or toilet after the medicine is no longer needed. If you dispose of these medicines down the sink or toilet, they cannot be accidently used by children, pets, or anybody else.

You may have also received disposal directions for these medicines when you picked up your prescription. If your medicine is on this list, and you did not receive information on disposal with your prescription, you can find directions on how to dispose of the medicines at DailyMed1. After you search on the drug name, the disposal information for these medicines can be found in one of the following sections of the prescribing information: 

 

  • Information for Patients and Caregivers
  • Patient Information
  • Patient Counseling Information
  • Safety and Handling Instructions
  • Medication Guide

 

It is important to note that disposal by flushing is not recommended for the vast majority of medicines. Unused or expired medicines that do not have flushing directions in the label can be disposed of safely in the household trash by:

 

  1. Mixing them with something that will hide the medicine or make it unappealing, such as kitty litter or used coffee grounds.
  2. Placing the mixture in a container such as a sealed plastic bag.
  3. Throwing the container in your household trash.

 

Below is some additional information about the disposal of medicine that is no longer needed. If you have additional questions about disposing of your medicine, please contact us at 1-888-INFO-FDA (1-888-463-6332).

 

 
Frequently Asked Questions

 

Why do the medications on the list have flushing directions for disposal?

The medicines on this list of medicines recommended for disposal by flushing are safe and effective when used as prescribed, but they could be especially harmful to a child, pet, or anyone else if taken accidentally. Some of the possible harmful effects include breathing difficulties or heart problems, possibly leading to death. For these reasons, FDA advises that flushing these medicines down the sink or toilet is currently the best way to immediately and permanently remove the risk of harm from the home.

FDA continues to work with and encourage the manufacturers of these medicines to develop alternative, safe disposal systems.

How should you dispose of medicines not found on the list?

Do not flush all medicines down the toilet. The FDA recommends that most medicines be disposed of in the household trash after mixing them with some unpalatable substance (e.g., coffee grounds) and sealing them in a container.  Unused portions of medicines must be disposed of properly to avoid harm. 

Drug take-back programs for disposal can be another good way to remove unwanted or expired medicines from the home and reduce the chance that someone may accidentally take the medicine. Contact your city or county government's household trash and recycling service to see if there is a take-back program in your community and if there are any rules about which medicines can be taken back. You can also talk to your pharmacist to see if he or she knows of other medicine disposal programs in your area. 

Does flushing the medicines on the list down the toilet or sink drain pose a risk to human health and the environment?

We are aware of recent reports that have noted trace amounts of medicines in the water system. The majority of medicines found in the water system are a result of the body’s natural routes of drug elimination (in urine or feces). Scientists, to date, have found no evidence of harmful effects to human health from medicines in the environment.

Disposal of these select, few medicines by flushing contributes only a small fraction of the total amount medicine found in the water. FDA believes that any potential risk to people and the environment from flushing this small, select list of medicines is outweighed by the real possibility of life-threatening risks from accidental ingestion of these medicines.

 

MEDICINES RECOMMENDED FOR DISPOSAL BY FLUSHING

This list from FDA tells you what expired, unwanted, or unused medicines you should flush down the sink or toilet to help prevent danger to people and pets in the home. Flushing these medicines will get rid of them right away and help keep your family and pets safe.FDA continually evaluates medicines for safety risks and will update the list as needed. 
 

Medicine

Active Ingredient

Abstral, tablets (sublingual)

Fentanyl

Actiq, oral transmucosal lozenge *

Fentanyl Citrate

Avinza, capsules (extended release)

Morphine Sulfate

Daytrana, transdermal patch system

Methylphenidate

Demerol, tablets *

Meperidine Hydrochloride

Demerol, oral solution *

Meperidine Hydrochloride

Diastat/Diastat AcuDial, rectal gel

Diazepam

Dilaudid, tablets *

Hydromorphone Hydrochloride

Dilaudid, oral liquid *

Hydromorphone Hydrochloride

Dolophine Hydrochloride, tablets *

Methadone Hydrochloride

Duragesic, patch (extended release) *

Fentanyl

Embeda, capsules (extended release)

Morphine Sulfate; Naltrexone Hydrochloride

Exalgo, tablets (extended release)

Hydromorphone Hydrochloride

Fentora, tablets (buccal)

Fentanyl Citrate

Kadian, capsules (extended release)

Morphine Sulfate

Methadone Hydrochloride, oral solution *

Methadone Hydrochloride

Methadose, tablets *

Methadone Hydrochloride

Morphine Sulfate, tablets (immediate release) *

Morphine Sulfate

Morphine Sulfate, oral solution *

Morphine Sulfate

MS Contin, tablets (extended release) *

Morphine Sulfate

Nucynta ER, tablets (extended release)

Tapentadol

Onsolis, soluble film (buccal)

Fentanyl Citrate

Opana, tablets (immediate release)

Oxymorphone Hydrochloride

Opana ER, tablets (extended release)

Oxymorphone Hydrochloride

Oxecta, tablets (immediate release)

Oxycodone Hydrochloride

Oxycodone Hydrochloride, capsules

Oxycodone Hydrochloride

Oxycodone Hydrochloride, oral solution

Oxycodone Hydrochloride

Oxycontin, tablets (extended release) *

Oxycodone Hydrochloride

Percocet, tablets *

Acetaminophen; Oxycodone Hydrochloride

Percodan, tablets *

Aspirin; Oxycodone Hydrochloride

Xyrem, oral solution

Sodium Oxybate

*These medicines have generic versions available or are only available in generic formulations.

 List revised:  February 2013

 

For specific drug product labeling information, go to DailyMed2 or Drugs@FDA3.

Mercury filled thermometers provide an effective low cost method for monitoring body temperature. A broken thermometer presents two immediate challenges, the broken glass and the metallic mercury. Both of these materials should be scooped immediately into a rigid container with a tight fitting cap and carefully sealed. Special care must be taken to ensure that all of the mercury "beads" are contained. Many of them may be very small and they will scatter on impact. The contained mercury and glass should be sent to an appropriate recycle operation. Laboratories, fluorescent light recyclers, and your state or local recycle coordinator should be able to help you find a recycler. Care should also be taken to avoid contact of the mercury with any items made of gold. Should a gold-to-mercury contact occur, contact a jeweler or chemist immediately to have the gold treated for mercury removal. This treatment should not be attempted in the home.

Contaminated wound dressings, disposable sheets and pads, gloves, and dialysis machine filters may be double bagged in a standard plastic garbage bag and securely fastened. This material may then be combined with other household garbage for disposal.

 

 

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