Why Proper Disposal of Household Medication Is So Important

EPA encourages you to use pharmaceutical take-back programs that accept unwanted household medicines. These take-back programs offer a safe and environmentally protective way to dispose of unwanted household medicines. In fact, pharmaceutical take-back programs offer a dual public health benefit by helping to:

• Combat the opioid crisis by reducing access to unwanted household medicines, which helps prevent drug abuse and accidental poisoning.
• Protect the environment by reducing the flushing of household medicines, which prevents their release into ground water and surface water.

Proper Household Medication Disposal

It is easy to properly dispose of unwanted household medications:

DO: Use a drug take-back program.

DO NOT: Flush expired or unwanted prescription and over-the-counter drugs down the toilet or drain (unless no drug take-back option is available and the label or accompanying patient information specifically instructs you to do so).

Five Options for Household Medicine Take-backs:

1. Drug Enforcement Administration take-back days.
2. Kiosks at pharmacies.
3. Kiosks at law enforcement agencies.
4. Mail-back envelopes.
5. Community take-backs.

Terminology

Below are some helpful notes on the terminology used on our webpages:

• Drug? Medicine? Medication? Pharmaceutical? You may notice different terms are used in different contexts and by different organizations. On these webpages, we use these terms interchangeably.
• Unwanted Medicine. A medicine may become unwanted - and then a waste - for many reasons: it expired; it wasn’t tolerated; it didn’t work; the patient didn’t need it anymore; etc.
• Active pharmaceutical ingredient. A substance that is incorporated into a finished drug product that performs the function of the drug product (as opposed to an inactive ingredient). API is a term that is more likely to appear in scientific literature.

Why Safe Storage is Important

According to a 2022 University of Michigan report (pdf), almost every American has prescription or over-the-counter medications in their home. To prevent accidental poisonings and reduce medicines getting into the environment, EPA urges you to:

1. Safely store medicines while they are in your home.
2. Use drug take-back programs to dispose of unneeded household medicines.

According to the U.S. Center for Disease Control, in 2019, 153 million opioid prescriptions were written in the U.S. While that is greatly reduced from the 2012 peak of 255 million opioid prescriptions, that is still equivalent to an opioid prescription for 46.7% of all Americans. In 5% of U.S. counties, enough opioid prescriptions were dispensed for every person to have one.

While not recommended, many people (32.4 - 91%) choose to keep their leftover opioid prescriptions rather than dispose of them. Whether the medications are for current use or being saved for future use, prescription opioids are present in a large percentage of U.S. households.

These data only account for opioid prescriptions, which are a small fraction of the total number of prescriptions filled each year. Statista estimates that more than four billion retail prescriptions are filled annually in the U.S. When considering all prescriptions, the data show a similar pattern. Again, while it is not a recommended practice, a 2019 survey (pdf) showed that 37% of people kept their leftover prescriptions for future use.

Safe Storage is Necessary at ALL TIMES

Given that so many households have medications, it is critical that households have safe in-home storage methods that will prevent unwanted access to medicines. It is especially important to prevent unwanted access to medicines that pose a serious risk in low doses.

To prevent unwanted access to household medicines, we recommend that households store medicines in a locked cabinet, closet, or safe. Medicine safes are available for purchase and use in the home, but any type of robust locking compartment would serve the intended purpose of limiting access, not just a dedicated medicine safe. Medicines can also be safely stored in locked fire boxes, gun safes, or any other device that is designed to limit access and resist tampering.

Take-back Programs Facilitate More Protective Disposal

EPA recommends that households use drug take-back options whenever they are available to dispose of unwanted household medications. Pharmaceutical waste managed through take-back programs is incinerated at permitted facilities with strict emission controls, removing the threat of pharmaceuticals entering groundwater and surface water.

When household medicines are no longer wanted, EPA encourages you to use drug take-back programs. These take-back programs offer a safe and environmentally protective way to dispose of unwanted household medicines. EPA recommends the following:

DO: Use a drug take-back program.

DO NOT: Flush expired or unwanted prescription and over-the-counter drugs down the toilet or drain (unless no drug take-back option is available and the label or accompanying patient information specifically instructs you to do so).

Five Options for Household Medicine Take-backs

Households have several options for properly disposing of unwanted household medicines using drug take-back programs.

1. Drug Enforcement Administration Take-back Days. Find a local law enforcement agency that is participating in the DEA’s twice-a-year National Prescription Drug Take-back Days in April and October. Check DEA's website. DEA Take-back Days also accept over-the-counter medications.

2. Kiosks at Pharmacies. Find year-round household pharmaceutical collection locations in your community with DEA's authorized collector locator. These DEA authorized collectors, such as pharmacies at retail stores or hospitals, install collection kiosks (that often resemble mail drop-off boxes) where the public can drop off unwanted household medicines. As of 2019, 71 percent of the U.S. population lives less than five miles from a permanent collection site, and in 42 states, at least half of the population lives within five miles of a site (per this Government Accountability Office Report (pdf)(1 MB). You can also go to an online mapping service and type in "drug disposal near me" or "medication disposal near me" to find your nearest drug disposal site.

3. Kiosks at Law Enforcement Agencies. Check with your local law enforcement agency to find out if they have a permanent kiosk available.

4. Mail-back Envelopes. Use a postage-paid, pre-addressed mail-back envelope for mailing back your unwanted household medicines for proper disposal. They are available for purchase at many retail pharmacies. Some retailers, community organizations, and states provide the mail-back envelopes for free.

5. Community Take-backs. Community groups may sponsor or coordinate pharmaceutical take-back events. These are often one-day or short-term collection events. DEA regulations require that law enforcement be present during these events.

If There Are No Take-back Options Available

If there are no take-back options available, households can use the steps below for household disposal. It not necessary to buy a specific product for this purpose. You can use common household items to make the drugs harder to access in the trash.

The #5 amber vials typically used for prescriptions are not recyclable in most areas of the U.S. and can be placed in the trash. However, check your local guidelines for which plastics are recyclable in your area.

If you received specific disposal instructions from your healthcare provider (e.g., doctor, pharmacist) for your unused or expired medicine, you should follow those instructions to dispose of your medicine. The best disposal option is to find a drug take back location, which may be found in retail, hospital, or clinic pharmacies; and/or law enforcement facilities.

If you don’t have a drug take back location near you, check the FDA’s flush list to see if your medicine is on the list. Medicines on the flush list are those (1) sought-after for their misuse and/or abuse potential and (2) that can result in death from one dose if inappropriately taken. If children, adults, or pets in your home accidentally or intentionally ingest, touch, misuse, or abuse a medicine on the flush list, they can suffer serious consequences including death. An example of a medicine on the flush list is fentanyl transdermal system (also known as a fentanyl patch), which contains an opioid. If a drug take-back program is not available, flushing medicines on the flush list helps keep everyone in your home safe by making sure these powerful and potentially dangerous medicines (when used inappropriately) are not accidentally or intentionally ingested, touched, misused, or abused.

Remember, don’t flush your medicine unless it is on the flush list.

Impact of flushing medicines on the environment

FDA recognizes that the recommendation to flush a few specific medicines when a take back program is not readily available raises questions about the impact of the medicines on the environment and the contamination of surface and drinking water supplies.

In an effort to address this concern, FDA staff published a paper entitled "Risks Associated with the Environmental Release of Pharmaceuticals on the U.S. Food and Drug Administration ‘Flush List’". This paper evaluates the environmental and human health risks associated with the flushing of 15 active ingredients found in these medicines. FDA concluded that these medicines present negligible risk to the environment. However, some additional data would be helpful for confirming this finding for some of the medicines.

FDA believes that the known risk of harm, including toxicity and death, to humans from accidental exposure to medicines on the flush list far outweighs any potential risk to human health and the environment from flushing these unused or expired medicines. Remember only flush medicines on the flush list if a take-back option is not readily available. FDA will continue to conduct risk assessments as a part of our larger activities related to the safe use and disposal of medicines.

If no drug take back sites, locations, or programs are available in your area, and there are no specific disposal instructions (such as flushing) in the medication guide or package insert, you can follow these simple steps to dispose of most medicines in your trash at home:

1. Mix medicines (liquid or pills; do not crush tablets or capsules) with an unappealing substance such as dirt, cat litter, or used coffee grounds;
2. Place the mixture in a container such as a sealed plastic bag;
3. Throw away the container in your trash at home; and
4. Delete all personal information on the prescription label of empty medicine bottles or medicine packaging, then trash or recycle the empty bottle or packaging.

Medicine take back options are the best way to safely dispose of unused or expired prescription and nonprescription (for example, over the counter) medicines.

Before disposing of prescription medicines, be sure to remove all personal information on pill bottle labels and medicine packaging. All of your medicines dropped off at the take back locations will be destroyed.

There are generally two kinds of take back options:

• Permanent collection sites
• Periodic take back event

Permanent Collection Sites

Some facilities and businesses are registered with the U.S. DEA to collect your unused or expired medicines. Find an authorized drug collection site near you or call the DEA Diversion Control Division Registration Call Center at 1-800-882-9539 for more information about these collection sites.

These collection sites safely and securely gather and dispose of your unused or expired medicines, including those that contain controlled substances. In your community, authorized collection sites may be retail, hospital, or clinic pharmacies; and/or law enforcement facilities. These collection sites may offer on-site medicine drop-off boxes; mail back programs; or other in-home disposal methods to assist you in safely disposing of your unused or expired medicines.

Periodic Events

The U.S. Drug Enforcement Administration (DEA) periodically hosts National Prescription Drug Take Back events. During these Drug Take Back Days, temporary drug collection sites are set up in communities nationwide for safe disposal of prescription drugs.

Local law enforcement agencies may also sponsor medicine take back events in your community. You can also contact your local waste management authorities to learn about events in your area.

This question and answer section provides additional details on drug disposal options and why FDA recommends flushing certain potentially dangerous medicines only when take back options are not readily available.

Q1 What's the best way to get rid of medicines (including prescription, over the counter (OTC), and dietary supplements) I no longer need or that have expired?

The best way to dispose of most types of unused or expired medicines (both prescription and over-the-counter) is to drop off the medicine at a drug take back site, location, or program immediately.

If you cannot get to a drug take back location promptly, or there is none near you, and your medicine is:

• on the FDA flush list, your next best option is to immediately flush this potentially dangerous medicine down the toilet.
• not on the flush list, you should follow these instructions to discard the medicine in your trash at home.

You can also check with your pharmacist. Some pharmacies offer mail-back programs and other ways to help you safely dispose your unused or expired medicines.

Q2 How do I get rid of needles and syringes?

Follow this link to get information on the proper way to dispose of sharps (needles, syringes, and lancets).

Q3 If I live in an assisted living community and take my own medicines, or my family member was in hospice and has since passed away, how can I safely dispose of medicines that are no longer needed or expired?

First, check with the health care management team in your community or hospice to find out the best way to dispose of unused or expired medicines.

If you learn that you are responsible for disposal of these medicines, follow the directions below:

1. The preferred method of medicine disposal is a drug take back option.
2. If these options are not readily available, check to see if your medicine is on the flush list. If it is, you should dispose of your medicine by flushing it down the toilet. These flush list medications are potentially dangerous and should not be disposed of in the trash.
3. If your medicine is not on the flush list, you can follow these instructions to dispose of your medicine in the trash at home.

Some opioid products with uncommon dosage forms (e.g., sprays, lozenges) have product-specific disposal instructions. Review the instructions that came with your prescription or contact your health care professional (e.g., pharmacist, doctor) to find out how to properly dispose of these medicines.

Q4 Why are some medicines on the flush list while other medicines are not? What is the rationale for this policy?

The few, select medicines recommended for disposal by flushing are safe and effective when used as prescribed. However, medicines on the flush list can result in death from one dose if inappropriately taken. These medicines are those sought-after for their misuse and abuse potential. If children, adults, or pets in your home accidentally or intentionally ingest, touch, misuse, or abuse a medicine on the flush list, they can suffer serious consequences including death.

For these reasons, FDA recommends that when it is not possible to immediately drop off these medicines at a drug take back program or a DEA authorized collector, consumers should flush them down the toilet to immediately and permanently remove this risk from their home.

We believe that the risk of harm from accidental exposure to these few select medicines far outweighs any potential risk to the environment that may come from disposal by flushing. FDA continues to work with and encourage manufacturers of these medicines to develop alternative, safe disposal systems as reducing this risk is of our utmost concern.

Q5 How big of a problem is accidental pediatric exposure to medicine in the United States?

Accidental exposure to medicine in the home is a major source of unintentional pediatric poisonings in the United States. Each year in the United States, approximately 60,000 emergency department (ED) visits 1 2 and 450,000 calls to poison centers 3 are made after children under 6 years of age find and ingest medication without caregiver oversight. Over two-thirds of ED visits for accidental pediatric medication exposures involve 1- or 2- year old children and nearly 20% result in hospitalization 1 .

Keeping medicines after they are no longer needed creates an unnecessary health risk in the home, especially if there are children present. Even child resistant containers cannot completely prevent a child from taking medicines that belong to someone else. In a study that looked at cases of accidental child exposure to a grandparent’s medicine, 45% of cases involved medicines stored in child-resistant containers 3 .

Cases of inadvertent exposure to some of these medicines were published in the American Association of Poison Control Centers’ 2018 annual report 4 . Below is a case summary to illustrate how some medicines can result in death if they are accidentally taken by children.

• A 2 year old boy was found lethargic by his mother with her methadone bottle open and 20 pills missing. She then put the child down for a nap and could not wake him 5 hours later. The child arrived to the emergency department (ED) in cardiac arrest, pupils were fixed and dilated. A heart ultrasound showed no cardiac activity after 30 minutes of resuscitation, and the boy was declared dead. The cause of death: methadone toxicity.

Q6 Does flushing medicines on the flush list pose a risk to human health or the environment? Does FDA’s recommendations about medicine disposal consider the effects of medicines in the environment?

FDA is aware of reports of very low, but measurable levels of medicines in surface waters such as rivers and streams, and to a lesser extent in drinking water. To date, scientists have found no evidence of harmful effects to human health from these few, select medicines in the environment.

The majority of medicines found in water are a result of the body’s natural routes of drug elimination (in urine or feces). Disposal of these few, select medicines by flushing, which is encouraged only when drug take back options are not readily available, would only contribute a small fraction of the total amount of medicine found in our surface and drinking water.

Based on the available data, FDA believes that the known risk of harm to humans from accidental exposure to these medicines far outweighs any potential risk to human health or the environment from flushing these medicines.

FDA works with other agencies, including the U.S. Environmental Protection Agency (EPA), to better understand the human health and environmental risks from medicines in our water. In addition, FDA continues to work with and encourage manufacturers of these medicines to develop safe, alternative disposal systems.

Q7 Can unused or unexpired medications be donated?

This depends on which state you live in. There are some online resources that may help you determine whether pharmaceutical donation and reuse programs exist in your state. It should be noted that most state programs do not accept controlled substances.

Also, please note that FDA does have concerns regarding the donation of unused drugs and does not endorse this practice. This is because the ultimate end user would have no assurance that the medications were appropriately stored. For many medications appropriate storage is essential to maintain their strength and quality.

Is your medicine cabinet full of expired drugs or medications you no longer use? Your medicine is for you. What’s safe for you might be harmful for someone else. The best way to dispose of your expired, unwanted, or unused medicines is through a drug take back program — or you can do it at home.

Drug Take Back Programs

The U.S. Drug Enforcement Administration (DEA) sponsors National Prescription Drug Take Back Day in communities nationwide. Many communities also have their own drug take back programs. Check with your local law enforcement officials to find a location near you or with the DEA to find a DEA-authorized collector in your community.

You can also check with your pharmacist. Some pharmacies offer on-site medicine drop-off boxes, mail-back programs, and other ways to help you safely dispose your unused medicines.

How to Dispose of Medicines at Home

When a take back option is not easily available, there are two ways to dispose of medicines at home, depending on the drug.

Flushing medicines: Because some medicines could be especially harmful to others, they have specific directions to immediately flush them down the sink or toilet when they are no longer needed, and a take-back option is not readily available.

How will you know? Check the label or the patient information leaflet with your medicine. Or consult the U.S. Food and Drug Administration’s list of medicines recommended for disposal by flushing when a take back option is not readily available. Remember, don’t flush your medicine unless it is on the flush list.

Disposing medicines in household trash: If a take back program is not available, almost all medicines, except those on the FDA flush list (see below), can be thrown into your household trash. These include prescription and over-the-counter (OTC) drugs in pills, liquids, drops, patches, and creams.

Follow these steps:

1. Remove the drugs from their original containers and mix them with something undesirable, such as used coffee grounds, dirt, or cat litter. This makes the medicine less appealing to children and pets and unrecognizable to someone who might intentionally go through the trash looking for drugs.
2. Put the mixture in something you can close (a re-sealable zipper storage bag, empty can, or other container) to prevent the drug from leaking or spilling out.
3. Throw the container in the garbage.
4. Scratch out all your personal information on the empty medicine packaging to protect your identity and privacy. Throw the packaging away.

If you have a question about your medicine, ask your health care provider or pharmacist.

Disposing Fentanyl Patches

The fentanyl patch is an example of a product that contains a powerful opioid medicine that can be dangerous to people it’s not prescribed for. This adhesive patch delivers a strong pain medicine through the skin.

Even after a patch is used, a lot of the medicine remains. That’s why the drug comes with instructions to flush used or leftover patches.

Disposing Inhaler Products

One environmental concern involves inhalers used by people who have asthma or other breathing problems, such as chronic obstructive pulmonary disease. Read handling instructions on the labeling of inhalers and aerosol products.

These products could be dangerous if punctured or thrown into a fire or incinerator. To properly dispose of these products and follow local regulations and laws, contact your trash and recycling facility.

Flushing Drugs and the Water Supply

Some people wonder if it’s okay to flush certain medicines when a take back option is not easily available. There are concerns about the small levels of drugs that may be found in surface water, such as rivers and lakes, and in drinking water supplies.

“The main way drug residues enter water systems is by people taking medicines and then naturally passing them through their bodies,” says Raanan Bloom, Ph.D., an environmental assessment expert at the FDA. “Many drugs are not completely absorbed or metabolized by the body and can enter the environment after passing through wastewater treatment plants.”

The FDA and the U.S. Environmental Protection Agency take the concerns of flushing certain medicines in the environment seriously. Still, there has been no sign of environmental effects caused by flushing recommended drugs.