Is your bathroom cabinet overflowing with expired medicines? If so, you’re not alone. Almost everyone has faced the dilemma of expired or unwanted drugs in the medicine cabinet. But few of us know the best way to dispose of the prescription and over-the-counter (OTC) drugs we use to control everything from a heart rate to a headache. Is it safe to take that expired medication? Or should you dispose of it? And if so, how should you dispose of it?

There are no perfect solutions for expired medication disposal. It’s tempting to simply toss unused medicines into the trash. But medications unthinkingly tossed in the trash are magnets for dogs and other critters, children, and people who might be looking for drugs for recreational use. If they do make it to the landfill, those medications can leak out into the environment, causing problems. Flushing them down the toilet adds them to lakes, streams, and even community drinking water.

Still, you can take some steps to dispose of your medications safely and minimize their impact on the environment. Here’s how.

Is it Safe to Take Expired Medications?

Many people wonder whether expired medicines are still safe and effective. Do you really need to throw out these expired medications? Unfortunately, the answer is yes: If your medication has expired, don’t use it.

Although the risks of using an expired drug are usually minimal, they are real. The chemical composition of a drug may change over time as it is stored, sometimes leading to unsafe byproducts.

In addition, expired medications and other medical products may lose potency – that is, they will be less effective. If the medicine does not work as well, you’ll need to take more of it to achieve the desired effect (called the therapeutic effect), increasing the risk of unwanted side effects. Every medicine comes with some sort of risk. The less potent the medicine is, the greater the risk – and the less you benefit from taking it.

Need to Know: How to Store Medications Safely

Even medications that have not reached their expiration date may lose effectiveness if they are stored incorrectly. Never store medications in a place where they are subject to extreme temperature swings – for instance, in a vehicle, or in a bag that’s left in hot or cold environments. Ideally, medications should always be stored in a cool, dry, temperature-controlled climate. Many medications – such as nitroglycerin – should be protected from light. If you are traveling, pack your medications in a carry-on bag, not in your checked luggage.

To Flush or Not to Flush

Flushing drugs down the toilet would seem to be an easy solution to the disposal problem. After all, once the drugs are flushed, children, dogs, or others who might be looking for them can’t pull them out of the trash. The immediate hazards are mitigated. However, the long-term hazards may have only just begun.

Even federal agencies can’t seem to agree on whether flushing drugs down the toilet is an acceptable solution for disposal. According to the U.S. FDA, a quick flush down the toilet is the best way to dispose of many drugs, including most narcotic pain relievers – and a better solution than putting them in the trash, where children, pets, and others may find time. The FDA offers a continuously updated list of drugs it recommends for flushing at FDA’s Web page on Disposal of Unused Medicines.

On the other hand, the Environmental Protection Agency provides a clear directive: “Do not flush medications, vitamins and other supplements down the toilet unless noted differently on the medication’s packaging.” Most environmental groups and local governments concur – and even the FDA says it doesn’t encourage flushing.

Why the controversy? A drug flushed down the toilet may be out of sight and out of mind – but that doesn’t mean it’s out of circulation. Drugs are in our water supply, and flushing them only adds to the environmental burden. In 2002, the U.S. Geological Survey sampled streams in 30 states. Of the 139 streams tested, 80 percent had measurable concentrations of prescription and nonprescription drugs, steroids, and reproductive hormones. Small amounts of drugs have been found in some drinking water.

The question, says FDA environmental assessment expert Raanan Bloom, PhD, is how the drug gets there. According to Bloom, most of the drugs found in surface waters and community drinking water supplies have been ingested and then excreted. After you take a drug, it is are only partially absorbed or metabolized. The remainder of the drug goes down the toilet when you urinate or defecate. So adding more drugs by flushing them has relatively little impact, according to the FDA. Still, the FDA says in a rather unclear guidance statement, it’s better not to flush if you don’t have to do so.

How to Dispose of Medications Safely

In 2007, the White House Office of National Drug Control Policy (ONDCP) worked with the FDA to develop and issue the first consumer guidance for proper disposal of prescription drugs. The guidelines were updated in October 2009. The same guidelines can be used for over the counter (OTC) drugs such as Tylenol (acetaminophen, paracetamol) or Ibuprofen.

Here’s a summary of those guidelines.

Before you toss your drugs, read the label! Most drug manufacturers include disposal instructions on medications or on the accompanying patient information pamphlet. Only flush medications down the toilset if the drug information specifically tells you to do so.
The best way to dispose of drugs is not to do it yourself. Instead, call your local household trash and recycling service. They can refer you to a community drug take-back program near you. These programs allow you to take unused drugs to a central location for proper disposal. You can also ask your pharmacist about take-back and drug recycling programs.
Many community drug take-back centers cannot accept narcotics unless a law enforcement officer is present. To address this problem, the Drug Enforcement Administration, working with state and local law enforcement agencies, sponsors National Prescription Drug Take Back Days throughout the United States. On these days, you can take almost any medications, including narcotics, to participating law enforcement agencies.

The next National Prescription Drug Take-Back Day is scheduled for April 28, 2012, from 10 a.m. to 2 p.m. (Eastern Time).

The drug collection effort is sponsored by the U.S. Drug Enforcement Agency (DEA). On that day, nearly 4,000 state, tribal, and local law enforcement agencies and other partners will collect prescription drugs.

More than 377,086 pounds (188.5 tons) of unwanted or expired medications were turned in during the last National Prescription Drug Take-Back Day on October 29, 2011. More than 5,300 law enforcement and other community partners participated. In total, during three days, nearly 500 tons (995,185 pounds) of expired or unwanted prescription medications have been collected.

To find a prescription drug take-back site in your community, click here.

If there are no instructions on the drug label and you cannot find a no take-back program, then use your household trash as a last resort. But you can’t just toss them in. Instead, follow these steps for most medications:

Remove the drugs from their original containers.
Mix them with some water and an unpalatable substance, such as kitty litter (unused!), coffee grounds, sawdust, charcoal, or powdered spices. This step makes the medication less appealing to pets or children – and unrecognizable to people who may intentionally search your trash for drugs.
Place the medication in a sealable plastic bag or other container to keep it from leaking through the garbage bag.
Before you toss the empty bottles in the trash, remove the labels or scratch out your name.

Consult your pharmacist if you are unsure about how to dispose of a particular medication safely.

Particularly Dangerous Medicines

Some medications pose particular problems for disposal, either because they are extremely toxic or they carry a high risk of misused. Drugs that are available as time-release patches may be especially dangerous for children and pets. Never throw these drugs in the trash:

Chemotherapy drugs. Chemotherapy drugs should be returned to the clinic that prescribed them. Many of these extremely dangerous drugs can cause serious damage if they are even touched; never flush them down the toilet.

Fentanyl patch: On April 19, 2012, the FDA issued a warning to health-care providers, patients, and caregivers about proper use, storage, and disposal of Fentanyl patches. Fentanyl is a powerful prescription pain reliever. The patch is prescribed for people who experience chronic pain.

In its warning, the FDA noted that at least 10 children have died and 12 have been hospitalized after they were exposed to the patches – for instance. The FDA recommended that used patches be folded in half so that the sticky sides meet and then flushed down a toilet. They should not be placed in the household trash where children or pets can find them.

In response to environmental concerns about the drug entering water systems, the warning statement said that “FDA recognizes that there are environmental concerns about flushing medicines down the toilet. However, FDA believes that the risk associated with accidental exposure to this strong narcotic medicine outweighs any potential risk associated with disposal by flushing. When the patches are no longer needed, disposing by flushing completely eliminates the risk of harm to people in the home.”

Narcotics: In some states, such as California, narcotics are considered hazardous waste and cannot be thrown in the trash. A drug recycling center cannot accept narcotics unless a law enforcement officer is present.

Did You Know?

Acetaminophen (paracetamol), marketed as Tylenol and found in many over-the-counter cold and cough remedies, is the most common cause of drug overdose in the United States.

How to Dispose of Asthma Inhalers

“Asthma inhalers” pose another disposal problem – less about the drug itself than the propellant used to deliver the drug. The commonly used term “asthma inhalers” is actually a misnomer, as not one really wants to inhale asthma! These devices are small inhalers that deliver medicine directly into the lungs of people who have asthma or other chronic respiratory diseases.

The FDA is gradually phasing out use of inhalers that contain chloroflurocarbons (CFC’s). CFC’s act as a propellant, blowing the medication into the person’s lungs. The FDA called for a phase-out of CFC’s in inhalers because of concern about their impact on the ozone layer of the Earth’s atmosphere. However, some inhalers still contain CFCs.

Most inhalers can be thrown into the trash or recycling bin. But in some areas, inhalers may be considered hazardous waste . Before you toss an inhaler in the trash, read the instructions on the label. Some inhalers should not be thrown into a fire or punctured. Call your local trash and recycling center for advice.