Disposing of old medicines is a growing problem. Flushing them may taint the environment. Is there a safer way?
WASHINGTON - What's the best way to throw away leftover, expired medicines? Once the answer was "flush 'em," to ensure children and animals couldn't stumble across the drugs and be poisoned.
Now scientists increasingly warn not to flush drugs. Antibiotics, hormones and other medicines are being found in waterways, raising worrisome questions about potential health and environmental effects.
"So what the heck do you do with it? This is not black and white," Georgetown University pharmacology chairman Kenneth Dretchen says with a sigh.
No one knows just how many unused drugs Americans dump each year, or how many are hoarded because patients don't realize the drugs have expired or simply don't know what to do with them. It's a question that arises each fall as pharmacy groups launch annual "clean out your medicine cabinet" campaigns.
Individual patients aside, one study estimated the nation's nursing homes discard anywhere from $73-million to $378-million worth of drugs a year. Some are incinerated, but many are flushed.
Australia has collected more than 760 tons of medicines since starting a program in 1998 that encourages consumers there to return unwanted drugs to pharmacies so they can be incinerated.
In the United States, the Environmental Protection Agency is studying whether to develop formal recommendations for disposing of old drugs.
At issue are the "pharmaceutical and personal care pollutants" that defy traditional wastewater treatment. Long a concern abroad, they made headlines here when the U.S. Geological Survey found traces of dozens - painkillers, estrogen, antidepressants, blood-pressure medicines - in water samples from 30 states.
Long-term effects aren't known, but scientists worry that exposure to even tiny amounts might cause some harm, at least environmentally. Studies have linked hormone exposure to reproductive side effects in fish, for example, and environmental exposure to antibiotics may encourage development of drug-resistant germs.
Chemicals get into water in many ways. There's runoff from farms or factories; indeed, the World Health Organization is pushing for a major decrease in farmers' use of antibiotics. Topical chemicals such as insect repellent are bathed off. Then there's excretion.
But disposal is starting to get more attention. The Food and Drug Administration is re-evaluating its policy for which drugs need the environmental assessments that can spark disposal instructions.
Separately, some states are working to allow nursing homes to donate leftover drugs to indigent patients, as long as the medicines weren't opened and were guarded against tampering.
For individual patients, officials offer some disposal advice:
* Take all of a prescribed medicine so there aren't leftovers, unless there's a specific reason to quit: for example, a bad side effect.
* Trash is better than sewer, with precautions against children or animals getting into it. Break up capsules and crush tablets, then put the remains back in the original container with its child-resistant cap. Tape it up and double-bag before tossing.
* Alternatively, check if local household hazardous-waste collection programs - where you're supposed to take old motor oil and batteries - accept expired medicines.
* The FDA suggests asking if pharmacies will take back expired drugs. Pharmacies have programs to incinerate or otherwise dispose of inventory they can't sell, but the industry couldn't say how many would accept consumers' leftovers.