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Proper drug disposal programs

Health Factors: Alcohol & Drug Use Air & Water Quality
Decision Makers: Community Members Local Government State Government Healthcare Professionals & Advocates Public Health Professionals & Advocates
Evidence Rating: Expert Opinion
Population Reach: 50-99% of WI's population
Impact on Disparities: No impact on disparities likely

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Description

Proper drug disposal programs accept expired, unwanted, or unused medicines from designated users and dispose of them responsibly. Programs can use in-person drop-offs, mail-in efforts, or permanent secure collection receptacles and can be administered by state or local governments, municipal trash and recycling services, pharmacies, hospitals, clinics, or community organizations partnered with law enforcement. A 2014 amendment to the federal Controlled Substances Act allows the US Drug Enforcement Administration (DEA) to register programs as authorized collectors of controlled substances, allowing collection of pharmaceutical controlled and non-controlled substances, but not illicit drugs (US DEA-Disposal regulations 2014). 

Expected Beneficial Outcomes

Reduced illicit drug use
Reduced unintentional poisoning
Reduced water pollution
Improved water quality

Evidence of Effectiveness

Proper drug disposal programs are a suggested strategy to reduce illicit drug use and unintentional poisoning (TFAH-Levi 2013, Simons 2010, US FDA-Unused medicines), reduce pharmaceutical contamination of fresh water, and improve water quality (Lubick 2010, Glassmeyer 2009, Ruhoy 2008, Becker 2010, US EPA-PPCPs). However, additional evidence is needed to confirm effects.

Ongoing statewide drug disposal programs with permanent collection receptacles may more effectively prevent drug abuse and accidental poisoning than temporary, one day drug take-back events (Ruhoy 2008, Simons 2010). Overall, the US Food and Drug Administration (FDA) suggests disposing of unneeded medicine through organized programs or take-back events; however, the FDA suggests flushing specific harmful drugs to prevent accidental ingestion or misuse (US FDA-Unused medicines).

Over 80% of sampled US streams have evidence of pharmaceuticals in the water (Becker 2010, USGS-Emerging contaminants). Active pharmaceutical ingredients (APIs) released into the environment via improper disposal (e.g., flushing or landfill leaching) can adversely affect aquatic life, contaminate freshwater resources, and promote drug resistance in bacteria (Kessler 2010, Pal 2010, US EPA-PPCPs). Flushing unused pharmaceuticals can cause spikes in APIs in the environment (Ruhoy 2008); flushed pharmaceuticals may also break down into compounds that have different toxicity levels than the original drug (Lubick 2010). Many federal agencies and experts suggest that individual households, hospitals, and health care facilities avoid flushing any pharmaceuticals to preserve water quality and protect aquatic life and ecosystems (Mankes 2013, US EPA-Medicine disposal).

Patient and pharmacist education may be needed to reduce improper drug disposal and increase use of proper medicine disposal programs (Seehusen 2006, Jarvis 2009). Benefit cost analysis suggests that establishing a proper drug disposal program would yield positive net social benefits (Kotchen 2009); ongoing bin-based programs appear to be more cost-effective than mail-in programs or one day events (Carnevale-Drug takeback 2012).

Implementation

United States

In 2014, the US Drug Enforcement Administration (DEA) amended the Controlled Substances Act, allowing more organizations to become authorized collectors that administer mail back programs and maintain collection receptacles. This change created new opportunities for communities to partner with law enforcement to administer take-back events (US DEA-Disposal regulations 2014).

Several states have legislation that authorizes and guides proper drug disposal programs for consumers (e.g., Maine (ME Statutes 22 604), Ohio (OH HB 93), and Washington (WA HB 2600)). Some states have legislation that prohibits health care institutions from flushing unused medications into public wastewater (e.g., Illinois (IL SB 1919)). Other states provide public guidelines and educational materials about proper drug disposal (e.g., Connecticut (CT-Medicine disposal), Florida (FL-Unwanted medications), New York (NY-Proper drug disposal), and New Jersey (NJ-Medication disposal)). 

The DEA’s 2014 drug take-back event included 5,495 collection sites across the country. Since 2010, the DEA has collected 4.8 million pounds of prescription drugs on only 9 days (US DEA Public affairs 2014). Sheriff's offices also host regularly scheduled drug take-back programs for the public. Operation Medicine Cabinet in Broward County, Florida is one example (Broward Sheriff-OMC).

Wisconsin

The Wisconsin Department of Natural Resources (DNR) provides public guidelines about proper drug disposal for households and non-household businesses and institutions on its website (WI DNR-Pharmaceutical waste).

Implementation Resources

AMCC-Rx drop - The American Medicine Chest Challenge (AMCC). Use the search tool to find the drop off location closest to you! Accessed on February 29, 2016
Dispose my meds - Dispose My Meds. Safe disposal of medications: Pharmacy locator. Accessed on January 25, 2016
Take back your meds - Take Back Your Meds. Washington needs a statewide medicine take-back program: Protect our kids, families, and environment. Accessed on January 25, 2016

Citations - Description

US DEA-Disposal regulations 2014 - US Drug Enforcement Administration (US DEA). Disposal regulations: Registrant fact sheet. 2014. Accessed on January 25, 2016

Citations - Evidence

Becker 2010 - Becker J. Minding the gap: Research priorities to address pharmaceuticals in the environment. Health Care Research Collaborative. 2010:1-24. Accessed on January 25, 2016
Carnevale-Drug takeback 2012 - Research and Policy Analysis Group of Carnevale Associates, LLC. Prescription drug takeback programs and substance abuse prevention: A policy brief. Gaithersburg: Carnevale Associates, LLC; 2012. Accessed on January 25, 2016
Glassmeyer 2009* - Glassmeyer ST, Hinchey EK, Boehme SE, et al. Disposal practices for unwanted residential medications in the United States. Environment International. 2009;35(3):566-572. Accessed on January 25, 2016
Jarvis 2009 - Jarvis CI, Seed SM, Silva M, Sullivan KM. Educational campaign for proper medication disposal. Journal of the American Pharmacists Association (JAPhA). 2009;49(1):65-68. Accessed on March 18, 2016
Kessler 2010 - Kessler R. Pharmaceutical factories as a source of drugs in water. Environmental Health Perspectives. 2010;118(9):382-385. Accessed on January 25, 2016
Kotchen 2009* - Kotchen M, Kallaos J, Wheeler K, Wong C, Zahller M. Pharmaceuticals in wastewater: Behavior, preferences, and willingness to pay for a disposal program. Journal of Environmental Management. 2009;90(3):1476-1482. Accessed on January 25, 2016
Lubick 2010* - Lubick N. Drugs in the environment: Do pharmaceutical take-back programs make a difference. Environmental Health Perspectives. 2010;118(5):A210-A214. Accessed on January 25, 2016
Mankes 2013* - Mankes RF, Silver CD. Quantitative study of controlled substance bedside wasting, disposal and evaluation of potential ecologic effects. The Science of the Total Environment. 2013;444:298-310. Accessed on January 25, 2016
Pal 2010* - Pal A, Gin KYH, Lin AYC, Reinhard M. Impacts of emerging organic contaminants on freshwater resources: Review of recent occurrences, sources, fate and effects. The Science of the Total Environment. 2010;408(24):6062-6069. Accessed on January 25, 2016
Ruhoy 2008* - Ruhoy IS, Daughton CG. Beyond the medicine cabinet: An analysis of where and why medications accumulate. Environment International. 2008;34:1157-1169. Accessed on January 25, 2016
Seehusen 2006 - Seehusen DA, Edwards J. Patient practices and beliefs concerning disposal of medications. The Journal of the American Board of Family Medicine. 2006;19(6):542-547. Accessed on January 25, 2016
Simons 2010 - Simons TE. Drug take-back programs: Safe disposal of unused, expired, or unwanted medications in North Carolina. Coastal Coalition for Substance Abuse Prevention. 2010:1-17. Accessed on January 25, 2016
TFAH-Levi 2013 - Levi J, Segal LM, Miller AF. Prescription drug abuse: strategies to stop the epidemic. Trust for America’s Health (TFAH). 2013. Accessed on February 20, 2017
US EPA-Medicine disposal - US Environmental Protection Agency (US EPA). Dispose of medicines, vitamins and other supplements properly. Accessed on February 10, 2016
US EPA-PPCPs - US Environmental Protection Agency (US EPA). Contaminants of emerging concern including pharmaceuticals and personal care products (PPCPs). Accessed on February 10, 2016
US FDA-Unused medicines - US Food and Drug Administration (US FDA). Disposal of unused medicines: What you should know. Accessed on February 13, 2017
USGS-Emerging contaminants - US Department of the Interior, US Geological Survey (USGS). Environmental health toxic substances: Emerging contaminants in the environment. Accessed on February 10, 2017

Citations - Implementation

Broward Sheriff-OMC - Broward County Sheriff’s Office. Operation medicine cabinet (OMC). Accessed on February 29, 2016
CT-Medicine disposal - State of Connecticut Department of Energy & Environmental Protection. Disposing of prescription medicines and over-the-counter (OTC) products. Accessed on January 25, 2016
FL-Unwanted medications - Florida Department of Environmental Protection. How to dispose of unwanted medications. Accessed on January 25, 2016
IL SB 1919 - Illinois 96th General Assembly. Safe Pharmaceutical Disposal Act: Senate Bill 1919. Accessed on January 25, 2016
ME Statutes 22 604 - State of Maine. Disposal of unused pharmaceuticals. Public Laws of Maine: Second Special Session of the 121st; Chapter 679 S.P. 671-L.D. 1926. Accessed on January 25, 2016
NJ-Medication disposal - New Jersey Department of Environmental Protection. Guidelines for proper disposal of household medication. Accessed on January 25, 2016
NY-Proper drug disposal - New York State Department of Environmental Conservation. FAQs about proper disposal of drugs. Accessed on January 25, 2016
OH HB 93 - Ohio 129th General Assembly. Revised code to establish and modify laws regarding the prevention of prescription drug abuse. Amended Substitute House Bill Number 93. Accessed on February 2, 2016
US DEA Public affairs 2014 - US Drug Enforcement Administration (US DEA). DEA public affairs: DEA and partners collect 309 tons of pills on ninth prescription drug take-back day. Accessed on February 29, 2016
US DEA-Disposal regulations 2014 - US Drug Enforcement Administration (US DEA). Disposal regulations: Registrant fact sheet. 2014. Accessed on January 25, 2016
WA HB 2600 - Washington State 60th Legislature. An act relating to providing safe collection and disposal of unwanted drugs. 2008 Regular Session: House Bill 2600; 2008:1-15. Accessed on January 25, 2016
WI DNR-Pharmaceutical waste - Wisconsin Department of Natural Resources (WI DNR). Pharmaceutical waste. Accessed on January 25, 2016

Page Last Updated

June 3, 2015

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