Medication use has soared during the past 50 years. And with the proliferation of pill bottles in the medicine cabinet, healthcare professionals have long counseled patients about minding their supplies and getting rid of those drugs that have expired.
“What we worry about is patients bringing in new drugs, putting them on the shelf with old expired drugs, and then when they pull out their medicine bottle to take their meds, they take the old outdated one,” says Launa Lynch, an assistant professor in the School of Pharmacy at South University — Savannah. “You also worry about children getting into medicine cabinets and pulling out those old prescriptions.”
But the conventional wisdom for dealing the problem — flushing unused drugs down the drain — has created some unintended consequences. Trace amounts of pharmaceuticals and personal care products are showing up in rivers and streams, says Lynch. And while levels are so infinitesimally low that studies so far show no health risk to humans, scientists increasingly voice concern about the impact on wildlife.
U.S. Geological Survey scientists, for instance, reported widespread incidence of “intersex” fish — that is, fish such as bass with both male and female characteristics — in river basins across the country in September 2009. Attributed commonly to pharmaceuticals and other household chemical compounds polluting waterways, this increased incidence of intersex raises concerns about the viability of fish populations and wider effects on the environment, says Lynch.
What is the safe way to dispose of unused medications? To help answer that question, South University’s School of Pharmacy recently teamed with officials in the city of Savannah to host the community’s first “Medicine Cabinet Cleanout” as part of its Earth Day RecycleRama celebration.
Area residents were invited to bring a variety of substances — human and pet medicines, prescription and over-the-counter drugs, vitamin and herbal supplements, liquids and pills — to Savannah’s Forsyth Park for safe disposal on April 17. To encourage appropriate disposal, organizers urged residents to drop off medicines along with recyclables such as paint, oil, tires, compact discs, batteries, and household electronics.
Thirteen pharmacy students and five faculty members from South volunteered at the event, identifying and sorting hazardous and non-hazardous medications. Many people took advantage of this rare opportunity. One man brought three garbage bags full of products that he said he had removed from his mother’s home, according to Lynch.
“This happens to be something that I want to research, looking at the amount of pharmaceuticals in waste streams and seeing how pharmacists can play a part in being good stewards,” she adds.
Promoting awareness and educating the public, the city also ran television commercial spots and set up a website on safe drug disposal, says Laura Walker, a Savannah environmental administrator who organized operations in cooperation with South University representatives. The effort was supported by the Savannah Water Resources Bureau, Walker says. It responds to a call from the U.S. Food and Drug Administration for communities to offer safe “drug take-back” programs.
Because the priority was the disposal of potentially harmful medications, no participants were questioned for surrendering any medication at this “amnesty event.” Participants were encouraged to remove labels from medicines if they wished. “We tried to make this as discreet, open, and safe for people as possible,” says Walker.
And what is the appropriate method for destroying medications? “Incineration is the best way,” Walker says.
That was mainly the job of Return Logistics Inc., a Savannah-based company in the business of medication disposal. Also an event sponsor, Return Logistics inventoried and incinerated the medications at its specially equipped facilities.
“Water filtration hasn’t gotten to the point where we can filter out all drug molecules, but we have become good at having incineration with scrubbers, so chemicals don’t become airborne,” Lynch explains. It is important not to try to incinerate drugs at home — in the fireplace, for instance — because toxins potentially can be released into the air, she adds.
Responsible medication disposal can be difficult for some populations, Walker says. Drug take-back programs like Savannah’s Medicine Cabinet Cleanout are rare across the southeast — organizers say it was only the second such event ever in South Carolina. In some western states, pharmacies offer a “drop box” for safe disposal of medicines. Maine has a drug take-back program that is facilitated through the mail, Walker notes.
The federal government has issued guidelines for proper disposal of medications, Lynch points out, and information also is available through the American Water Works Association.
“We want to shift the paradigm of people’s thinking about the old guidelines for flushing drugs down the toilet when they become expired,” says Lynch. “There’s a better way to take care of it.”