John Burke, commander of the Warren County, Ohio, drug task force and retired commander of the Cincinnati Police Pharmaceutical Diversion Squad, is a 39-year veteran of law enforcement. Cmdr Burke also is the current president of the National Association of Drug Diversion Investigators. For information, he can be reached by e-mail at , via the Web site www.rxdiversion.com, or by phone at 513-336-0070.
I recently presented a speech to a group of educators at a local high school in my area, and the inevitable questions came up about discarding your unused prescription drugs from your medicine cabinet. One of the teachers wanted to know how to dispose of these drugs, and I presented the group with the options of flushing them down the toilet or grinding them up and mixing them with cat litter or coffee grounds.
Later, in the evaluations, one of the teachers wrote that I should not tell them to flush drugs down the toilet, which would cause the fish and the ecosystem to suffer, and this was going to destroy the planet. As you can imagine, I do not want to be responsible for destroying the planet, but it brought up a constant question that probably needs a better answer than the 2 that I gave them.
I happened to attend a meeting in New England a couple of weeks later and was with some of the most respected physicians and pharmacists in the country, and once again this question came up. Debate continues over how much damage is caused by flushing pharmaceuticals, unless you have a septic system—in which case, I was told, it is definitely not a good idea. The cat litter example also was criticized, however, since much of that ends up in landfills, possibly polluting the earth. It also was mentioned in this discussion that, in the case of some drugs that are taken, 30% of the drug is excreted in the urine into the same sewer system as those that are flushed or thrown down the drain at home.
In some cases, patients took their unused pharmaceuticals back to the pharmacy, which may or may not have accepted them. The question here is, can the pharmacist legally possess those pills, even to destroy them in front of another witness, but then how is that destruction done? In the past, the drugs were probably disposed of down the toilet, as pharmacists did not have the time to become involved in a prescription drug destruction program.
Over the years, we have had physicians tell their patients to return their unused drugs to them when they said that they were ineffective or caused some side effect. Sometimes this was done because the physician suspected the patient of drug seeking and did not want to give out another prescription unless he or she could see that few of the drugs had been taken. In a few other cases, however, this was done by a physician for less than honorable purposes. The question remains, can the physician legally possess these drugs that are not prescribed to him?
During the conference I attended, a southern pharmacist mentioned that, at the pharmacy where he worked, patients could pour their unwanted pills into a device that contained some type of solution that made the drugs unusable. I am not sure who disposed of the solution, and in what method, but that seemed to have some promise, as no one else touched the pills.
I am interested in your experience and suggestions for some type of model program in the United States to properly dispose of unwanted pharmaceuticals. As we move to continue to educate patients on reducing drug diversion and not keeping unwanted pharmaceuticals at home, they are going to want a good answer on how to dispose of them.