Take Back Day: Dispensing Advice on Medication Disposal

The US Drug Enforcement Administration’s (DEA) National Take Back Day is fast approaching on April 27, 2024 in more than 4000 locations across US cities and towns.¹ Occurring twice a year in April and October, this campaign has collected 17.9 million pounds of medication since its start in Fall 2010.¹ Last October’s Take Back Day took in 300 tons of medication alone.¹

This is one of several national and local harm-reduction initiatives to address not only the opioid epidemic—in which drug overdose deaths remain high at over 100,000 annually—but also to prevent other injuries including pediatric harm due to drug exposures.^1,2 Risks are not limited to opioids. Any prescription medication, OTC product, or supplement can be harmful if not taken as prescribed or per product labeling. Accidents and unintentional injuries are the fourth leading cause of death among Americans in 2021 according to the CDC, and unintentional poisonings contribute to this statistic.³ The FDA reports that accidental poisonings from medications found at home result in 60,000 emergency department visits and 450,000 calls to poison control annually.⁴ 

Community pharmacists are in a prime position to bring awareness to their patients about drug take-back campaigns. Simply reminding their patients to clear unused medications out of their cabinets can make a big impact. Because of pharmacists’ accessibility, information can be disseminated quickly. The DEA provides infographics for download that can be printed, posted, and distributed to customers, if store policies allow.

The proper removal and disposal of accumulated prescriptions, OTC medications, and dietary/nutritional supplements that are unused, no longer prescribed, expired, or otherwise unwanted, promotes medication safety. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), 4% of adolescents who misused opioids have taken prescription opioids from another person’s prescription supply without their permission or knowledge.⁵ Delaying removal and disposal results in the accumulation of household medications and risks several unintended consequences, including risk of misuse, poisoning, and overdose to those living in or visiting the home.

It is essential that pharmacists first familiarize themselves with the various methods of unused medication disposal along with the FDA’s recommendations on taking appropriate action when disposing of unused medications. Having this knowledge readily available aids in counseling patients effectively and guides patients who have questions about what to do with accumulated medications. Per the FDA, the ideal method of disposing of unused medications is through take-back programs or collection sites and kiosks.⁴ If patients miss the National Take Back Day or another community event, they can be directed to authorized permanent collection sites at local police stations, community pharmacies, or hospitals. Medications disposed of in this manner are neutralized, destroyed, and kept out of the waste stream. A key advantage not to be overlooked is the confidentiality these programs afford to the patient or caregiver.

When take back events or collection sites are not available or immediately accessible, patients have additional options. Medication mail back envelopes are a simple and secure way to send medications away for disposal. Pharmacies can stock these postage-paid, pre-addressed envelopes for purchase or distribution. When no other option is available, guide patients to the FDA website and review the FDA’s “flush” and “non-flush” lists to determine whether a medication is okay to flush or not. The medications that appear on the flush list, mostly opioids (including fentanyl patches), can result in death from one dose,⁴ so mitigating such accidental exposure to children, pets, and adults would be lifesaving. The FDA affirms “that the risk of harm from accidental exposure to these few select medicines far outweighs any potential risk to the environment that may come from disposal by flushing.”⁴ For non-flushable medications, the FDA advises consumers to mix them in dirt, cat litter, or coffee grounds, seal in a container or a sealable plastic bag, and throw it away in the trash.⁴

Pharmacists are trusted and accessible to the community and can make an impact on the continued success of these programs by promoting these events through patient counseling, posting flyers, or using social media. During routine counseling, pharmacists can identify patients who may benefit from hearing about disposal methods. Patients who have had a change in strength of medication may benefit from counseling opportunities to consider disposal of the supply of the strength no longer needed/required. Additionally, for patients who have post-op prescriptions for opioids or other pain medications, counsel the patient or caregiver that if any medication is left over, consider disposal and give them instructions on how to do it properly (flush).

Conclusion

Pharmacists’ recommendations regarding disposal are impactful. The Department of Environmental Science and Management at Portland State University conducted a series of surveys, interviews, and focus groups to better understand consumer behavior regarding medication disposal. Researchers “found that customer awareness of drop boxes as well as knowledge about risks of improper disposal are low, however awareness was greater at pharmacies with drop boxes.”⁶

Safe, appropriate, and regular disposal of unused medications is in everyone’s best interest. Pharmacists have an important role in counseling patients, promoting take back events, and providing disposal resources from online sources such as the DEA and FDA websites. Pharmacists’ high esteem in the public’s eye is supported by the profession’s legacy of trust. A pharmacist’s guidance is highly regarded as unbiased and for the good of the patient. Guiding patients and caregivers on the disposal of unused medications not only increases awareness but improves access to removal and disposal options.

References

1. United States Drug Enforcement Administration. Take Back Day. Accessed April 9, 2023. https://www.dea.gov/takebackday#collection-locator

2. Spencer MR, Garnett MF, Miniño AM. Drug overdose deaths in the United States, 2002–2022. NCHS Data Brief, no 491. Hyattsville, MD: National Center for Health Statistics. 2024. DOI: https://dx.doi.org/10.15620/cdc:135849

3. Centers for Disease Control and Prevention. National Center for Health Statistics. Accessed April 9, 2024. https://www.cdc.gov/nchs/fastats/leading-causes-of-death.htm

4. U.S. Food and Drug Administration. Accessed April 11, 2024. https://www.fda.gov/drugs/disposal-unused-medicines-what-you-should-know/drug-disposal-questions-and-answers

5. Substance Abuse and Mental Health Services Administration. National Survey on Drug Use and Health (NSDUH); 2015.Accessed April 9, 2023. https://www.samhsa.gov/data/data-we-collect/nsduh-national-survey-drug-use-and-health

6. Ehrhart AL, Granek EF, Nielsen-Pincus M, Horn DA. Leftover drug disposal: Customer behavior, pharmacist recommendations, and obstacles to drug take-back box implementation. Waste Manag. 2020 Dec;118:416-425. doi: 10.1016/j.wasman.2020.08.038. Epub 2020 Sep 17. PMID: 32949811.