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Abstract

The continued increase in the usage of medications has led to a variety of negative consequences, including adverse effects on our environment and an increase in misuse/abuse of these products. Improper disposal of unused medications results in significant impacts to wildlife and the potential to adversely affect human cells. Increases in misuse/abuse have resulted in substantial increases in emergency department visits for drug-related issues. Drug overdose is now the leading cause of accidental death in the United States. Education of both healthcare providers and the general public about these issues and the proper disposal of unused medications is crucial.

Keywords

Medication disposal, medication misuse, medication abuse

Introduction

Terminology:

Drug? Medicine? Medication? Pharmaceutical? You may notice different terms are used in different contexts and by different organizations. On these web pages, we use these terms interchangeably.

Unwanted Medicine: A medicine may become unwanted - and then a waste - for many reasons: it expired; it wasn't tolerated; it didn't work; the patient didn't need it anymore; etc.

 Active pharmaceutical ingredient: A substance that is incorporated into a finished drug product that performs the function of the drug product (as opposed to an inactive ingredient). API is a term that is more likely to appear in scientific literature.

The use of medications and other pharmaceuticals continues to rise. In 2009, 3.9 billion prescriptions were dispensed in pharmacies in the United States, compared to 2.8 billion in 1999. Although many prescriptions are filled in the United States, there are various reasons why these prescriptions are not used completely or as intended. Patients may prematurely discontinue medications due to side effects or changes in therapy, or medications that are intended to be used only as needed may expire before the quantity dispensed is taken. In addition, it is estimated that more than 50% of Americans do not take medications as they are prescribed, and approximately one third do not finish the course of therapy or skip doses. Additionally, patients with terminal illnesses or those who die unexpectedly may also have unused medications. Unused or unwanted medications may lead to pharmaceutical waste in the environment, as well as potential medication misuse. The magnitude of the growing prescription abuse problem has also been addressed by the White House and the Obama Administration. In 2011, the Prescription Abuse Prevention Plan was announced to expand the National Drug Control Strategy and emphasizes 4 areas: education, safe disposal, prescription monitoring, and effective enforcement. It is important to be aware of the potential dangers of improper disposal, as well as suggested methods and opportunities available to facilitate disposing of medications appropriately. Improper drug disposal can make it easy for would-be abusers to access medications that are no longer needed. With the opioid epidemic rising throughout the country, it's more important than ever that drugs aren't within easy reach of someone who might abuse them.

Environmental Impact: 

 Medications can enter the environment in a variety of ways. These include direct disposal as trash or excretion by humans or animals. Although it is impossible to determine what percentage of the medications in the wastewater stems from improper disposal as opposed to excretion and bathing, trace elements of medications have been found in surface, ground, and even treated drinking water. While the amounts of medications in these sources are very low, there have been studies to suggest that the effects of medications at these levels range from gender and genital abnormalities in fish to adversely affecting human cells in a laboratory setting. Flushing medications down the toilet as well as rinsing them down the sink are commonly advised as means of disposal; however, evidence suggests that it may be a major contributor to the contamination of local water systems. By design, most water treatment systems are geared toward removing particulate matter, odor, oxygen demand, nutrients, and pathogens, but not the small dissolved components that would result from medications entering water sources. Analgesics, hormone therapies, and blood pressure medications are just a few that have been found in waterways in the United States. Similar studies have shown that pharmaceutical products are present in wastewater and drinking water throughout the United States. Current disposal methods and water treatments do not adequately remove medications from our environment.

Medication Misuse:

    The increased use and availability of prescription medications has also led to an increase in the misuse and abuse of these compounds. Misuse and abuse are used interchangeably to denote the use of prescription or over-the-counter medications for nonmedical reasons or in a manner other than prescribed. It is estimated that 20% of the US population who are over the age of 12 years have misused prescription medications at least once in their lifetime, and 2.4 million people misused medications for the first time within the past year. The most commonly misused medications include over-the-counter medications, opioids, stimulants, and central nervous system depressants. The most frequently misused opioids include hydrocodone and oxycodone, whereas dextroamphetamine and methylphenidate are the most commonly misused stimulants. Central nervous system depressants that are commonly misused include both benzodiazepines such as diazepam and alprazolam as well as the no benzodiazepine hypnotics such as zolpidem, eszopiclone, and zaleplon. The majority of these medications were obtained from sources other than through legitimate prescriptions. The most common source of medications is reported to be from friends or family members where the drugs are obtained either through gift, purchase, or theft.  This increase in misuse has also resulted in a significant increase in emergency department (ED) visits. In fact, between 2004 and 2011, there was a 100% increase in ED visits for drug-related events, with over 1 million visits attributed to the misuse of prescription drugs. This has also resulted in an increase in mortality associated with drug misuse. Drug. overdose is now the leading cause of death from unintentional injury in the United States and for the first time has overtaken traffic fatalities as the leading cause of death from unintentional injury.

Why Proper Disposal of Household Medication Is So Important:

       EPA encourages you to use pharmaceutical take-back programs that accept unwanted household medicines. These take-back programs offer a safe and environmentally protective way to dispose of unwanted household medicines. Pharmaceutical take-back programs offer a dual public health benefit by helping to: Combat the opioid crisis by reducing access to unwanted household medicines, which helps prevent drug abuse and accidental poisoning Protecting the environment by reducing the flushing of household medicines, which prevents their release into groundwater and surface water.

The Dangers Of Improper Drug Disposal:

The unfortunate reality when it comes to drug disposal is that many consumers don't know the right way to discard their old prescriptions. Many forget about existing drugs in the home, while others opt to flush or throw away their unwanted pharmaceuticals. The result is often pills that end up in landfills, the water supply, or in the hands of a child or potential abuser. To protect the environment and our communities, consumers should be aware of potential disposal complications and be educated on the proper methods of disposing of unneeded drugs.

What not to do with old prescriptions:

 Many people grew up in households where it was customary to toss old prescriptions in the trash, leave them lying around the house, or flush them down the toilet or sink; however, these practices can have serious repercussions.

There are three main reasons why these means of disposal are both inadequate and dangerous:

1. It has a negative environmental impact:

Improper prescription disposal can lead to drugs leaching into the water system. In recent years, several pharmaceutical-related chemicals have been found in waterways across the country and even in our drinking water. According to the University of Illinois, these chemicals can be traced back to drugs such as antibiotics, anti-depressants, steroids, seizure medications, painkillers and more. These chemicals not only have the potential to harm humans, they also threaten marine ecosystems. Studies have shown that these prescription chemical byproducts are causing changes in the behavior, reproduction and growth of many species, specifically frogs and fish. To understand the dangers of flushing pills down the toilet or throwing them in the trash, it is important to first understand how prescriptions end up in our waterways in the first place. Medication can reach water in several ways. Shockingly, 40 percent of the nation's water supply is permeated by pharmaceuticals through aquifers deep underground, according to an Associated Press investigation.It's not just consumers who are improperly disposing of medications, either. According to the Environmental Protection Agency (EPA), livestock farms, hospitals and nursing homes are all large contributors of the prescriptions that end up in our waterways. Since septic systems and wastewater facilities are not designed to remove medicinal chemicals from water, there is no current treatment to remove traces of pharmaceuticals from treated water. Even if you choose to throw your prescription pills away in the trash, they'll still likely end up being pumped to wastewater treatment plants.

2. It can lead to accidental poisoning:

When old drugs are left insecurely in a home rather than disposed of properly after their use, it's easy for children or pets to get access to them and face accidental poisoning. Children are naturally curious. Pills that may be colorful or look like candy can especially present a poisoning threat to young children when left around the home. Each year, more than 60,000 kids ages 5 and under unintentionally take a medicine or overdose on it. Even more alarmingly, studies have found that 95 percent of unintentional medication overdose visits to emergency rooms are caused by a young child who got into medicine while a parent or caregiver wasn't looking.

3. It can open the door to abuse :

Improper drug disposal can make it easy for would-be abusers to access medications that are no longer needed. With the opioid epidemic rising throughout the country, it's more important than ever that drugs. aren't within easy reach of someone who might abuse them. According to the Rockville, Maryland-based Substance Abuse and Mental Health Services Administration (SAMHSA), many teenagers mistakenly believe prescription drugs are safer or less harmful than other kinds of drugs. However, what is unrealized by many is that the fastest-growing drug problem in the United States isn't cocaine, heroin or methamphetamines- it's prescription pills. Knowing the basics of prescription disposal can help individuals better manage their medications to make it less likely that old drugs aren't abused.

Proper Household Medication Disposal:

It is easy to properly dispose of unwanted household medications.

 

 

DO:

Use a drug take-back program.

 

 

 

DO NOT:

Flush expired or unwanted prescriptions and over-the-counter drugs down the toilet or drain (unless no drug take-back option is available and the label or accompanying patient information specifically instructs you to do so).

 

Five Options for Household Medicine Take-backs

1. Drug Enforcement Administration take-back days.

2. Kiosks at pharmacies.

3. Kiosks at law enforcement agencies.

4. Mail-back envelopes.

5. Community take-backs.

How to properly dispose of unwanted medications:

   There are many reasons why someone might want to get rid of old pills. Perhaps an individual no longer needs their prescription or maybe they didn't use quite as many pills as they thought they would and they've expired. Regardless of the situation, individuals must follow disposal best practices.

Drug take-back programs:

Several times per year, the Drug Enforcement Administration (DEA) hosts a National Prescription Drug Take-Back Day to provide a safe, convenient, and responsible way for disposing of medications.

 Since its inception in 2010, the DEA has collected more than 9 million pounds of medicine from the public on drug take-back days. Moreover, the program has seen an increase in participation, as last fall's event collected a record-setting 912,305 pounds of prescription drugs. While this is happening at the national level, many states and counties are getting involved in take-back initiatives by launching their programs to reduce the public health and environmental impacts of unused drugs. Earlier this year, five New York state hospitals collected unused pharmaceuticals for free as part of a six-month drug take-back pilot program. This program encouraged residents to drop off expired or unused medications via collection kiosks and prepaid mail-back envelopes for free to help individuals find take-back programs near their homes, the DEA's National Take-Back Day website features a collection site locator and has more information on national, state and county-specific take-back programs.

2. Drug collection kiosks:

Many retailers and hospitals are joining in on community drug collection efforts by installing drug collection kiosks at convenient locations.

For example, Deerfield, Illinois-based Walgreens, and Lake Forest, Illinois-based waste disposal company Stericycle Environmental Solutions recently teamed up to install more than 600 drug collection kiosks in Walgreens stores nationwide to provide a safe, convenient and free way for consumers to return unused medication. Discarding old medicine in these kiosks is as simple as putting a letter in the mailbox. Plus, the availability of these kiosks helps ensure consumers have access to safe, easy free drug disposal. Not only are kiosks convenient for regular customers, they also present higher volume potential, increased store foot traffic, and can be used as a public service marketing tool. Consumers wanting to participate in these programs should be aware of the type of drugs that can and cannot be accepted. Most medications, vitamins, ointments, liquids and lotions can be accepted, while needles, medications, vitamins, ointments, liquids and lotions can be accepted, while needles, inhalers, hydrogen peroxide, and illegal drugs cannot.

3. Smarter purchases:

Of course, the easiest way to cut down on prescriptions in the waste stream is by citizens making more conscientious purchases. When sick, consumers should only buy the medicine they need instead of stocking up. Consumers should also skip bulk purchases and ask their doctors for smaller amounts of medication when the situation dictates. By making more mindful disposal decisions, consumers can better manage their prescriptions in a socially and environmentally conscious manner. The end result is that households and communities. Throughout the country can benefit from reduced contamination and safer neighborhoods.

Disposal Methods and Programs:

There are a couple recommended and preferred methods for medication disposal. These include medication take back events and disposal in household trash. While somewhat controversial, the Food and Drug Administration (FDA) also recommends flushing certain medications that may be harmful to household inhabitants, including children and pets, in addition to suggesting the return of unwanted or unused medications at medication take-back events. These medications most commonly include narcotic analgesics and controlled substances. In the event that a medication take-back event is not available, the FDA recommends mixing of unwanted medications with an undesirable substance and then disposing the mixture in the household trash. These recommendations from the FDA.

Ensuring that patients are properly educated and instructed on disposal methods is vital to prevent environmental harm and, potentially, medication abuse. A survey of pharmacy patrons in New York suggests that less than one third of patients receive information related to proper medication disposal. However, previous counseling of proper disposal methods increased the likelihood that patients would return medications to a pharmacy or other recommended source rather than inappropriately discarding medications by flushing down toilets. To combat the increased number of medications available for misuse, abuse, and environmental exposure, medication take-back events have been increasing in number across the country. The Drug Enforcement Administration (DEA) sponsors 2 national take-back days throughout the year, in fall and spring. The inaugural event was held in fall 2010 with more than 4000 collection sites across the United States, and approximately 242 000 pounds of unwanted or unused medications were collected. The most recent event, held in spring 2014, had more than 6000 sites participate and more than 780 000 pounds of medications were collected. In addition to specific medication take-back days and household disposal. Another option available to dispose of unwanted or unused medications is the Dispose My Meds Program. This service is available to the public and is sponsored by the National Community Pharmacists Association Foundation. There are currently more than 1600 pharmacies across the United States that participate in the program, making year-round disposal available to members of the respective communities.

Food & Drug Administration Recommendations for Household Disposal:

1. Take medications out of original containers.

2. Combine with undesirable substance like kitty litter.

3. Place mixture in disposable container with a lid and seal.

4. Remove any identifying information on empty original container.

5. Place the sealed mixture and empty original container in trash.

Educational Programs:

Other programs have served to provide more education about proper disposal techniques. The American Pharmacists Association, the Pharmaceutical Research and Manufacturers of America, and the US Fish and Wildlife Service partnered to create an educational campaign titled SMARXT Disposal. The program sought to provide awareness to the public about proper medication disposal that was environmentally friendly. In addition, the Ohio State University College of Pharmacy developed an initiative, Generation Rx, in 2007 to provide medication safety and prescription abuse awareness to their local community. In 2011, Generation Rx partnered with the Cardinal Health Foundation and the American Pharmacists Association's Academy of Student Pharmacists to provide educational programming at the national level. The program currently targets youth, collegians, and adults through a variety of methods, including skits and other educational programming. Resources and toolkits are available at the programs. Yet another program worth highlighting is sponsored by the National Associations of Boards of Pharmacy Foundation, Aware Rx. This program provides resources to both pharmacists and student pharmacists as to safe acquisition, appropriate use, and education regarding abuse and misuse of medications. There are also additional resources that provide suggestions for identifying fraudulent prescriptions and how to improve safety and security in the pharmacy.

CONCLUSIONS

It is clear that proper disposal of unused medications is vital to reduce both the availability for misuse and the negative impact on our environment. Education of both health care providers and the general public about the potential problems and the proper disposal of medications are also crucial in helping reduce these harmful consequences, and are 2 of the 4 areas emphasized in the National Drug Control Strategy. Programs such as AwareRx, Generation Rx. DEA's National Drug Take Back initiatives, Dispose My Meds, and SMART Disposal may be expanded and implemented in communities in order to combat the problems associated with the increase in medication usage in the United States. Whether becoming a site for medication disposal, or simply making resources available to the public, many opportunities are available for pharmacists to reduce the environmental impact as well as prevent medication misuse and abuse. Other health care providers and public health workers, alike, also should encourage proper disposal and provide education whenever possible.

Acknowledgment:

We are thankful to Arihant College of Pharmacy, Ahilyanagar. For providing us with the platform and infrastructure for preparing this article also thanks to our Principal Dr. Yogesh Bafana sir, and Assistant professor Mr. Swapnil Kale for their support and expert opinion during the writing process.

REFERENCE

  1. Sechusen DA, Edwards J. Patient practices and beliefs concerning disposal of medications. J Am Board Fam Med. 2006;19:542- 547. [DOI 1 [PubMed] [Google Scholar ]
  2. Prescription Solutions and National Council on Patient Information and Education. New Survey: More than half of Americans do not take prescription medicines as instructed, pointing to growing health problem [news release). Irvine, CA: Prescription Solutions and National Council on Patient Information and Education; November 12, 2009. [Google Scholar]
  3. Glassmeyer ST, Hinchey EK, Boehme SE, et al. Disposal practices for unwanted residential medications in the United States. Environ Int. 2009;35:566-572. [DOL] [PubMed] Google Scholar l
  4. National Institute on Drug Abuse. Research Report: Prescription Drugs: Abuse and Addiction (NIH Publication No. 11-4881). Washington, DC: National Institute on Drug Abuse; October 2011, [Google Scholarl
  5. Substance Abuse and Mental Health Services Administration. Results From the 2012 National Survey on Drug Use and Health: Summary of National Findings (NSDUH Series H-11, HHS Publication No. (SMA) 13-1795). Rockville, MD: Substance Abuse and Mental Health Services Administration; 2013. [Google Scholar)
  6. Johnston LD, O'Malley PM, Bachman JG, Schulenberg JE. Monitoring the Future: National Results on Adolescent Drug Use: Overview of Key Findings, 2010. Ann Arbor, MI: Institute for Social Research, University of Michigan; 2011. [Google Scholar 1
  7. Substance Abuse and Mental Health Services Administration. Drug Abuse Warning Network, 2011: National Estimates of Drug-Related Emergency Department Visits (HHS Publication No. (SMA) 13-4760, DAWN Series D-39). Rockville, MD: Substance Abuse and Mental Health Services Administration; 2013. [Google Scholar]
  8. Centers for Disease Control and Prevention. Drug overdose in the United States: fact sheet. http://www.cdc.gov/homeandrecreationalsafety/overdose/facts.html. Updated February 2014. Accessed May 8, 2014.
  9. Food and Drug Administration. How to dispose of unused medicines. http://www.fda.gov/downloads/Drugs/Resources- ForYou/Consumers/Buying Using MedicineSafely/UnderstandingOver-the-CounterMedicines/ucm107163.pdf. Published 2011.Accessed July 23, 2014.

Reference

  1. Sechusen DA, Edwards J. Patient practices and beliefs concerning disposal of medications. J Am Board Fam Med. 2006;19:542- 547. [DOI 1 [PubMed] [Google Scholar ]
  2. Prescription Solutions and National Council on Patient Information and Education. New Survey: More than half of Americans do not take prescription medicines as instructed, pointing to growing health problem [news release). Irvine, CA: Prescription Solutions and National Council on Patient Information and Education; November 12, 2009. [Google Scholar]
  3. Glassmeyer ST, Hinchey EK, Boehme SE, et al. Disposal practices for unwanted residential medications in the United States. Environ Int. 2009;35:566-572. [DOL] [PubMed] Google Scholar l
  4. National Institute on Drug Abuse. Research Report: Prescription Drugs: Abuse and Addiction (NIH Publication No. 11-4881). Washington, DC: National Institute on Drug Abuse; October 2011, [Google Scholarl
  5. Substance Abuse and Mental Health Services Administration. Results From the 2012 National Survey on Drug Use and Health: Summary of National Findings (NSDUH Series H-11, HHS Publication No. (SMA) 13-1795). Rockville, MD: Substance Abuse and Mental Health Services Administration; 2013. [Google Scholar)
  6. Johnston LD, O'Malley PM, Bachman JG, Schulenberg JE. Monitoring the Future: National Results on Adolescent Drug Use: Overview of Key Findings, 2010. Ann Arbor, MI: Institute for Social Research, University of Michigan; 2011. [Google Scholar 1
  7. Substance Abuse and Mental Health Services Administration. Drug Abuse Warning Network, 2011: National Estimates of Drug-Related Emergency Department Visits (HHS Publication No. (SMA) 13-4760, DAWN Series D-39). Rockville, MD: Substance Abuse and Mental Health Services Administration; 2013. [Google Scholar]
  8. Centers for Disease Control and Prevention. Drug overdose in the United States: fact sheet. http://www.cdc.gov/homeandrecreationalsafety/overdose/facts.html. Updated February 2014. Accessed May 8, 2014.
  9. Food and Drug Administration. How to dispose of unused medicines. http://www.fda.gov/downloads/Drugs/Resources- ForYou/Consumers/Buying Using MedicineSafely/UnderstandingOver-the-CounterMedicines/ucm107163.pdf. Published 2011.Accessed July 23, 2014.

Photo
Sakshi Bobade
Corresponding author

Arihant college of pharmacy, kedgaon, Ahilyanagar.

Photo
Swapnil Kale
Co-author

Arihant college of pharmacy, kedgaon, Ahilyanagar.

Photo
Tanavi Bafana
Co-author

Arihant college of pharmacy, kedgaon, Ahilyanagar.

Photo
Sathe Sunil
Co-author

Arihant college of pharmacy, kedgaon, Ahilyanagar.

Sakshi Bobade, Swapnil Kale, Tanavi Bafana, Sathe Sunil, A Detailed Review on Medication Disposal Programs: Reducing Environmental Impact & Abuse, Int. J. Sci. R. Tech., 2024, 1 (11), 275-280. https://doi.org/10.5281/zenodo.14250752

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