Contradictory federal policies on how to dispose of unused prescription medications—plus the lack of disposal options—appear to be creating confusion among patients and providers, according to those testifying Wednesday at a hearing of the Senate Special Committee on Aging on drug waste and disposal.
"Odds are that many of us have half empty bottles of medicine lying around our houses. Some of us may have thought we were doing the right thing by flushing them down the toilet, or throwing them away with our trash. But these disposal methods can have a damaging effect on our environment," said the Committee Chairman Herb Kohl (D-WI), who is calling for a new federal guideline on prescription drug disposal.
Under current policies, the Food and Drug Administration (FDA) and the Office of National Drug Control Policy (ONDCP) now post disposal guidelines that conflict with information posted by the Environmental Protection Agency (EPA) and the Fish and Wildlife Service.
"Disposing of unused or expired medications in a fashion that is simple, legal, and environmentally responsible is a challenge," said R. Gil Kerlikowske, director of the White House?s Office of National Drug Policy Control.
Currently, his office advises controlled substance users to dispose of drugs in one of three ways: flushing them (in the case of limited dangerous drugs); throwing them in the trash with proper precautions; or participating in prescription take-back events. His group calls for flushing "exceptionally dangerous drugs" because misuse of these prescription drugs "creates a high risk" of immediate harm: "Their potential danger outweighs the potential environmental impact," he added.
The EPA and Fish and Wildlife Service, though, have opposed the flushing of prescription medications—citing studies, such as those from the U.S. Geological Survey that have found many bodies of water throughout the states contaminated by personal care products, including prescription drugs.
More take-back programs are being used across the country for the disposal and destruction of prescription drugs, but all require a waiver from the Drug Enforcement Agency if it involves controlled substances. Programs have ranged from permanent sites that accept the prescriptions to one day events. But, new ideas have been developed such as the mail/ship back program now used in Maine.
An operational test agreement was formed between the U.S. Postal Service and the Maine Drug Enforcement Agency to ship unused medications in mailer envelope distributed at 150 pharmacy and health and human service agencies throughout the state, said Stevan Gressitt, MD, the founding director of the Maine Institute for Safe Medicine.
The program, implemented in 2007, handles both controlled and noncontrolled medications. All drugs undergo high heat incineration upon receipt, Gressitt said at the hearing.
One strategy that needs more focus is "to make sure drugs aren't wasted in the first place," Kohl said. This means finding ways for physicians not to over-prescribed medications. For instance, he cited another program in Maine that aims to reduce waste by limiting initial prescriptions for a list of drugs that are known to provoke adverse drug reactions in some people.
Once the patient and physician decide to continue the medication, more is prescribed. "Not surprisingly, waste also reduces costs," Kohl said. The program save Maine's Medicaid program nearly $250,000 just this year, he said.