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Combating Prescription Drug Misuse and Abuse: Physician and Patient Roles and Responsibilities for Disposal of Unused Medications

  • March 2018
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    Introduction

    As the country grapples with an opioid epidemic, a frontline of this battle is preventing unused medications from getting into the hands of those who might misuse them. Appropriate disposal of unused medications is paramount for success in this area; however, it is also important to dispose of these medications without harming the environment or others.

    It is important to remember that it is not lawful for physicians to take custody of a patient’s prescription medication for the purpose of disposal unless the physician is a licensed collector.

    This issue brief will provide physicians with resources to guide their patients on how to properly dispose of prescription medications, as well as information for physicians on disposal of sample medications at their offices.


    Disposal of Patient Medication

    The Drug Enforcement Administration (DEA) recommends the following ways in which an individual can dispose of unused medications:

    Authorized Collectors and Participating Government Entities

    A patient can take his or her medications to an authorized collector site. An authorized collector is defined as a registered manufacturer, distributor, narcotic treatment program, hospital/clinic with an onsite pharmacy, or retail pharmacy that is authorized to receive a controlled substance for the purpose of destruction.1 In addition, patients can take unused medications to a local or state law enforcement agency or other government entity that maintains a drug drop box.


    Finding Medication Disposal Sites

    Physicians and patients can look to several resources to find information on where they can dispose of their unused medications. The first is the DEA’s Office of Diversion Control, which keeps an updated searchable database of facilities.2 The Illinois Environmental Protection Agency (IEPA) has also developed an interactive tool to find medication disposal facilities throughout Illinois.3 For those patients feeling more comfortable dropping medication off at a government office or law enforcement agency, the National Association of Boards of Pharmacy has developed a locator tool for patients to check for government entities in their area that have a drug drop box.4 Patients should be cautioned to contact the facility to ensure it is still serving as a medication collector, before bringing their prescriptions to the location.


    Drug Take-Back Event

    Law enforcement and other government agencies often host drug take-back events throughout the year for people to turn in their unused prescription medications. Typically held in the spring and fall, these events give people an opportunity to clean out medicine cabinets of unused medications. Patients should look for event listings in their local media. In addition, the DEA is hosting a National Take-Back Initiative on April 28, 2018. Further information about this particular initiative and future initiatives can be found on the DEA’s website.5 It is important to note to patients that they are only permitted to dispose of prescription medications that are prescribed to them or to a member of their household. It is illegal for a person to dispose of medications that are not prescribed to them or to a member of their household.6

    Destroying Medications

    The U.S. Environmental Protection Agency (EPA), the Food and Drug Administration (FDA) and the IEPA have developed guidelines on how people may safely discard their old medications.7,8,9 Instructions include removing medications from bottles and mixing with undesirable items, such as coffee grounds or kitty litter, and then placing them in a container such as a margarine tub before putting in the garbage.

    Flushing Medications

    There are a small number of medicines that the FDA considers to be so harmful in the hands of another person or animal that if no other immediate way of disposing of those drugs is possible, the recommendation is for those drugs to be flushed down the sink or toilet. Medications containing active ingredients such as Fentanyl, Buprenorphine, Diazepam or Meperidine Hydrochloride are listed as those that should be flushed immediately. Visit ISMS’s Safe Medication Disposal page or the FDA’s website for a complete list of medications recommended for immediate flushing.10,11 It should be noted again that physicians may not take possession of these medications from patients for flushing. Physicians can, however, help their patients flush patients’ unused medications at their medical offices.


    Disposal of Pharmaceutical Samples in a Physician's Office

    Return to Manufacturer

    Physicians run into similar problems when it comes to disposing of pharmaceutical samples in their medical offices. In these cases the DEA recommends that physicians first contact their pharmaceutical sales representatives. Many pharmaceutical manufacturers will take back their samples for proper disposal.

    Contact a Reverse Distributor

    If this is not an option, physicians should then look to special authorized collectors known as "reverse distributors." These companies are registered to take all types of drugs back from physicians for the purpose of proper destruction. There are currently three                                                                                                                                    companies in Illinois that are registered with the DEA as reverse distributors:

    • Pharma Logistics – 847-837-1224
    • Pharmaceutical Return Services – 800-215-5878
    • Qualanex – 800-505-9291

    DEA Guidance for Physicians

    The DEA allows physicians in lawful possession of a controlled substance to destroy prescription medication in accordance with DEA rules.12 Physicians unsure of the protocol for destroying medications in their offices, or seeking other options, should contact their local DEA office to seek further guidance on proper disposal options:

    • Chicago – 312-353-1236
    • Springfield – 800-478-7630

    Conclusion

    Proper disposal of unused prescription medications is one of many important ways to help curb the serious opioid epidemic facing the United States. While physicians cannot take back medications from patients, they can direct patients to several resources throughout Illinois where patients can be assured their medications are being appropriately destroyed. Every effort should be made to take unused medications to a licensed entity or appropriate government agency for proper disposal. When those options are not available, patients should destroy or flush medications using EPA, FDA and IEPA guidelines to prevent harm to others or the environment. Utilizing this combination of resources will help remove unused medications from homes and physician offices and get them to where they will not be a detriment to others.


    Helpful Resources

    Drug Enforcement Administration – Office of Diversion Control

    Drug Enforcement Administration – Drug Disposal Information

    Disposal Act: General Public Fact Sheet

    Title 21, Code of Federal Regulations

    Illinois Environmental Protection Agency – Environmentally Safe Disposal of Pharmaceuticals  

    Food and Drug Administration – Disposal of Unused Medicines  

    Illinois State Medical Society – Safe Medication Disposal  



    1 http://www.deadiversion.usdoj.gov/drug_disposal/fact_sheets/ disposal_registrant.pdf

    2 https://www.deadiversion.usdoj.gov/pubdispsearch/spring/ main?execution=e1s1

    3 http://www.epa.illinois.gov/services-locator/index?MedWaste=true

    4  https://nabp.pharmacy/initiatives/awarxe/drug-disposal-locator/

    5 http://www.deadiversion.usdoj.gov/drug_disposal/takeback/index.html

    6 http://www.deadiversion.usdoj.gov/drug_disposal/fact_sheets/ disposal_public.pdf

    7 https://archive.epa.gov/region02/capp/web/pdf/ppcpflyer.pdf

    8 http://www.fda.gov/Drugs/ResourcesForYou/Consumers BuyingUsingMedicineSafely/EnsuringSafeUseofMedicine/ SafeDisposalofMedicines/ucm186187.htm

    9 http://www.epa.illinois.gov/topics/waste-management/waste-disposal/ medication-disposal/fact-sheet/index

    10 https://www.isms.org/take-back

    11 https://www.isms.org/Resources/For_Physicians/Medication/Safe_Medication_Disposal/

    12 http://www.deadiversion.usdoj.gov/21cfr/cfr/1317/subpart_a.htm



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