Routing old drugs from medicine chest to trash bin

It’s time to pooper-scoop that leftover medicine.

Mixing cough syrup, Vicodin or Lipitor with cat litter is the new advice on getting rid of unused medications. Preferably used cat litter. It’s a compromise, better for the environment than flushing -- and one that renders dangerous medicines too yucky to try if children, pets or drug abusers stumble through the trash.

A government experiment is about to send that advice straight to thousands of patients who use potent painkillers, sleeping pills and other controlled substances.

Why? Prescription drug abuse is on the rise, and research suggests that more than half of people who misuse those drugs get them for free from a friend or relative. In other words, having leftovers in the medicine cabinet is risky. Anyone visiting your house could swipe them.

So 6,300 pharmacies around the country have signed up for a pilot project with the Substance Abuse and Mental Health Services Administration. When patients fill prescriptions from a list of abuse-prone medicines, from Ambien to Vicodin, the pharmacist also will hand over a flier urging them to take the cat-litter step if they don’t wind up using all their pills.

Not a cat owner? Old coffee grounds work, or doggie doo, even sawdust. Just seal the medicine and the, er, goop in a plastic bag before tossing in the trash.

“We don’t want to assert that this is a panacea for the larger problem,” says Dr. H. Westley Clark of the substance abuse agency. “It just provides them with a caveat that these are not things you can just lay around.”

But the concern isn’t only about controlled substances. How to best dispose of any medicine, prescription or over-the-counter, is a growing issue.

Unfortunately, “we don’t have a silver bullet,” says Joe Starinchak, of the U.S. Fish and Wildlife Service.

No one knows just how many unused drugs Americans dump each year, or how many are hoarded because patients simply don’t know what to do with them or that they should dispose of them.

Once, patients were told to flush old drugs down the toilet. No more -- do not flush unless you have one of the few prescriptions that the Food and Drug Administration specifically labels for flushing.

That’s because antibiotics, hormones and other drugs are being found in waterways, raising worrisome questions about potential health and environmental effects. Already, studies have linked hormone exposure to fish abnormalities. Germs exposed to antibiotics in the environment may become more drug-resistant.

Some communities set aside “take-back” days to return leftover doses to pharmacies or other collection sites for hazardous-waste incineration. The Environmental Protection Agency recently funded a pilot program by the University of Maine to see if consumers would mail back unused drugs -- a program that local officials estimate could cull as much as 1.5 tons of medications.

But it’s unclear whether incineration is better for the environment than the slow seepage from a landfill, cautions Fish and Wildlife’s Starinchak.

Plus, take-back programs require legal oversight to make sure what’s collected isn’t then diverted for illegal use.

Starinchak calls the yucky-bag disposal method interim advice -- the top recommendation until more research can determine how best to balance the human health, environmental and legal issues.

So early next year, Fish and Wildlife will team with the American Pharmacists Assn. for a larger campaign called SMARxT Disposal. The campaign will spread this latest advice through even more drugstores, to purchasers of all types of medicine.

“There is a $64,000 question here: Whether people really will get rid of it,” says Carol J. Boyd, director of the University of Michigan’s Institute for Research on Women and Gender and a well-known specialist on drug diversion.

Say you’re prescribed a week’s worth of Vicodin for pain after a car crash, and you use only three days’ worth. Most people would keep the rest, to avoid paying for more if they suffer serious pain for some other reason later. Boyd isn’t sure how to counter that money issue.

But keeping the leftovers makes them accessible for misuse by children, other relatives or visitors. Stealing aside, Boyd’s research uncovered that friends and family openly share these pills -- “Use this, it helped me” -- even with teens and college students, apparently not realizing there could be serious health consequences.

“The public needs to know this,” Boyd says of the disposal advice. “What’s not easy is, we don’t know if it’s working.”

--

(BEGIN TEXT OF INFOBOX)

How to toss unused medication

New government guidelines on disposal of leftover medications:

* Don’t flush unused drugs down the toilet, unless they’re one of a handful that expressly advise that on the prescription label.

* Crush or dissolve leftover medicine in a little water. Then mix with a yucky substance -- cat litter, coffee grounds, even dog waste -- in a sealed plastic bag or other unmarked container, and put in the trash. That renders the drug unpalatable if a child, animal or drug abuser rummages through the trash.

* Remove and destroy the prescription label and any other personal identifying information from the original drug container before throwing it away.

* An alternative is to call pharmacies or local environmental or hazardous waste collection sites to see whether they run drug “take-back” programs.

* Some medicines should never be left over. Antibiotics in particular come in the exact quantity you’re supposed to take. Stop taking them before they’re gone and the infection can return, possibly in a harder-to-treat form.

Sources: Substance Abuse and Mental Health Services Administration; U.S. Fish and Wildlife Service.