After having a wisdom tooth pulled you are sent home with 30 Percocet tablets. You heal quickly and the pain is so mild that you only end up taking 5 pills. You have kids in the house and you don’t want to leave 25 opioid painkillers lying around: How can you safely dispose of the unused medication?
Hand them back to your dentist? Nope, that’s a crime.
Flush them down the toilet? Nope, bad for the environment.
Go to a National Prescription Take Back Day drop off site? Sure, if one happens to be scheduled, but it might be many months off.
It shouldn’t and doesn’t need to be this hard, as an article in the current issue of Practical Pain Management reveals.
Author: Keith Humphreys
Keith Humphreys is the Esther Ting Memorial Professor of Psychiatry at Stanford University and an Honorary Professor of Psychiatry at Kings College London. His research, teaching and writing have focused on addictive disorders, self-help organizations (e.g., breast cancer support groups, Alcoholics Anonymous), evaluation research methods, and public policy related to health care, mental illness, veterans, drugs, crime and correctional systems. Professor Humphreys' over 300 scholarly articles, monographs and books have been cited over thirteen thousand times by scientific colleagues. He is a regular contributor to Washington Post and has also written for the New York Times, Wall Street Journal, Washington Monthly, San Francisco Chronicle, The Guardian (UK), The Telegraph (UK), Times Higher Education (UK), Crossbow (UK) and other media outlets.
View all posts by Keith Humphreys
Can we link this problem of abundance to the massive shortage of opioids for pain relief in poor countries?
Sealed drop-off boxes in pharmacies for all unused medications would be easy and cheap. A crooked pharmacist would surely not bother breaking in to the box in hopes of finding something resaleable, when other forms of diversion would be easier and more effective. All you need for security is supervision of a small number of sorting centres.
BTW, the equivalence made by the DEA between used cat litter and coffee grounds as unappealing substances for blending old pills is extraordinary. Are these the same weirdos who find the lovely dry scaliness of snakes disgusting?
Might be more of a tempting theft target, either by force or stealth. I suspect it’s the addicted, rather than crooked, that is the concern.
Sold pills are carefully counted at accounted for. Returned pills come in unknown amounts and quality.
If I return 20 real pills for disposal, a pill handler could forward 20 aspirin for disposal. Who will know the difference?
Substituting a patient’s pills would be noticed when the patient’s pain prevails.
I’m sure there’s a shortage in the US too, given our cr*ppy healthcare system. You’re right though, we should be saving and re-distributing them.
Yep, drug policy is a mess. It almost seems a waste of time seeking rational solutions to common problems like this when “the DEA recommends that patients remove the medications from the original bottles, mix them with something unappealing like coffee grounds or used cat litter, seal them in a disposable container or bag, and throw them in the garbage“, but I applaud your efforts, and wish you luck. You’ll need it, because rational thinking doesn’t seem to come naturally to an organization whose top administrator refuses to differentiate between marijuana and heroin, meth, or crack when asked by Congress to rank them by potential harm to the imbiber.
I remember the days when shade-tree mechanics killed weeds with used motor oil or poured it down storm drains. That was a serious pollution problem, but since nobody was getting high on the used oil, the obvious rational solution of recycling was easily adopted, and now most places you can buy motor oil will accept used oil for recycling any time they’re open for business. Imagine the pollution we would encourage if we were to limit acceptance of used motor oil to once or twice a year, and limited those who can accept it to federally deputized entities. If we weren’t so damned obsessed with vainly trying to save everyone from themselves through force of law, this would be a no-brainer instead of the no-brains policy we have now where you can’t even take it back to the place you got it from, even though they’re already federally licensed to handle such substances.
But prescription drugs are not the same thing as motor oil. I wonder, once in the hands of those special deputies who, unlike licensed doctors and pharmacies, can be trusted not to destroy themselves (or sell to someone else who might destroy themselves), what happens to them? I doubt they get recycled back into prescription drugs. How are they ultimately disposed of?
um, throw them in the garbage.
This would go to the environmental problem. Is it really that bad though?
This page from the NY env. dept. has some facts: http://www.dec.ny.gov/chemical/45083.html
- drugs are showing up in rivers and streams
- birth control and antibiotics are likely harmful.
Nothing about opioids. I would say at this point the environmental cost is outweighed by the risk of teens developing addictions.
Here’s another question: to what extent are these drugs broken down in the body, and not just eventually expelled in urine, presumably re-entering environment?
Actually, several German states recommend that you do dispose of pharmaceutical products by putting them in the trash.
You do have to understand a few things about German/European waste disposal schemes to realize why that is not clinically insane.
First of all, in Germany, households are required to separate trash. Recyclable waste products are separated from non-recyclable products and put in separate bins/bags. So, only non-recyclable waste ends up in landfills.
Second, as a matter of EU law, all landfill waste is first run through incineration plants. As a consequence, it is illegal to put untreated waste in landfills in most European countries (the UK is lagging behind in terms of implementation). Incineration (at a minimum of 850 degrees Celsius/1650 degrees Fahrenheit) is assumed to reliably make drugs inert.
There is, however, still the issue that drugs may not be reliably disposed of or stolen from garbage bins. So, in actuality, there are still many alternative ways of disposing of drugs. I believe that putting regulated drugs (such as opiates) in the trash may still not be legal.
The traditional way in Germany was to simply return unused drugs to pharmacies. That was subsidized, so pharmacies incurred no costs. It still strikes me as both the simplest and sanest solution; you’re returning unused drugs to exactly those people who already know best how to deal with them and they’re being incentivized to take them. However, a few years ago, the subsidies ended, so not all German pharmacies do that anymore. My understanding is that pharmacies are still where most Germans take their drugs.
Although it is technically illegal many doctors will accept painkillers back from patients who no longer need them. Mine keeps a number in a locked cabinet in case of emergencies when a patient contacts him early in the morning or late at night with a pain issue during hours when pharmacies aren’t open. Simply loosening the restrictions to allow doctors with privileges to prescribe the medications to also store (limited quantities) of them, possibly with some paperwork, would legitimize an already widespread practice.
From my own experience I’m guessing there is a lot of waste in the prescribing of all different types of medication, both of the actual medication and the money that went into paying for it by both the insurance company and the patient, through his co-pays/deductibles.
When we were trialing different pyschotropic medications for my son, we had a lot of leftovers since we would start with a month’s worth and often not make it through the first two weeks before it was obvious it wasn’t working; we dropped one medication after two doses, leaving 58 unused pills. Our local Children’s hospital does not accept samples from manufacturers so all the medications were bought by us. And of course some medication are in controlled classes and could not be given as samples, anyway.
Our insurance plan penalizes us if we don’t purchase three months of any medications we take regularly at one time, which also leads to waste. If a medication or dosage is changed midway through any three month period, whatever was being taken automatically becomes trash. That just happened this spring with my daily asthma medicine.
Every time I toss something out I think of all the wasted money and all the people who aren’t getting the medication they need because they are not insured, and I just sigh. I can’t believe there’s not a better way.
If you dissolve the drugs in a quart of water and pour them on the lawn, would that allow biological breakdown before the drugs enter the water supply? This would be convenient and eliminate any problems of potential theft or misuse by family members.
A few years back, after getting all four of my wisdom teeth removed in one visit the oral surgeon sent me home with no pain Rx, “Just take some Ibuprofen — you’ll be fine.” He was right.