Drug disposal advice sometimes down the toilet
Groups, agencies at cross-purposes on take-back plans
Alyson Huntting recently injured her back after falling down some steps, and a doctor at Kaiser Permanente's emergency room prescribed oxycodone.
It's a potent narcotic, and Huntting didn't like the side effects. She soon stopped using it, but was shocked to read this instruction in the pamphlet Kaiser issued with the pills: 'If this medicine is no longer needed, dispose of the unused tablets by flushing them down the toilet.'
'It just blew me away,' Huntting says. 'This is something that should not be put in anybody's water supply.'
Huntting is well aware of community programs that encourage residents to bring back unused prescription drugs, to keep them out of our rivers, where treated sewage winds up. There are several drop boxes in the Portland area for people to bring surplus medicines - all located in police stations because some of the targeted drugs are controlled substances that might fall into the wrong hands.
There are people who will 'beg, borrow and steal to get this stuff,' Huntting says, but she has no intention of flushing it down her toilet.
On this issue, it appears that regulators, government agencies, police, pharmacies and environmentalists are working at cross-purposes, and giving contradictory messages to the public.
Increasingly, Portland-area police and crime prevention groups are teaming with water and sewer authorities and environmental regulators to urge residents to return unused prescription drugs. Kaiser and other pharmacies, following the lead of the U.S. Food and Drug Administration, are urging people to put some medicines in the toilet instead.
Kaiser Permanente is obliged to follow FDA requirements, and the federal agency says surplus prescription narcotics must be flushed down the toilet, says Kaiser's Portland spokesman, Dave Northfield.
'Our pharmaceutical people are not that excited about including that direction, but they figured well, if the feds want us to do it it, we'd better do it,' Northfield says. 'You don't want to mess around with these federal regulators, especially with regard to narcotics.'
But the FDA's position on the issue has been evolving, and some say local pharmacies' instructions to patients aren't keeping pace.
'Until two years ago, they (the FDA) were saying that flushing is the only alternative,' says Maggie Conley, household hazardous waste coordinator for the Oregon Department of Environmental Quality.
But the FDA has been revisiting the issue as more parts of the country organize drug takeback programs, and as research shows that pharmaceuticals are contaminating our rivers and the fish that live there.
'A year ago, we might have had a couple drop box locations around the state,' Conley says. 'Now there are at least 20, and we hope to have more.'
Choice in disposal
On its website, the FDA maintains a select list of medicines 'recommended for disposal by flushing,' including oxycodone, morphine, methadone, percodan and other drugs. And on its Web page titled 'Disposal of Unused Medicines,' the FDA maintains there's no scientific evidence showing harmful effects on humans from disposing of drugs in the toilet. In addition, it says most medicines get into the sewer system after people consume them and trace amounts are expelled in their feces or urine.
But the FDA's advice is getting more nuanced, to account for environmental concerns. Its website now reads: 'There is a small number of medicines that may be especially harmful and, in some cases, fatal in a single dose if they are used by someone other than the person the medicine was prescribed for. For this reason, a few medicines have specific disposal instructions that indicate they should be flushed down the sink or toilet when they are no longer needed and when they cannot be disposed of through a drug takeback program.'
Some say Kaiser and other area pharmacies ought to be emphasizing the latter clause about drug take-back programs.
It sounds like their prescription handouts are out of date, Conley says.
Sewage treatment experts say the best way to handle pharmaceuticals in the water supply is to stop them at the source, before they enter the system.
'Wastewater treatment can't remove all this stuff,' says Dean Marriott, director of Portland's Bureau of Environmental Services. 'It's ending up in the Columbia River. We're finding it in the fish tissue when we do sampling.
'We're doing everything we can to discourage people from flushing it,' Marriott says.
So what's a person to do who gets these written instructions to toss their unused prescriptions in the toilet?
Thomas Burns, director of pharmacy programs for the Oregon Health Authority, says there's no Oregon laws governing the disposal of prescription drugs. Regulation of pharmacies is handled by the state, Burns says.
'The FDA recommendations are just that, recommendations,' he explains. 'The FDA guidance is just that, guidance.'
Tossed in the burner
In Portland, people may take prescription drugs and over-the-counter medicines to drop boxes at Portland police precincts downtown, East Portland and North Portland, as well as the Multnomah County Sheriff's Office in East Portland.
Police departments in Beaverton, Fairview, Hillsboro and Tigard also have lock boxes.
No questions are asked when people bring in the medicines, and people aren't asked to leave their names.
'The boxes are full all the time,' says Portland Police spokesman Robert King. 'We empty them once or twice a week.'
Police bring the medicines to Marion County's Waste-To-Energy Facility in Brooks, also known as the garbage burner, where they're incinerated.
Find out more
• Oregon drop-off sites for prescription drugs and over-the-counter medicines: www.deq.state.or.us/lq/sw/hhw/DrugTakeBackSites.pdf
• Medicines the FDA suggests be flushed down the toilet: www.fda.gov/Drugs/ResourcesForYou/Consumers/BuyingUsingMedicineSafely/EnsuringSafeUseofMedicine/SafeDisposalofMedicines/ucm186187.htm#MEDICINES