Saving the world one pill at a time

Unlike most Americans, when Nate Donato cleans out his medicine cabinet he doesn’t just toss his unused prescription pills into the trash or pour them down the sink. Instead, the 21-year-old North Carolinian takes the extra time and trouble to mix the old pills with rotten vegetables and other food waste before throwing them away, to make sure no one is tempted to scavenge them from the garbage.

Donato’s mother, a drug and alcohol counselor, is all too aware of the dangers of drug abuse, he said, and the family’s careful drug disposal technique is a deliberate attempt to keep unused medications out of the wrong hands. “She’s worried that people will get ahold of the medicines that we’re throwing away,” he said. “So by getting rid of them that way, she hopes that it will discourage people from finding them.”

Few families are as cautious, however. Even as the evidence grows that improperly disposed medications are contaminating water supplies and raising the risk of accidental poisonings and deliberate abuse, most consumers still don’t get rid of their old pills safely. A 2006 survey published in the “Journal of the American Board of Family Medicine” revealed that more than half of the 301 respondents had flushed their old medications, and more than half of them had also stored unused or expired medications in their homes rather than throwing them away.

Some governments, companies and activists are now trying to change that. The CVS Pharmacy chain, the second-largest in the United States, launched a national drug disposal program just last year, allowing local police to coordinate with pharmacies for drug take-back days, which allow citizens to safely return unused medications. A few communities, meanwhile, are pushing to make drug take-back programs even more accessible to the public. King County in Washington passed a law last year requiring drug manufacturers to finance a secure medicine return system, which will allow citizens to bring their old medications to collection sites at any time, where the drugs will be retrieved and incinerated. Sen. Hannah-Beth Jackson, D-Calif, of Santa Barbara introduced a similar bill this year, and the state of West Virginia is currently coordinating with local police to set up prescription drug disposal boxes in each county.

Ever-increasing rates of prescription drug abuse are a key motivator for these programs. Approximately 100 people die of a drug overdose every day in the U.S., and in 2008, 14,800 of these deaths were caused by prescription painkillers, according to a report from the U.S. Centers for Disease Control and Prevention. Many national organizations — including the Partnership at DrugFree.org, the SAMA Foundation and the federal Food and Drug Administration — now recommend responsible medication disposal as one way to combat prescription drug abuse.

“Let’s say, for instance, you just dump the pills in a trash can,” said Jim Hunter, a senior control manager on FDA’s controlled substances staff. “Those pills still have potential to cause accidental poisoning, especially if they’re out of the original container.” The FDA recommends a procedure similar to the one used by the Donato family — removing the labels from medication containers and mixing the contents with undesirable substances, like coffee grounds or sand, before throwing them away. “The purpose of that recommendation is to render the drug unavailable for and undesirable for even a pet to take it,” Hunter said.

Flushing unwanted medications down the toilet may seem like an easier alternative, but recent studies have environmentalists balking at this solution. A 2008 Associated Press investigation discovered trace amounts of pharmaceuticals, including everything from birth control hormones to antibiotics, in the water supplies of 24 major metropolitan areas, including Atlanta, Philadelphia, Detroit, Las Vegas and San Diego.

Experts are still trying to figure out how serious a problem these trace pharmaceuticals really are. Sara Rodriguez-Mozaz and Howard Weinberg, researchers from the University of North Carolina at Chapel Hill, published a 2010 article in “Environmental Health Perspectives” on the topic of drugs in water. They concluded that “despite rising concerns about the presence of trace amounts of pharmaceuticals in drinking water, little evidence is currently available that associates these chemicals with adverse human health risks.” However, they also argued that the environment could suffer from drugs in the water as some aquatic organisms are much more sensitive to these chemicals than humans.

Simply hanging onto old medications forever is not a good option either, according to Dr. Dean Seehusen, author of the 2006 survey and family doctor at Dwight D. Eisenhower Army Medical Center in Fort Gordon, Ga. People who keep unused prescription drugs lying around their houses may be tempted to take them later on for other health problems. This can compromise a doctor’s ability to determine just how sick a patient is. “It makes it tougher to make a proper diagnosis if somebody’s taken antibiotics they just pulled out of their closet,” Seehusen said. “It makes it harder for the provider to determine if there’s an infection because you’ve altered the environment.”

Keeping old medications around the house can also endanger children and other members of the household, Hunter said, noting that more than 200,000 cases of improper medication use were reported to poison control centers in 2007, and nine percent of these cases involved accidental exposure to another person’s medicine. “If one gets rid of medicine if it’s no longer used or needed in the home, it can’t be a source of that accidental poisoning,” he said.

In light of the dangers of conventional drug disposal, many experts now recommend that citizens take part in drug take-back programs, such as the ones launched by CVS Pharmacy and King County. Unfortunately, Seehusen’s survey suggests that few people take advantage of these programs. Only 22.9 percent of respondents to the survey have ever returned unused medications to a pharmacy, and only 19.7 percent have ever received advice from a healthcare provider on how to properly dispose of their drugs.

Still, there’s room for optimism. King County has collected approximately 17,000 pounds of drugs — the equivalent of 8.5 million doses of Tylenol — through take-back events since 2010, according to Anne Burkland, policy aide to King County Board of Health Chair Joe McDermott. She said she is hopeful that the county’s new secure medicine return system will grow. “We think that as the program becomes more convenient, it will be even more well-used,” she said.

Seehusen agreed that convenient take-back programs are the best solution. Many communities offer isolated drug take-back days throughout the year, but he thinks that we can do better. “They should be easy, accessible and open at any time,” he said.