Don’t Flush that Drug – Don’t Trash it Either
Health Canada recently warned, “Traces of pharmaceuticals are being detected in the environment, primarily in water (surface water, coastal water, groundwater, and drinking water) and soil. There is growing evidence that throwing pharmaceuticals (prescription drugs, non-prescription, over-the-counter drugs) and other personal care products in the garbage, or flushing them down the toilet or the sink is contributing to this issue, and consequently may have a harmful effect on the environment and indirectly, on human health.”1
A quick look in your medicine cabinet might reveal a collection of medications you no longer need. Perhaps there is something there from years ago, when you had that sore shoulder, or there are unused birth control pills, or anti-diarrheal medications you needed on your vacation to Mexico, but that situation has (fortunately) passed. Chances are you’ll find medications that you just don’t need and it’s time to dispose of them. But wait – don’t flush them!
Canadian survey results from 20052 show that 24% of all households reported having leftover or expired medication in their home. The national average of these households that disposed of these medications in regular garbage, down the drain or toilet, or by burying them is about 40%. Provincially, the responses from households who disposed of leftover or expired medication in an unsafe or uncontrolled manner ranged from a low of about 38% (in Quebec and Prince Edward Island) to a high of 84% (in Newfoundland).
Why is this action such a bad thing? When used correctly, medications can have very positive and beneficial effects for patients, such as managing health conditions, warding off disease, and even curing illness. However, unintended exposure to small or trace amounts of drugs that are not medically necessary can have a detrimental, long-term effect on plants, animals, and humans.
It seems clear that Canadians need a change in disposal practices to help reduce environmental exposure to potentially harmful chemicals.
Range of Risk
Not all drugs carry the same risk to the environment, but all require safe disposal. Typically, drugs are not naturally occurring agents. Even if a manufacturer derives a medicine from an organic substance, such as a plant, it is quite different from its source after transformation into a drug. Unless a substance can quickly break down into its basic compounds, it will remain in and/or affect the ecosystem. Although the chemical concentrations of a pill or two seem very low, they still might be sufficient to cause alterations to, or have adverse effects on, the environment. The cumulative effect of all consumers who throw away a pill or two could have a direct or indirect impact on animal and human health. Pregnant women, newborns, and children are more sensitive to the ill effects of even low amounts of contaminants.
The dangers are obvious for cytotoxic drugs, for example, which are part of a chemotherapy regimen used in cancer treatment. These drugs affect cell function and have the ability to alter DNA and cause chromosome damage. Although there are no specific studies to demonstrate the negative impact of drugs on the environment, evidence shows that exposure to cytotoxic drugs has caused an increased rate of chromosome damage in exposed workers.3 Furthermore, working with cytotoxic drugs has been associated with negative health effects such as higher incidences of miscarriage, birth defects, low birth weight, and infertility. To minimize and prevent any unnecessary exposure, hospitals and specialized medical centres strictly control the handling of these medications during treatment and disposal of anything left over. However, more recently, the use of these drugs has expanded, in that they now have a place in the home treatment of some conditions, including those of the skin (e.g., psoriasis), joints (e.g., rheumatoid arthritis), and muscle. In these situations, the use and disposal of the drug is often under the control of the individual patient, who should carefully adhere to the use and disposal protocols, but who is under no mandate to do so.
Antibiotics can enter our ecosystem if improperly discarded; this promotes resistance of bacteria and fungus, leading to increasing rates of infections that are difficult to treat. A physician prescribes antibiotics in a precise dose and for a specific duration, meaning to kill the bacteria and cure an infection, and the patient should take it as directed until it is finished. If bacteria encounter low levels of antibiotics, insufficient to kill them, this promotes the development of resistant bacterial strains. Residual antibiotics in the environment could kill weak bacteria, and the stronger and more resistant bacteria could survive and multiply, resulting in a greater number of more resistant strains.
Public attitude toward other drug categories is more complacent. All drug products – prescription, over-the-counter, or personal care products – contain active ingredients that may have an effect on aquatic life, animal life, soil, plants, and human health. They all need to be disposed of in a responsible and safe manner. This should concern everyone.
Responsibility for Safe Disposal
Everyone who has a role in the use of medications has a responsibility to ensure the appropriate use and safe disposal of them.
Canada’s Research-Based Pharmaceutical Companies, the Canadian Generic Pharmaceutical Association, and the Nonprescription Drug Manufacturers Association of Canada (now Consumer Health Products Canada)were the leading organizations that formed the Post Consumer Pharmaceutical Stewardship Association, a non-profit organization (www.medicationsreturn.ca). Its stewardship role is to respond to government and environmental issues relating to the efficient collection and safe disposal of leftover medicines returned by the public in provinces that have regulations requiring industry stewardship programs. Funded by the pharmaceutical industry, the program objective is to divert leftover and/or unused medications from landfills and sewers, as well as to ensure safe and effective collection and disposal. Consumers drop off products at pharmacies; from there, staff ship them to an appropriate disposal site for controlled incineration.
Most pharmacies have a drug take-back or drug return program where the pharmacy arranges to have drugs disposed of in an environmentally safe manner. These programs maintain confidentiality of your personal information as it appears on the prescription bottles. However, it is not mandatory to return medication with the labels intact. Discuss confidentiality with the pharmacist but, if in doubt, peel off the label before handing it in.
See the sidebar below for a brief summary of programs available in the various provinces and territories. Unless specified, there is no charge for the consumer to use these programs. If your pharmacy does not offer a program for safe disposal of unused or expired drugs, then encourage them to participate in one. Even in the absence of obligation, many organizations and facilities dealing with hazardous chemicals, including pharmaceutical manufacturers, follow strict internal protocols regarding their handling and disposal.
Safe Medication Habits
- Since the medication your physician prescribed for you has a specific purpose, be sure you take it as directed.Ask your physician and/or pharmacistexactly when you should take it and when you should stop; ask what to do if you inadvertently miss a dose or experience an adverse effect. When prescribed antibiotics, it is very important to take them as directed until the prescription is finished, even if you feel better after taking only a few doses. Typically, antibiotics are taken for a full course, unless your physician or pharmacist has said otherwise, in which case the remaining antibiotic should be disposed of in a safe manner.
- Don’t share medicines or give leftover prescription drugs to someone else to take. This is a dangerous practice, as medications can interact with each other and work differently in other people, or under certain conditions.
- Don’t store medicines with food or household products; unless directed otherwise by your pharmacist, keep medicines in a cool dry place away from direct light, preferably in a high, lockable cupboard, away from moisture, and away from children. Keep medicines in their original labelled container and keep the cap closed.
- It is a good idea to go through your medicine cabinet at least once a year to identify medications that you no longer use, have expired, or have spoiled (e.g., exposed to moisture or water, stored incorrectly) and then take these drugs to your pharmacy for disposal. You can ask your pharmacist how to obtain new products, if necessary.
- Never dispose of pharmaceuticals in household garbage, by washing them down the drain, placing them in your compost cart, in recycling bags, or by flushing them down the toilet.
When used appropriately, medications improve and save lives, as well as help make our healthcare system more cost-effective, by warding off the costs of untreated illness. In addition, unused and expired medications need appropriate disposal so they do not contaminate our environment and end up still active in our water supply, landfills, and soil.
Studying the effects of safe disposal of medications is much more complex than studying the effects of drugs in treating disease, where it’s possible to conduct clinical trials comparing active medications to inactive substances (placebo). We must all have a better understanding of the risks and act responsibly to dispose of medications. If your local pharmacy is not already involved in one, then encourage them to participate in a safe disposal or take-back program.4
Pharmaceutical Disposal Across Canada
You can return old and/or unused medication at any of the 800 participating community pharmacies across Alberta.
You can return expired or unused medications at 943 participating community pharmacies across BC. In that province alone, pharmacies collected more than 50,705kg of unused or expired medicines during 2009.5
You can return expired or unwanted medications to a pharmacy in your community through a program offered by the pharmaceuticals and consumer health industries.
There is no formal province-wide program; however, the majority of the province’s regional Solid Waste Commissions offer household hazardous waste programs through the user-pay approach with regular tipping fees. In addition to these programs, the majority of pharmacies in the province offer and finance voluntary pharmaceutical take-back programs.
Newfoundland and Labrador
Unwanted pharmaceuticals can be disposed of at a Multi-Materials Stewardship Board’s sponsored Household Hazardous Waste day, scheduled annually.
There is currently no official program in place except for management of cytotoxic pharmaceuticals.6
Nova Scotia has a formal province-wide program for the disposal of household pharmaceutical waste via provincial community pharmacies.
Nunavut does not have a formal territory-wide program; however, you can typically return pharmaceuticals to community pharmacies and health centers.
As of July 2010, the province extended its Orange Drop recycling program to include pharmaceuticals for both humans and pets, including prescription medications, over-the-counter drugs, natural health products, thermometers, and sharps (needles, syringes, lancets, and pens). The Orange Drop program advises Ontarians to live by the BUD rule, encouraging you to:
- Buy only what you need.
- Use it all up.
- Drop off the rest and they’ll recycle, reprocess, or safely dispose of it.
Prince Edward Island
Islanders with expired or unused pharmaceuticals have a take-back program that allows you to take unwanted prescription and over-the-counter medications to local pharmacies for environmentally safe disposal. You can also take pharmaceuticals directly to any of the Island Waste Management Corporation drop-off centers for safe disposal.
Quebec does not have a formal province-wide program for the disposal of household pharmaceutical waste. However, Quebec municipalities have different collection modes for household hazardous waste, including pharmaceuticals. Those include collection days, mobile depots, and permanent depots. In addition, community pharmacies are required through regulations under the Pharmacy Act to collect pharmaceuticals returned by consumers for safe disposal. The province’s municipalities and community pharmacies are in charge of managing the cost of these programs.
Saskatchewan has a formal province-wide program for the disposal of household pharmaceutical waste. The Pharmaceutical Waste Disposal program allows you to return pharmaceuticals to the majority of the province’s community pharmacies for safe disposal. It is an initiative of the Saskatchewan College of Pharmacists (SCP). Under this program, pharmacies have to pay for the pick-up of the pharmaceutical waste they collect from you.
The Yukon does not have a formal territorial-wide program for the disposal of household pharmaceutical waste. However, most community pharmacies in the Yukon have informal take-back programs through which they accept pharmaceutical waste from their customers. Yukon periodically offers various household hazardous collection days in communities.