Drug Diversion and Abuse: Prescription Drug Disposal: Is Flushing Best?

John Burke, commander ofthe Warren County, Ohio,drug task force and retiredcommander of the CincinnatiPolice PharmaceuticalDiversion Squad, is a 39-yearveteran of law enforcement.Cmdr Burke also is the currentpresident of theNational Association of Drug DiversionInvestigators. For information, he can bereached by e-mail at linkEmail('burke','choice.net'), viathe Web site www.rxdiversion.com, or byphone at 513-336-0070.

I recently presented a speech to agroup of educators at a local highschool in my area, and the inevitablequestions came up about discardingyour unused prescription drugs fromyour medicine cabinet. One of the teacherswanted to know how to dispose ofthese drugs, and I presented the groupwith the options of flushing them downthe toilet or grinding them up and mixingthem with cat litter or coffee grounds.

Later, in the evaluations, one of theteachers wrote that I should not tellthem to flush drugs down the toilet,which would cause the fish and theecosystem to suffer, and this was goingto destroy the planet. As you can imagine,I do not want to be responsible fordestroying the planet, but it brought up aconstant question that probably needs abetter answer than the 2 that I gavethem.

I happened to attend a meeting in NewEngland a couple of weeks later and waswith some of the most respected physiciansand pharmacists in the country,and once again this question came up.Debate continues over how much damageis caused by flushing pharmaceuticals,unless you have a septic system—inwhich case, I was told, it is definitely nota good idea. The cat litter example alsowas criticized, however, since much ofthat ends up in landfills, possibly pollutingthe earth. It also was mentioned in thisdiscussion that, in the case of somedrugs that are taken, 30% of the drug isexcreted in the urine into the samesewer system as those that are flushedor thrown down the drain at home.

In some cases, patients took theirunused pharmaceuticals back to thepharmacy, which may or may not haveaccepted them. The question here is, canthe pharmacist legally possess thosepills, even to destroy them in front ofanother witness, but then how is thatdestruction done? In the past, the drugswere probably disposed of down the toilet,as pharmacists did not have the timeto become involved in a prescriptiondrug destruction program.

Over the years, we have had physicianstell their patients to return theirunused drugs to them when they saidthat they were ineffective or causedsome side effect. Sometimes this wasdone because the physician suspectedthe patient of drug seeking and did notwant to give out another prescriptionunless he or she could see that few ofthe drugs had been taken. In a few othercases, however, this was done by aphysician for less than honorable purposes.The question remains, can the physicianlegally possess these drugs that arenot prescribed to him?

During the conference I attended, asouthern pharmacist mentioned that, atthe pharmacy where he worked, patientscould pour their unwanted pills into adevice that contained some type of solutionthat made the drugs unusable. I amnot sure who disposed of the solution,and in what method, but that seemed tohave some promise, as no one elsetouched the pills.

I am interested in your experience andsuggestions for some type of model programin the United States to properly disposeof unwanted pharmaceuticals. Aswe move to continue to educate patientson reducing drug diversion and not keepingunwanted pharmaceuticals at home,they are going to want a good answer onhow to dispose of them.

So, visit www.PharmacyTimes.com/DisposeDrugs and submit your feedbackto Pharmacy Times, or email me at

linkEmail('burke','choice.net')

, before I destroy theplanet.