US Pharm. 2014;39(12):1

One of the questions pharmacists are frequently asked by patients has nothing to do with side effects, adverse events, or any other pharmacologic result; it has to do with how to discard unused prescription medications.

There are a number of reasons that medications go unused. Some of the more common are the death of the patient, a change in the patient’s medication by a physician, or the patient’s improvement to a point where the medication is no longer needed. Multiply the 3.9 billion prescriptions filled each year by the number of unused medications—estimated to be about 40%—and the figure is staggering. Surveys released by the National Community Pharmacists Association found that three-quarters of adults do not always take their prescription medicine as directed. Having vials of unused prescription drugs lying around the house or in medicine cabinets is not only bothersome and confusing; for many elderly patients, it can also be deadly, especially when the vials contain prescription opioids.

For obvious health reasons, most state boards of health do not allow pharmacies to take back unused medications. The rationale for this is that once a prescription leaves the pharmacy, there is no way of knowing how or where it was stored or whether it has been contaminated in some fashion. Thus, many states offer community-based “take back” programs for the safe disposal of medications. For those consumers who wish to dispose of unused medications themselves, the FDA has an excellent primer.

Pharmacists should print out this informative article and offer a copy to patients who wish to dispose of unused nonopioid medications at home. But dealing with unused opioid prescription drugs is quite another matter.

According to the CDC, 40 Americans die daily from an overdose of a prescription painkiller; that’s more deaths than by heroin and cocaine overdoses combined. The 2012 National Survey on Drug Use and Health revealed that approximately 6.8 million Americans abuse pharmaceutical drugs. Furthermore, the Drug Enforcement Administration reports that two in five teenagers believe prescription drugs are safer than illegal drugs and that 30% of teenagers believe prescription painkillers are not addictive. Unused prescription opioids are a magnet for these teenagers, and proper drug disposal is essential to prevent overdoses resulting directly from stolen, unused prescription opioids.

New Jersey is one state that has been in the forefront of safe disposal of unused prescription medications. Under its program, Project Medicine Drop, people can anonymously dispose of unused prescription medications 24/7 in 102 drop boxes at police departments, sheriff’s offices, and State Police barracks. Since 2011, consumers have dropped off 36,533 pounds of medicine, with almost half that total occurring this year alone. And the DEA has launched a program that permits patients to return unused prescription medications designated as controlled substances to pharmacies. The program is voluntary, and pharmacists should check with their local DEA office to review the rules and learn how they can register their store as a collection site.

I encourage pharmacies to participate in this program where available. Pharmacists can and should play a key role in mitigating drug abuse in this country. Agreeing to enlist their facility in an unused prescription take-back program is a good start.

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