Saturday, October 17, 2009

FDA Clarifies How to Dispose of Opioids

The U.S. Food and Drug Administration (FDA) has launched a new Web page for consumers [available here] on how to dispose of opioid analgesics and other controlled substances. Quite simply, the FDA recommends that opioids should be flushed down the sink or toilet.

The goal is to keep unused opioids away from children and others who could be severely harmed by taking them accidentally or illegitimately. However, despite the safety reasons for flushing certain drugs, some people have questioned the practice because of concerns about trace levels of drug residues found in surface water, such as rivers and lakes, and in some community drinking water supplies. Yet, according to Raanan Bloom, PhD, an Environmental Assessment Expert in the FDA's Center for Drug Evaluation and Research, most drugs are not completely absorbed or metabolized by the body, so the main way drug residues enter water systems is by people ingesting medications and then naturally passing them into waste water via their urine or feces. The FDA believes that any potential risk to people and the environment from flushing opioids is outweighed by the real possibility of life-threatening risks from the unauthorized ingestion of these medicines.

There has been some confusion because not all medicines should be flushed down the sink or toilet. The FDA recommends that most nonopioid drugs can be disposed of in household trash after mixing them with an unpalatable substance (eg, coffee grounds) and sealing them in a container. Another disposal option is through drug take-back programs, as federal and state laws permit; however, such programs may not be readily available in some communities.

All opioids have disposal instructions in their professional prescribing information but this information often does not get passed along to consumers. The FDA Web page has a specific list of narcotic Schedule-CII opioids as recommended for flushing; however, since all opioids can be hazardous if they fall into the wrong hands, it seems a simple matter for practitioners to instruct patients as they hand them prescriptions for any opioid products, “As soon you are done using this medication, be sure to flush any remaining portion down the sink or toilet.” Giving such advice takes practically no time and could save a life.