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Leisa Rockelein

Professor Holahan

Environmental Science 460

12/14/2018

Improper Drug and Medicine Disposal in the US

As of 2017, approximately 55 percent of Americans regularly take a prescription

medicine, but often it is not just one-of those who use reported being prescribed medication the

average number of prescriptions per person was four, with many also taking over-the-counter

drugs. Also found in 2017, the number of prescriptions for Americans increased 85 percent

between 1997-2016, from 2.4 billion to 4.5 billion a year, meanwhile, the U.S. population only

increased 21 percent (Preidt 2017). Another study found that of those taking at least one

prescribed medication that at least 17 percent are take three or more prescription medications

("More Americans Take Prescription Medication"). All of these statistics are significant as they

all mean one thing: more medicine in the hands of consumers, and more medicine being

improperly disposed to potentially harm humans and the environment. A 2016 study found that

over 2/3 of Americans are unsure of how to properly dispose of prescription medication, with the

majority either disposing improperly or not at all (Marketing 2018). 2/3 of 45 billion consumers

from 2016 means 3 billion people improperly disposing of their medicine-with the number in

2018 likely being even higher. The impact of these drugs ending up where they are not supposed

to have harmful effects on environmental and human health. When drugs are improperly

disposed of or not disposed of at all, water quality can be poorly affected with the entry of

compounds into the drinking water, the environment can be harmed by the metabolism and

excretion of the drug compounds, kids, and animals can get access to dangerous medicines that
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could harm them, drug addicts or dealers can access them, and prescription drugs can be used as

a means of self-harm as well. More than 70 percent of people who abused or misused

prescription painkillers got them from a friend or relative – whether free, or by purchasing or

stealing them (Marketing 2018). Therefore, improper disposal of prescription and over the

counter medication is an environmental issue that needs to be addressed. In this paper I will

compare four policies aimed at decreasing improper disposal of medications, and although there

is only comparison with the minimal current techniques, my recommendation finding the

institution and enforcement of permanent collection sites and drug take back events between law

enforcement, retail pharmacies, and other agencies although several of the policies could be

combined, which would provide the largest and most successful results.

Data collected supports that millions of Americans drink water that is contaminated with

trace concentrations of pharmaceutical drugs. As more tests are conducted by state and federal

agencies, a wide range of medication components (including but not limited to anticonvulsants,

mood stabilizers, hormones, and antibiotics) have been discovered in the drinking water of at

least 46 million Americans. Many research studies have found traces of varying medical

compounds in surface waters and research indicates that drug compounds enter underground

aquifers that supply an estimate of 40% of the water supply in the US. Medications flushed down

the toilet, as the FDA suggests for several medications, or in drains are one means through which

chemicals pass through the sewer system and enter our water. A study at an outpatient pharmacy

about patient medication disposal practices found that over 50% of the sample reported flushing

their medications down the toilet. Problematically, pharmaceutical traces have been shown to

withstand standard water treatment methods. Excretion is one route through which these

compounds are also believed to enter wastewater systems as only a small amount of medication
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is entirely absorbed into by the body leading to substances entering groundwater and, in sewage

systems, where treatment does not fully eradicate them from our water system. Together these

factors contribute to wastewater that contains pharmaceutical residues (Kinrys, Gold,

Worthington, & Nierenberg 2018). The current policies of offering safe disposal through

collection events and permanent collection while also advising flushing and garbage is clearly

unsuccessful given the environmental impact, as well as human impact. It is important that we

reduce or end the major factor of the flushing of medicines to help preserve and protect our water

for humans, marine life, and animals.

The proper disposal of unused medications is a necessary for preventing prescription drug

abuse and keeping our water supply safe. Although federal government agencies such as the

FDA suggest mixing unused medications with dirt, kitty litter or coffee grounds in a plastic bag

before tossing them into the trash, or flushing exceptionally harmful medications down the toilet,

the safest way to dispose of medications is by placing them in a collection receptacle at a

pharmacy or utilizing mail-back solutions (Marketing 2018). Most medications can be safely

disposed of by using medicine take-back programs or using U.S. Drug Enforcement Agency

(DEA) authorized collectors, with sites including retail pharmacies, hospital or clinic

pharmacies, and law enforcement agencies. These collectors securely collect and dispose of

various prescription drugs. Some pharmacies may also offer mail-back envelopes to assist

consumers in safely disposing of their unused medicines through the U.S. Mail right from their

homes (Center for Drug Evaluation and Research). These methods are ideal as they remove the

drugs immediately out of the home minimizing direct human threat but without disposal that

could harm the environment.

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This brings me to my first and my most recommended policy advisement to the US FDA

and DEA, and other drug related industries. I believe the best policy would be to institute local

governments to work with law enforcement, retail pharmacies, hospitals and more to either

create permanent collection sites or mandate more drug take back events, such as every month/2

weeks/2 months depending on the community size and drug usage. This option is efficient

because other than mail back programs, this is the safest way to dispose of drugs. While the

permanent collection may take more work initially for the agencies, more places may opt for this

option since once it is set up, it is done for good and requires minimal additional funds, while

continual events take continual work and funds for each event. This is good since a permanent

collection means a permanent option for safe drug disposal for communities, and that

medications can be turned in at any time. In the long term, either option would ensure all

consumers have access to dispose of their drugs, and since consumers are already going to their

pharmacies to pick up their prescription, bringing excess medication is no extra work for them.

The environmental impact would seemingly be great, as these collections prevent medicines

from ending up into our water, and especially permanent drop offs do not contribute significantly

to environmental waste, especially compared to consumers currently throwing out medicine in

plastic bags along with varying compounds. I would assume as time goes on with more

collection options in all communities, the water quality would continue to improve as fewer

compounds end up in the system. In terms of equity, this is fair as every community is given an

opportunity to return their medication regardless of outside factors. The only barrier I could think

of in low income communities’ issues with transportation to give in their medication. However, I

imagine this problem would be minimal as consumers in these areas must have someway to pick

up their medication, and they can bring old medication when picking up new. I would also hope
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an incentive program perhaps leading to a rebate or something similar on medication fees or

copays would also help low income or disadvantaged communities. Feasibly, the biggest barrier

with consumers is making consumers understand why it is important for them to return their

medicines. Education and possibly a government supported incentive program as mentioned

above would help resolve this. This way, people are being incentivized to return medication for

moral and environmental reasons or personal and monetary reasons, depending on the person,

but they are being incentivized. Although this may cost money, the government would save

money on from less water clean-up and eventually less need to advertise that not returning your

medicines could lead to human harm or death as well as environmental harm. Knowing the US

Government, especially our current POTUS and his lack of care for the environment, it would be

a hard push considering this policy requires strong control over state and local government by

the federal government as well as the federal government spending, however, with likely support

from the democratic party and other parties, interest groups, and the public, it could be won, and

I believe it would be worth it, and it would be self-sufficient once began. The other issue with

feasibility I could predict is agencies struggling with appropriate compliance regulations,

registration, and disposal costs within the take back programs, but I believe this could be

mitigated by federal funding and the facilitated connections between pharmacies and partner law

enforcement agencies, as well as assistance being led in becoming authorized pharmacies and

being walked through registration processes.

The next policy recommendation I will explain is strong but not as strong as the previous

policy alone. However, this policy could combine with the above policy or other policies to

strengthen prevention. Consumers must encounter pharmacy technicians to receive their

medications and the public looks to these technicians as the experts on medications. This is why
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required training and protocol for pharmacy technicians would allow the public to have a source

to directly convey medical disposal standards and recommendations that were personalized,

updated, and current. Efficiency wise, it would take time and money to train pharmacy

technicians, however, this would decrease as current technicians would evolve to only needing

refresher and update trainings, and only new technicians would need full training. However, this

is a direct one on one interaction that would provide the correct and necessary information to

those who need it. In terms of environmental impact, this policy would likely have some but not

total success. Education about proper disposal and why iit'simportant would likely affect the

environmentally conscious or caring, and average consumers to commit to proper disposal.

However, some average consumers or anti-environmentalists would likely be unaffected by this.

However. I would say some impact is better than none, especially combined with other factors.

In terms of equity, I think as long as a universal standard and protocol is set, this plan should

reach any and everyone getting medication from a pharmacy technician. Again, funds and

education may not be as readily available to lower income or disadvantaged, but a universal

protocol can help mitigate this. Feasibility wise, I find this similar to the equity, as in some areas

it may be more difficult but as all technicians are educated, less money and effort is needed to

refresh veteran technicians or train smaller amounts of new technicians. It would likely not be

difficult to add an extra hour onto training, meetings, or work hours to do this.

Works Cited

Center for Drug Evaluation and Research. “Safe Disposal of Medicines - Medicine Disposal:

Questions and Answers.” U S Food and Drug Administration Home Page, Center for
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Drug Evaluation and Research,

www.fFDAgov/drugs/resourcesforyou/consumers/buyingusingmedicinesafely/ensuringsa

feuseofmedicine/safedisposalofmedicines/ucm186188.htm.

“More Americans Take Prescription Medication.” Medscape Log In,

www.medscape.com/viewarticle/500164.

Marketing, Author. “Two-Thirds of Americans Improperly Dispose of Medication.” Sharps

Compliance Blog, 8 Feb. 2018, blog.sharpsinc.com/improperly-dispose-of-medication.

Kinrys, Gustavo, et al. “Medication Disposal Practices: Increasing Patient and Clinician

Education on Safe Methods.” Journal of International Medical Research, vol. 46, no. 3,

Nov. 2018, pp. 927–939., doi:10.1177/0300060517738681.

Preidt, Robert. “Americans Taking More Prescription Drugs Than Ever.” WebMD, WebMD, 3

Aug. 2017, www.wWebMDcom/drug-medication/news/20170803/americans-taking-

more-prescription-drugs-than-ever-survey.