II. Precautions: Controlled substance storage

  1. Prescription Opioids should be in locked cabinet, away from children in the home
  2. Opioids are a risk for unintentional Overdose and Substance Abuse by teens and children
    1. Opiates are the most common ingestion requiring hospitalization in children under age 6 years old
  3. Safe storage guideline is followed in only one third of households with young children (12% with older children)
    1. McDonald (2017) Pediatrics 139(3) +PMID:28219969 [PubMed]

III. Precautions: Expired Medications

  1. Most medications (esp. tabs, capsules) maintain their potency for years past their expiration date
    1. Medications stored in vials or under adverse conditions (e.g. excessive heat) may degrade more quickly
    2. Lyon (2006) J Pharm Sci 95(7):1549-60 [PubMed]
  2. Toxicity from Expired Medications is very rare and limited to case reports
    1. In this case, the Tetracycline formulation has since changed and is no longer a risk
    2. Gross (1963) Ann Intern Med 58:523-8 [PubMed]
  3. For some critical medications, possible decreased potency after expiration date may be unacceptable
    1. Insulin
    2. Antiepileptics
    3. Contraceptives
    4. Epinephrine Autoinjector
    5. Naloxone
    6. Nitroglycerin
  4. Some medications once opened and started require following the "Beyond Use Date"
    1. Dry Powder Inhalers after foil rapping is removed
    2. Reconstituted antibiotics
  5. References
    1. (2020) Presc Lett 27(6):36

IV. Precautions: Medication Disposal

  1. Do not flush medications down toilet
    1. Controlled substances are an exception (see below)
    2. Dispose of non-controlled substances in the trash
    3. Check product labels for safe disposal recommendations
  2. Adverse effects of medications contaminating waste water
    1. May have toxic effect on wildlife and humans
    2. May contribute to Antibiotic Resistance
  3. Needle disposal
    1. Sharps Container
    2. Needle and auto-injector disposal
    3. SafeNeedleDisposal.org
      1. https://safeneedledisposal.org/
  4. Resources
    1. EPA Information on Pharmaceuticals and Personal Care Products
      1. http://www.epa.gov/ppcp/

V. Precautions: Unused Controlled Substance disposal

  1. Only case in which Flushing medication down toilet may be appropriate (other options below are preferred)
  2. Collection receptacles at retail pharmacies
    1. Syringes and Inhalers are not allowed in disposal bins
  3. Dispose with medical waste at clinic
  4. DEA take-back program
    1. http://www.deadiversion.usdoj.gov/drug_disposal/takeback/
    2. Law enforcement stations may also have Medication Disposal receptacles
  5. Mail-back programs
    1. Pharmacies may have pre-addressed, pre-paid packaging available
  6. Google Maps (Query "Drug Disposal Near Me")
    1. https://www.google.com/maps/search/drug+disposal+near+me/

VI. References

  1. (2014) Presc Lett 21(11): 65

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