Prescription Safety

Aka: Prescription Safety, Medication Disposal, Drug Disposal, Controlled Substance Disposals, Medication Safety, Medication Expiration Date, Expired Medications

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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 adequate 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. Medications with preservatives may be higher risk of contamination and infection after expiration date
    1. Examples: Topical eye drops
  5. Some medications once opened and started require following the "Beyond Use Date"
    1. Dry Powder Inhalers after foil rapping is removed
    2. Reconstituted Antibiotics
  6. References
    1. (2020) Presc Lett 27(6):36
    2. (2025) Presc Lett 32(5): 26-7

IV. Precautions: Medication Disposal

  1. Disposal of old or unused medications prevents the all-too-common accidental Poisoning
    1. Left-over-medications for just-in-case circumstances are high risk of accidental Poisoning (or diversion)
  2. Do not flush medications down toilet (with some exceptions)
    1. Controlled substances are an exception (see below)
    2. Dispose of non-controlled substances in the trash
      1. May mix medications with cat litter or coffee grounds to prevent diversion
    3. Check product labels for safe disposal recommendations
      1. Higher risk medications for disposal include Chemotherapy and Inhalers
    4. FDA Flush List
      1. https://www.fda.gov/drugs/disposal-unused-medicines-what-you-should-know/drug-disposal-fdas-flush-list-certain-medicines
  3. Adverse effects of medications contaminating waste water
    1. May have toxic effect on wildlife and humans
    2. May contribute to Antibiotic Resistance
    3. Risk of Flushed Medications (EPA Information on Pharmaceuticals and Personal Care Products)
      1. https://www.epa.gov/sites/default/files/2018-11/documents/cecs-ppcps-factsheet.pdf
  4. Needle and Autoinjector Disposal
    1. Sharps Container
    2. Alternative if sharps container is unavailable
      1. Puncture-resistant leakproof, thick plastic container (e.g. laundry detergent bottle)
      2. Do not fill >75% and duct tape over the lid to prevent leakage
    3. SafeNeedleDisposal.org
      1. https://safeneedledisposal.org/
  5. State-Run Drug Donation Programs
    1. Unopened, non-controlled substance, non-Expired Medications may be accepted

V. Precautions: Unused Controlled Substance Disposal

  1. Only case in which Flushing medication down toilet may be appropriate (other options below are preferred)
    1. See FDA flush list above
  2. Remove all identifying, Protected Health Information (PHI) from the bottle before disposal
  3. Collection receptacles at retail pharmacies
    1. Syringes and Inhalers are not allowed in disposal bins
  4. Dispose with medical waste at clinic
    1. However, clinic take-back is a risk of diversion by clinic staff, and is discouraged
  5. DEA take-back program
    1. https://apps.deadiversion.usdoj.gov/pubdispsearch/spring/main
    2. Law enforcement stations may also have Medication Disposal receptacles
  6. Mail-back programs
    1. Pharmacies may have pre-addressed, pre-paid packaging available
    2. Opioid manufacturers are required (via REMS) to supply pre-paid mail-back envelopes
  7. Google Maps (Query "Drug Disposal Near Me")
    1. https://www.google.com/maps/search/drug+disposal+near+me/

VI. References

  1. (2025) Presc Lett 32(10): 58
  2. (2014) Presc Lett 21(11): 65

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