How do I dispose unused or expired medicine?

By Dr. Nutan Rao
Associate Professor (Department of Pharmaceutical Chemistry)
Vivekanand Education Society’s College of Pharmacy

Since ages mankind has come across so many diseases and to treat them, a vast variety of medicines. With the increasing populations and number of medicines, there always arises a question ‘How do I dispose unused or expired medicine?
Disposal of daily household or office biodegradable and non-biodegradable waste is a normal routine. The same cannot be followed for the disposal of medicines. Unused or expired medicines do possess RISK, if they’re taken by someone they weren’t prescribed for. HARM, if accidentally taken by a child or pet. DANGER, or even death, if not used as directed. Hence safe disposal of medicines before they can cause any harm is a prerequisite. Food and drug administration (FDA) has come to our rescue and has provided several guidelines by which the unused or expired medicines can be disposed off.
The best option is to find a drug take-back location. This could be a local pharmacy or a police station. These take-back locations may offer on-site medicine drop-off boxes, mail-back programs, or in-home disposal products. This works very well in US as the DEA webpage enables you to find the nearest take-back location based on the zip code entered. However, in India, the system is not so well developed and needs urgent attention. There are sporadic take-back locations in India, most of which are unknown to public. Medicine take-back programs are the only secure and environmentally sound way to dispose of leftover and expired medicine. Wherever feasible, returning to the manufacturer should be the first choice because the manufacturer is likely to have good disposal methods that allow recycling of components.
If there is no drug take-back location near you, FDA’s Flush List can be referred to see if the medicine to be disposed off is on that list. Medicines on the Flush List may be especially dangerous with just one dose if they are administered by children, pets, or other family members. Flushing certain types of medicines, such as opioids, helps keep everyone safe by making sure these powerful drugs are not accidentally or intentionally swallowed, touched, or misused. No medicine should be flushed unless it is on the Flush List. An investigation was carried out by few researchers to evaluate the ecological and human-health risks associated with the environmental release of the 15 active pharmaceutical ingredients (APIs) currently on the FDA "flush list". The evaluation suggests that even when highly conservative assumptions are used-including that the entire API mass supplied for clinical use is flushed, all relevant sources in addition to clinical use of the API are considered, and no metabolic loss, environmental degradation, or dilution of wastewater effluents are used in estimating environmental concentrations-most of these APIs present a negligible eco-toxicological risk, both as individual compounds and as a mixture. Using similar conservative assumptions for human-health risks, all 15 APIs present negligible risk through ingestion of water and fish. 
If there is no drug take-back location nearby and the medicine is not on the Flush List, it can be simply disposed in the trash. For medicines meant to be disposed in the trash, FDA recommends mixing them with an unappealing substance such as dirt, cat litter, or used coffee grounds. The mixture can be placed in a sealed plastic bag before throwing it away. All information on the prescription label of empty medicine bottles or medicine packaging should be scratched, and then the empty bottle or packaging can be trashed or recycled.
Another way out for unused medicines is to donate the medicines to the needy ones. Poor sections of society are not able to purchase the medicines due to the inadequate finances. Unused medicines/surplus medicines can be donated to reliable organizations. For donation of surplus medicines in Mumbai, https://sharemeds.in/donate-medicines/ can be accessed for the locations. Their objectives are to bridge the gap between surplus community and deficit community, to ensure that surplus medicine is utilised in the correct manner, to ensure that the underprivilege community is not devoid of proper medical care and to reduce medical waste. Their tagline is rightly depicting their work. “Tiny Drops of water make an Ocean”.