Are you aware that some of the most dangerous substances to children and adolescents may be sitting in your medicine cabinet? Every year, children mistakenly ingest prescription medications that are not secured properly. Even scarier is that some adolescents purposely find and abuse these medications. In fact, according to the Centers for Disease Control and Prevention, the number of deaths from drug poisonings has been steadily increasing since 1999. Old, leftover prescription medications pose a serious threat to everyone in the household.

It is imperative that expired, leftover or unused prescription medications are disposed of properly and immediately. But, it’s not enough to simply throw these straight into the trash. Many medications should be flushed down the toilet – but check on the label or accompanying instructions to be sure. For medications that are not to be flushed, mix them with a substance like wet coffee grounds or cat litter, seal them and place them in the trash.

Another great resource to utilize if you’re unsure of the best way to dispose of these medications is to bring them to a government-organized Drug Take Back Day. You can call your local government’s trash or recycling service to find out if a take-back program is available in your community. You can also visit www.dea.gov or call 800-882-9539 to find a take-back site near you.

Listen in as we talk with Terry Laurila, a pharmacy manager at Nationwide Children's, and Julie Zaucha, Manager of Pharmacy Operations at Nationwide Children’s, about the best ways to dispose of old, unused prescription medications – and the hazards they pose if left in the medicine cabinet.

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Dr. Rick McClead: Have you ever reached into your medicine cabinet to find an old prescription vial that has an outdated medication? You no longer take that medication. It may or may not even effective. Leaving it in your medicine cabinet poses dangers to young children and others. Can you throw the medication in the trash? Can you flush the pills down the toilet? What is a responsible person supposed to do?

Disposal of expired, unwanted and unused prescription drugs — next on Children's on Quality.

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Dr. Rick McClead: Welcome to Children's on Quality. This is your host, Dr. Rick McClead, Medical Director of Quality Improvement Services at Nationwide Children's Hospital. My guest for this edition of Children's on Quality are Terry Laurila, Pharmacy Manager of Home Care Services at Nationwide Children's Hospital, and Julie Zaucha, Manager of Pharmacy Operations at Nationwide Children's Hospital.

Welcome to Children's on Quality.

Terry Laurila: Hello.

Julie Zaucha: Thank you. It's nice to be here.

Dr. Rick McClead: Julie, let me begin with you. How do I know that a medicine on my cabinet has expired?

Julie Zaucha: Well,there will be an expiration date on the label and that means a number of things. One, the medication itself is expired and is no longer effective. A good example of this would be the oral, the liquid antibiotics like amoxicillin. It also could mean that your prescription has expired and that you need to see you physician again. Because you may no longer need to be on that medication and your doctor might think it's not appropriate for you to take it anymore.

Dr. Rick McClead: So if I identify an expired medication, you know, I might need that later on. Is there any reason to believe that most of the medications are unsafe or ineffective?

0:02:05

Julie Zaucha: By law, even pharmacies have to dispose of medication after they have expired and they are no longer to be used. So it would be unsafe for someone to keep it. One, again, because the medication may no longer be effective; and two, it may not be the right medication for you to take. And even though you think, "Oh, well, I feel the same way when I took this before. I'll just take it again." It might not be appropriate at all and it could be very dangerous for you to take the medication.

Dr. Rick McClead: Well, you know what the counter argument to that is, "I paid a lot of money for this drugs and I hate to throw this away because I might need it later." You know, "My yogurt date is expired too but it's good for a week or so afterwards." Is there any reason to be concerned about the safety other than it not being effective to others or to children.

Julie Zaucha: Yes. So it's very unsafe to keep medications around especially when children could get into them. Good examples of that would be your pain medications. In a survey in 2010, they actually were able to determine that everyday on average over 2000 children between the ages of 12 to 17 abuse pain medications for the first time. So, that's really, really high. And here, we are seeing a lot of drug abuse even in children coming through our emergency department.

So it's very important that we get rid of these medications because children have no fear.

Dr. Rick McClead: So, these medications like grandma and grandpa's oxycodone actually could be a source of drugs for a child to to intentionally abuse.

Julie Zaucha: Correct.

Dr. Rick McClead: And become addictive but it could also lead to an overdose that could…

Julie Zaucha: That could kill them.

Dr. Rick McClead: Cause a child to die.

0:03:59

Julie Zaucha: And a good example of that are fentanyl patches. Especially small children, they think they're tattoos and they'll put them on. And so, even when the fentanyl patches had been on at patient for the 72 hours that they're supposed to and they need to remove them to put a new one on, there's still quite a bit of fentanyl in the patch itself. So it's very important that fentanyl patches get folded in half, and then folded in half again and flushed down the toilet. And it is imperative that you actually visualize that it goes down the toilet.

Dr. Rick McClead: Well, fentanyl is one of those opioid drugs like morphine and heroin and things to that nature.

Julie Zaucha: Yeah.

Dr. Rick McClead: Well, Terry, Julie made some good points. And I really understand now a little bit better as to why concern about these expired medications need to be addressed. What should I do? Do I just put them in the trash or flush them down the toilet or what should happen?

Terry Laurila: There are certain drugs that should be disposed of by flushing them down the toilet. Those drugs that should be flushed down the toilet are going to be the narcotics as well as the fentanyl patches. The other drugs, the oral drugs, can actually be disposed of by putting them in coffee grounds or even in an old mayonnaise jar. Put a little liquid in there so that the pills dissolve. Because you really want to protect anyone from getting these drugs and maybe abusing them, even your pets getting into those drugs and getting an overdose that way.

So those are two ways of getting rid of the medications. Another way is actually to go ahead and utilize one of the drug take-back programs.

Dr. Rick McClead: And what's that all about?

Terry Laurila: The drug take-back program is organized by the FDA last September. A similar program collected 244 tons of unused and unwanted medications at more than 5,000 locations around the country. Today, more than a million pounds of drugs had been collected at four previous take-back programs. Visit www.da.gov or call 1-800-882-9539 for a site near you.

0:06:23

Dr. Rick McClead: Well, Terry, I have heard a lot of bad things about stuff showing up in our environment, in fish, in the water supply, et cetera. Don't these drugs pose a problem that way if I don't use the appropriate disposal mechanism or flushing it down the toilet? We're talking about putting fentanyl patches down there. That's getting into the water supply. Isn't that a concern of somebody?

Terry Laurila: Yes, that is a concern. Trace amounts of medication are found in the water supply but most of the drugs that are found in the water supply are there through normal body processes, through the stools and through the urine. Now, flushing a narcotic and the fentanyl patches down the toilet have those levels cause any environmental problems?

Other medications are not to be flushed down the toilet because those have been shown to cause environmental problems. And that is why we say to like throw them away in the trash in a secured container or through a drug take-back program. Because disposal of those medications are then through the landfill process or through incineration.

Dr. Rick McClead: Now, I was looking on the FDA website about disposal of medications and preparation for our conversation. And they have a list of medications that could be flushed and they mentioned these various narcotics. But what shouldn't I? They didn't list the ones that I shouldn't put down there.

Terry Laurila: I would consider everything else other than those that go down the toilet should be disposed of by putting them in unwanted containers such as with coffee grounds and again the old mayonnaise jar that no one would want to get into.

0:08:11

Dr. Rick McClead: And I heard about using cat litter too, as a way…

Terry Laurila: Yes, kitty litter is fine.

Dr. Rick McClead: Yeah. So, if we're going to dispose of the medication that is not on the list, that is on the FDA website or the DEA website — that we'll have a list of with our podcast — then, those should be disposed of by these other means through the trash?

Terry Laurila: Correct.

Dr. Rick McClead: Does package insert have something about how to dispose of a given medication?

Terry Laurila: It does if it says that it needs to be flushed down the toilet.

Dr. Rick McClead: What happens when we disposed of medications in coffee grounds?

Terry Laurila: By putting it in the coffee grounds, they're usually wet. Because anytime you put drugs in with something wet, they're going to absorb that liquid and expand and actually be no longer a pill. It will just be a big glop. And big glops are not sellable in the streets. Nor are they easily taken.

Julie Zaucha: But it doesn't do anything to change the chemical nature of the drug.

Dr. Rick McClead: Well, Julie, if I dispose of this medication properly, I still have a pill vial that's got my name, it's got my prescription number, it's got the name of the drug and what I was taking, et cetera. What about that? Does that pose a hazard to me?

Julie Zaucha: Well, I would recommend that you remove the label and dispose of that in any way you do any of your personal information, whether you shred it or however you handle that personally.

And then, I recycle my prescription vials. If it did have liquid in it, I would rinse it out, just like you would any food I eat on it, before you put it in a recycling trash. But that's what I do. It actually has a number on it and so you can recycle that plastic.

Dr. Rick McClead: Interesting.

0:10:07

Well, Terry, you have mentioned the FDA's take-back program that's scheduled for April 27th of this year. A take-back program, because there were 5,000 last September, you mentioned, but that's not the whole country. So what are my options if I think I'd like to get my community to do this? What should happen?

Terry Laurila: In order to go ahead and organize a drug take-back program, you need to involve local enforcement, because those medications that are being returned have to be maintained so that no one would ever like be able to steal those and use those again. And so that's why local law enforcement is involved and it needs to be scheduled through them.

Dr. Rick McClead: And they can contact an individual for here in Ohio that's listed on that website, the DEA website.

Terry Laurila: That is correct.

Dr. Rick McClead: Well, that is all the time that we have for this edition of Children's On Quality. I thank my guests, Terry Laurila and

Julie Zaucha from the Department of Pharmacy Services at Nationwide Children's Hospital.

Also, thank you, our listeners.

If you have comments or questions about any topic that you hear on Children's on Quality, or you just want to touch base with us, please send your comments and questions our way via the Nationwide Children's Hospital Facebook page or the Twitter account.

Children's on Quality is produced by Kelly Nightingale. Our theme music, Fleeing Moments, was composed by Ryan McClead.

Next time on Children's on Quality, we would discuss quality improvement of inflammatory bowel disease. Until then, this is your host, Dr. Rick McClead, wishing you the best of good health.

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