Is your medicine cabinet filled with expired drugs or medications you no longer use? How should you dispose of them?

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Most drugs can be thrown in the household trash, but consumers should take certain precautions before tossing them out, according to the Food and Drug Administration. A few drugs should be flushed down the toilet, and a growing number of community-based "take-back" programs offer another safe disposal alternative.

Guidelines for Drug Disposal

The FDA worked with the White House Office of National Drug Control Policy to develop the first consumer guide for proper disposal of prescription drugs. Issued by ONDCP in February 2007 and updated in October 2009, the federal guidelines are summarized here:

* Follow any specific disposal instructions on the drug label or patient information that accompanies the medication. Do not flush prescription drugs down the toilet unless this information specifically instructs you to do so.
* Take advantage of community drug take-back programs that allow the public to bring unused drugs to a central location for proper disposal. Call your city or county government's household trash and recycling service (see blue pages in the phone book) to see if a take-back program is available in your community. The Drug Enforcement Administration, working with state and local law enforcement agencies, is sponsoring National Prescription Drug Take Back Days throughout the United States.
* If no instructions are given on the drug label and no take-back program is available in your area, throw the drugs in the household trash, but first:
1. Take them out of their original containers and mix them with an undesirable substance, such as used coffee grounds or kitty litter. The medication will be less appealing to children and pets, and unrecognizable to people who may intentionally go through your trash.
2. Put them in a sealable bag, empty can, or other container to prevent the medication from leaking or breaking out of a garbage bag.


The FDA's Deputy Director of the Office of Compliance Ilisa Bernstein, Pharm.D., J.D., offers some additional tips:
* Before throwing out a medicine container, scratch out all identifying information on the prescription label to make it unreadable. This will help protect your identity and the privacy of your personal health information.
* Do not give medications to friends. Doctors prescribe drugs based on a person's specific symptoms and medical history. A drug that works for you could be dangerous for someone else.
* When in doubt about proper disposal, talk to your pharmacist.

Bernstein says the same disposal methods for prescription drugs could apply to over-the-counter drugs as well.

Why the Precautions?

Disposal instructions on the label are part of the FDA's "risk mitigation" strategy, says Capt. Jim Hunter, R.Ph., M.P.H., senior program manager on FDA's Controlled Substance staff. When a drug contains instructions to flush it down the toilet, he says, it's because FDA, working with the manufacturer, has determined this method to be the most appropriate route of disposal that presents the least risk to safety.

Drugs such as powerful narcotic pain relievers and other controlled substances carry instructions for flushing to reduce the danger of unintentional use or overdose and illegal abuse. For example, the fentanyl patch, an adhesive patch that delivers a potent pain medicine through the skin, comes with instructions to flush used or leftover patches. Too much fentanyl can cause severe breathing problems and lead to death in babies, children, pets, and even adults, especially those who have not been prescribed the drug.
"Even after a patch is used, a lot of the drug remains in the patch," says Hunter, "so you wouldn't want to throw something in the trash that contains a powerful and potentially dangerous narcotic that could harm others."

Environmental Concerns

Despite the safety reasons for flushing drugs, some people are questioning the practice because of concerns about trace levels of drugs found in surface water, such as rivers and lakes, and in some community drinking water supplies. The main way drug residue enters water systems is by people taking medications and then naturally passing them through their bodies, says Raanan Bloom, Ph.D., an environmental assessment expert in the FDA's Center for Drug Evaluation and Research. "Most drugs are not completely absorbed or metabolized by the body, and enter the environment after passing through waste water treatment plants."

A company that wants the FDA to approve its drug must submit an application package to the agency. FDA requires, as part of the application package, an assessment of how the drug's use would affect the environment. Some drug applications are excluded from the assessment requirement, says Bloom, based on previous agency actions.

"For those drugs for which environmental assessments have been required, there has been no indication of environmental effects due to flushing," says Bloom. In addition, according to the Environmental Protection Agency, scientists to date have found no evidence of adverse human health effects from pharmaceutical residues in the environment.

Nonetheless, FDA does not want to add drug residues into water systems unnecessarily, says Hunter. The agency reviewed its drug labels to identify products with disposal directions recommending flushing or disposal down the sink. This continuously revised listing can be found on the FDA's Web page on Disposal of Unused Medicines.

Another environmental concern lies with inhalers used by people who have asthma or other breathing problems, such as chronic obstructive pulmonary disease. Traditionally, many inhalers have contained chlorofluorocarbons, a propellant that damages the protective ozone layer. The CFC inhalers are being phased out and replaced with more environmentally friendly inhalers.

Depending on the type of product and where you live, inhalers and aerosol products may be thrown into household trash or recyclables, or may be considered hazardous waste and require special handling. Read the handling instructions on the label, as some inhalers should not be punctured or thrown into a fire or incinerator. To ensure safe disposal, contact your local trash and recycling facility.

This article appears on FDA's Consumer Updates

How can I prepare ahead of time?

* Learn about your local community’s emergency warning system for severe thunderstorms
* Discuss thunderstorm safety with all members of your household
* Pick a safe place in your home for household members to gather during a thunderstorm This should be away from windows, skylights and glass doors that could be broken by strong winds or hail
* Make a list of items to bring inside in the event of a severe thunderstorm
* Make trees and shrubbery more wind resistant by keeping them trimmed and removing damaged branches
* Protect your animals by ensuring that any outside buildings that house them are protected in the same way as your home
* Consult your local fire department if you are considering installing lightning rods
* Get trained in first aid and learn how to respond to emergencies
* Put together an emergency preparedness kit:
Water—one gallon per person, per day
Food—non­perishable, easy­to­prepare
Flashlight
Battery­powered or hand­crank radio (NOAA Weather Radio, if possible)
Extra batteries
First aid kit
Medications (7­day supply) and medical items
Multi­purpose tool
Sanitation & personal hygiene items
Copies of personal documents
Cell phone with chargers
Family & emergency contact information
Extra cash

What should I do during a thunderstorm?

* Listen to local news or NOAA Weather Radio for emergency updates. Watch for signs of a storm, like darkening skies, lightning flashes or increasing wind.
* Postpone outdoor activities if thunderstorms are likely to occur. Many people struck by lightning are not in the area where rain is occurring.
* If a severe thunderstorm warning is issued, take shelter in a substantial building or in a vehicle with the windows closed. Get out of mobile homes that can blow over in high winds.
* If you can hear thunder, you are close enough to be in danger from lightning. If thunder roars, go indoors! The National Weather Service recommends staying inside for at least 30 minutes after the last thunder clap.
* Avoid electrical equipment and telephones. Use battery­poweredTVsandradios instead.
* Shutter windows and close outside doors securely. Keep away from windows.
* Do not take a bath, shower or use plumbing.
* If you are driving, try to safely exit the roadway and park. Stay in the vehicle and turn on the emergency flashers until the heavy rain ends. Avoid touching metal or other surfaces that conduct electricity in and outside the vehicle.
* If you are outside and cannot reach a safe building, avoid high ground; water; tall, isolated trees; and metal objects such as fences or bleachers. Picnic shelters, dugouts and sheds are NOT safe.

What do I do after a thunderstorm?

After the Storm Passes:

Never drive through a flooded roadway. Turn around, don’t drown!

Stay away from storm-damaged areas to keep from putting yourself at risk from the effects of severe thunderstorms.

Continue to listen to a NOAA Weather Radio or to local radio and television stations for updated information or instructions, as access to roads or some parts of the community may be blocked.

Help people who may require special assistance, such as infants, children and the elderly or disabled.

Stay away from downed power lines and report them immediately.

Watch your animals closely. Keep them under your direct control.

If Lightning Strikes …

Follow these steps if someone has been struck by lightning:

Call for help. Call 9-1-1 or the local emergency number. Anyone who has sustained a lightning strike requires professional medical care.

Check the person for burns and other injuries. If the person has stopped breathing, call 9-1-1 and begin CPR. If the person is breathing normally, look for other possible injuries and care for them as necessary. People who have been struck by lightning do not retain an electrical charge and can be handled safely.

If your community has experienced a disaster, register on the American Red Cross Safe and Well Web site available through RedCross.org to let your family and friends know about your welfare. If you don’t have Internet access, call 1-866-GET-INFO to register yourself and your family.

Information from the American Red Cross Southeastern Pennsylvania Chapter

Click here for an interactive diagram by The Associated Press showing the cyclical process of how water is used in a nuclear plant.

FDA Consumer Safety Officer Armando Zamora explains what to do if you think you may have a recalled product. There are many numbers and dates on the foods, drugs, cosmetics, and other products we use every day. Some help manufacturers track inventory, while others help retailers ensure quality. But when unsafe products must be removed from the market, these numbers and dates can also help identify them quickly.