The Importance of Prescription Drug Take-Backs
What do you do with medications you no longer need or that have expired? A common choice is to flush them or pour them down the drain.
Don’t do it! Times have changed and there are better methods for disposing of unwanted medicines.
Why is flushing bad for the environment? Americans use $230 billion worth of prescription drugs yearly—that’s a lot of medicines entering our waterways and doesn’t even include over-the-counter medications!
Pharmaceuticals are not designed to kill (unlike pesticides) so the damage caused to wildlife can be more subtle and build up over time. For example, hormones and antidepressant drugs include endocrine-disrupting compounds that interfere with the reproduction and normal growth of many aquatic species like frogs and fish. These impacts include delayed metamorphosis, altered reproductive systems, delayed reproductive development, reduced fertility, abnormal hormone levels, impaired immune systems, and structural and neurological damage. Inter-sex frogs have recently been found in urban ponds contaminated with wastewater.
What affects one species affects multiple species through a trophic cascade. In one experimental lake study, estrogen from birth control pills nearly wiped out the fathead minnow population. Then came the decline in trout who feed on the minnow, while insect populations multiplied because there were fewer minnows and trout to consume them. So all the meds that were once used to make us feel better are now making our aquatic life and environment very sick.
Throwing medications in the trash is not a solution either. Even when mixed with other substances or crushed, these meds are still chemically active and can cause great harm. Studies have shown that medicines in a landfill can be released to the local environment through the landfill liquid, aka garbage juice, which makes its way to wastewater treatment plants where it cannot be removed. These meds will also leach into the soil infecting our environment. Even when a pill is crushed, the dust it releases could potentially expose a person to a dangerously high dosage before it ends up in the landfill, entering our environment through soil or water.
What about just leaving the pills in their original container and throwing them away? This is triple damning: you’ve put more discarded plastic in the environment, dumped medications into the environment, and left them easily accessible to curious children, pets, and, wildlife. Accidental poisonings are unfortunately common and children are often the victims. Meanwhile, human medications are the leading cause of pet poisonings, most often from trash-related toxic exposures. Just as we do not put used motor oil or leftover paint thinner in the trash, we should not put these potent pharmaceutical chemicals in the trash either.
So what can we do?
Instead of flushing or throwing out your meds, find a pharmaceutical take-back program in your area and dispose of your medicine where they will be properly incinerated. For example, you can dispose of unwanted medicines in the front lobbies of the Hamilton County Sheriff’s offices at 6233 Dayton Boulevard and 8395 Hickory Valley Road on weekdays from 9 AM-4 PM. Also, the Town of Signal Mountain has a permanent drug take-back repository in the lobby of the police and fire department that is open 24 hours a day.
Daphne Kirksey, External Affairs Manager with Tennessee American Water states, “For over 10 years, Tennessee American Water has partnered with law enforcement, drug abuse prevention organizations, and other organizations to organize and promote Drug Take Back awareness days. Drug Take Back has a two-fold purpose to help protect the environment and reduce misuse of medications such as prescription opioids. Instead of flushing old medicines down the drain, Tennessee American Water encourages residents to properly dispose of medications by dropping them off at a permanent drug take-back drop box in their community or participating in the biannual U.S. Drug Enforcement Administration (DEA) National Drug Take Back event.”
This year's National Drug Take Back Day will occur on October 28th from 10 AM-2 PM, but there are many other take-back events throughout the year! This Friday, July 21st, Hamilton County will host a joint drug take-back, shred, and senior health fair event from 10 AM-2 PM at the North River Civic Center in Hixson. Bring unwanted prescriptions and documents to be properly disposed of, and make sure check out available health resources while you are there.
If you can’t participate in these events, Hamilton County Coalition’s interactive Map (below) shows the locations of permanent, year-round prescription drug take-back boxes in our region. Or, check here to find Take Back Day locations in other areas.
Some of you may wonder about human excrement that contains medicines—what’s the difference? Our bodies have metabolized the drugs, making them less concentrated and lessening their environmental impact. This is still not great, but better than flushing intact meds. One example of this comes from the most consumed stimulant in the world: caffeine. Whether caffeine is from coffee, chocolate, energy drinks, or pharmaceuticals, it is partially excreted in our waste and is showing up in our rivers and waterways. One study found it to be in more than 50% of over 1,000 sampling sites along 258 rivers around the world. Scientists are still learning how the ubiquity of caffeine in our waterways negatively impacts a wide range of aquatic life. As our society’s addiction to caffeine remains strong, these negative effects will only increase and the deeper biological effects on our environment need more research.
The Guardian reports on a part of the response to this issue: a new thought process called eco-directed sustainable prescribing (EDSP), developed by Christian Daughton with the United States Environmental Protection Agency. He states, “The immediate outcome sought is to redirect consumer wastes down the avenues with the smallest ecological footprints. The ultimate outcome is to continually reduce unneeded, imprudent consumption.” This proposal would mean that doctors consider the environment as well as their patients when they prescribe a drug. It would ask doctors to do two things: first, reduce the frequency and dosage of prescriptions, and second, consider how the drugs they prescribe are metabolized and excreted from the body. Everyone metabolizes drugs differently, so there is more research to be done here.
The article goes further stating, “Beyond the proper disposal of unwanted drugs, the ultimate focus with regard to pollution prevention is perhaps better placed on the way in which drugs are marketed, prescribed, and dispensed. Healthcare systems could be re-designed so that only the optimal medications are prescribed in minimal doses individualized for each patient and dispensed in quantities that facilitate their full consumption. The potential for environmental impact can also be considered in selecting medications. The ideal outcome would be a profound reduction in the types and quantities of leftover drugs requiring disposal. The end result of a greener healthcare system could be not just a cleaner environment, but also more efficient usage of healthcare resources, reduced healthcare costs, improved therapeutic outcomes and reduced incidence of purposeful abuse and accidental poisonings from diversion of stockpiled or improperly disposed drugs. The health of humans is absolutely intertwined with the health of the environment. Perhaps the healthcare community should develop a credo analogous to the Leave no Trace motto—prescribe and dispense only what's needed—no more. Leave no medication behind.”
It would be a great leap for our healthcare system to adopt these methods—much more research is needed, but one has to start somewhere. For now, do your part to keep our environment healthy in all the choices you make. Love our Mother Earth—she’s the only one we’ve got.
