How to Dispose of Unused Medicine

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

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 (FDA). 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

FDA worked with the White House Office of National Drug Control Policy (ONDCP) to develop the first consumer guidance 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 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

 (www.deadiversion.usdoj.gov) throughout the United States.

Take drugs out of their original containers and mix them with

an undesirable substance, such as used coffee grounds . 0 0

If no instructions are given on the drug label and no take-back programs are available
your area, throw the drugs in the household trash, but first:

• 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.

• Put them in a sealable bag, empty can, or other container to prevent the medication from leaking or breaking out of a garbage bag.

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 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

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 drug residues found in surface water, such as rivers and lakes, and in some community drinking water supplies. However, the main way drug residues enter 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 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 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 indica­ 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 at FDA's Web page on Disposal of Unused Medicines

www.fda.gov/Drugs/ResourcesForYou/Consumers/BuyingUsingMedicineSafely/EnsuringSafeUseofMedicine/SafeDisposalofMedicines/ucm186187.htm

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 (CFC's), 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. lb ensure safe disposal, contact your local trash and recycling facility.

Find this and other Consumer Updates at

www.fda.gov/ForCorisumers/ConsumerUpdates

Winter Weather: Outdoor Safety

When the weather is extremely cold, and especially if there are high winds, try to stay indoors. Make any trips outside as brief as possible, and remember these tips to protect your health and safety:

Dress Warmly and Stay Dry

Adults and children should wear:

• a hat
• a scarf or knit mask to cover face and mouth
• sleeves that are snug at the wrist
• mittens (they are warmer than gloves)
• water-resistant coat and boots
• several layers of loose-fitting clothing

Be sure the outer layer of your clothing is tightly woven, preferably wind resistant, to reduce body-heat loss caused by wind. Wool, silk, or polypropylene inner layers of clothing will hold more body heat than cotton. Stay dry—wet clothing chills the body rapidly. Excess perspiration will increase heat loss, so remove extra layers of clothing whenever you feel too warm. Also, avoid getting gasoline or alcohol on your skin while de-icing and fueling your car or using a snow blower. These materials in contact with the skin greatly increase heat loss from the body. Do not ignore shivering. It’s an important first sign that the body is losing heat. Persistent shivering is a signal to return indoors.

Avoid Frostbite and Hypothermia

When exposed to cold temperatures, your body begins to lose heat faster than it can be produced. Prolonged exposure to cold will eventually use up your body’s stored energy. The result is hypothermia, or abnormally low body temperature. Body temperature that is too low affects the brain, making the victim unable to think clearly or move well. This makes hypothermia particularly dangerous because a person may not know it is happening and won’t be able to do anything about it.
Hypothermia is most likely at very cold temperatures, but it can occur even at cool temperatures (above 40°F) if a person becomes chilled from rain, sweat, or submersion in cold water.
Frostbite is an injury to the body that is caused by freezing. Frostbite causes a loss of feeling and color in affected areas. It most often affects the nose, ears, cheeks, chin, fingers, or toes. Frostbite can permanently damage the body, and severe cases can lead to amputation. The risk of frostbite is increased in people with reduced blood circulation and among people who are not dressed properly for extremely cold temperatures
For more information about frostbite and hypothermia, see Winter Weather: Stay Safe & Healthy.

Avoid Exertion

Cold weather puts an extra strain on the heart. If you have heart disease or high blood pressure, follow your doctor’s advice about shoveling snow or performing other hard work in the cold. Otherwise, if you have to do heavy outdoor chores, dress warmly and work slowly. Remember, your body is already working hard just to stay warm, so don’t overdo it.

Understand Wind Chill

The Wind Chill index is the temperature your body feels when the air temperature is combined with the wind speed. It is based on the rate of heat loss from exposed skin caused by the effects of wind and cold. As the speed of the wind increases, it can carry heat away from your body much more quickly, causing skin temperature to drop. When there are high winds, serious weather-related health problems are more likely, even when temperatures are only cool.

Avoid Ice

Walking on ice is extremely dangerous. Many cold-weather injuries result from falls on ice-covered sidewalks, steps, driveways, and porches. Keep your steps and walkways as free of ice as possible by using rock salt or another chemical de-icing compound. Sand may also be used on walkways to reduce the risk of slipping.

Be Safe During Recreation

Notify friends and family where you will be before you go hiking, camping, or skiing. Do not leave areas of the skin exposed to the cold. Avoid perspiring or becoming overtired. Be prepared to take emergency shelter. Pack dry clothing, a two-wave radio, waterproof matches and paraffin fire starters with you. Do not use alcohol and other mood altering substances, and avoid caffeinated beverages. Avoid walking on ice or getting wet. Carefully watch for signs of cold-weather health problems.

Be Cautious About Travel

• Listen for radio or television reports of travel advisories issued by the National Weather Service.
• Do not travel in low visibility conditions.
• Avoid traveling on ice-covered roads, overpasses, and bridges if at all possible.
• If you must travel by car, use tire chains and take a mobile phone with you.
• If you must travel, let someone know your destination and when you expect to arrive. Ask them to notify authorities if you are late.
• Check and restock the winter emergency supplies in your car before you leave.
• Never pour water on your windshield to remove ice or snow; shattering may occur.
• Don’t rely on a car to provide sufficient heat; the car may break down.
• Always carry additional warm clothing appropriate for the winter conditions.

What to Do if You Get Stranded

Staying in your vehicle when stranded is often the safest choice if winter storms create poor visibility or if roadways are ice covered. These steps will increase your safety when stranded:

• Tie a brightly colored cloth to the antenna as a signal to rescuers and raise the hood of the car (if it is not snowing).
• Move anything you need from the trunk into the passenger area.
• Wrap your entire body, including your head, in extra clothing, blankets, or newspapers.
• Stay awake. You will be less vulnerable to cold-related health problems.
• Run the motor (and heater) for about 10 minutes per hour, opening one window slightly to let in air. Make sure that snow is not blocking the exhaust pipe—this will reduce the risk of carbon monoxide poisoning.
• As you sit, keep moving your arms and legs to improve your circulation and stay warmer.
• Do not eat unmelted snow because it will lower your body temperature.
• Huddle with other people for warmth.

Content from CDC

Winter Weather: Indoor Safety

Heat Your Home Safely

If you plan to use a wood stove, fireplace, or space heater, be extremely careful. Follow the manufacturer’s instructions and remember these safety tips:

• Use fireplace, wood stoves, or other combustion heaters only if they are properly vented to the outside and do not leak flue gas into the indoor air space.
• Do not burn paper in a fireplace.
• Ensure adequate ventilation if you must use a kerosene heater.
• Use only the type of fuel your heater is designed to use—don’t substitute.
• Do not place a space heater within 3 feet of anything that may catch on fire, such as drapes, furniture, or bedding, and never cover your space heater.
• Never place a space heater on top of furniture or near water.
• Never leave children unattended near a space heater.
• Make sure that the cord of an electric space heater is not a tripping hazard but do not run the cord under carpets or rugs.
• Avoid using extension cords to plug in your space heater.
• If your space heater has a damaged electrical cord or produces sparks, do not use it.
• Store a multipurpose, dry-chemical fire extinguisher near the area to be heated.
• Protect yourself from carbon monoxide (CO) poisoning by installing a battery-operated CO detector and never using generators, grills, camp stoves, or similar devices indoors.

Cook Safely

• Never use a charcoal or gas grill indoors—the fumes are deadly.
• Never use an electric generator indoors, inside the garage, or near the air intake of your house because of the risk of carbon monoxide poisoning.
• Plug in appliances to the generator using individual heavy-duty, outdoor-rated cords.
• Do not use the generator or appliances if they are wet because of the risk of electrocution.
• Do not store gasoline indoors where the fumes could ignite.

Light Your Home Safely

If there is a power failure:

• Use battery-powered flashlights or lanterns rather than candles, if possible.
• Never leave lit candles unattended.

Conserve Heat

You may need fresh air coming in for your heater or for emergency cooking arrangements. However, if you don’t need extra ventilation, keep as much heat as possible inside your home. Avoid unnecessary opening of doors or windows. Close off unneeded rooms, stuff towels or rags in cracks under doors, and close draperies or cover windows with blankets at night.

Monitor Body Temperature

Infants less than one year old should never sleep in a cold room because (1) infants lose body heat more easily than adults; and (2) unlike adults, infants can’t make enough body heat by shivering. Provide warm clothing for infants and try to maintain a warm indoor temperature. If the temperature cannot be maintained, make temporary arrangements to stay elsewhere. In an emergency, you can keep an infant warm using your own body heat. If you must sleep, take precautions to prevent rolling on the baby. Pillows and other soft bedding can also present a risk of smothering; remove them from the area near the baby.
Older adults often make less body heat because of a slower metabolism and less physical activity. If you are over 65 years of age, check the temperature in your home often during severely cold weather. Also, check on elderly friends and neighbors frequently to ensure that their homes are adequately heated.

Keep a Water Supply

Extreme cold can cause water pipes in your home to freeze and sometimes rupture. When very cold temperatures are expected:

• Leave all water taps slightly open so they drip continuously.
• Keep the indoor temperature warm.
• Improve the circulation of heated air near pipes. For example, open kitchen cabinet doors beneath the kitchen sink.

If your pipes do freeze, do not thaw them with a torch. Instead, thaw them slowly by directing the warm air from an electric hair dryer onto the pipes.
If you cannot thaw your pipes, or the pipes are ruptured, use bottled water or get water from a neighbor’s home. As an emergency measure—if no other water is available—snow can be melted for water. Bringing water to a rolling boil for one minute will kill most microorganisms or parasites that may be present, but won’t remove chemical pollutants sometimes found in snow.

Eat and Drink Wisely

Eating well-balanced meals will help you stay warmer. Do not drink alcoholic or caffeinated beverages—they cause your body to lose heat more rapidly. Instead, drink warm, sweet beverages or broth to help maintain your body temperature. If you have any dietary restrictions, ask your doctor.