Correction to This Article
The article on the disposal of prescription drugs misinterpreted a statistic from the Kaiser Family Foundation. The average number of retail prescriptions dispensed in the United States in 2007 was more than 12 per person.

Governments Offer Advice but No Assistance in Disposing of Unused Drugs

By Susan Q. Stranahan
Special to The Washington Post
Tuesday, May 5, 2009

At the Leesburg Pharmacy, located in a Loudoun County strip mall, a big, round fish tank sits atop the prescription counter. There are no fish inside, not even any water: The tank is a repository for unused medications. People can drop off the Vicodin that didn't get used once the pain of a root canal subsided. Or the heart pills remaining after a grandmother's death. Or an asthma inhaler that had passed its expiration date. Or an antidepressant that turned out to have unpleasant side effects.

Once a week, the tank is emptied; the drugs are packed in cartons by pharmacy personnel and ultimately incinerated by a commercial waste firm.

"Our customers are thrilled because they had no idea what else to do with this stuff," said Cheri Garvin, chief executive of the employee-owned pharmacy.

These are customers who are trying to do the responsible thing. Over the years, Americans have been alerted to the dangers of a lot of problematic waste materials -- paint thinner, batteries, air conditioners. But leftover pills can seem so small, so easily disposable, that many people routinely flush them down toilets, wash them down sinks or throw them in trash that goes to a landfill.

And then they often end up in places where they shouldn't be, like the public water supply.

The average American takes more than 12 prescription drugs annually, with more than 3.8 billion prescriptions purchased each year, according to the Kaiser Family Foundation. The most commonly cited estimates from Environmental Protection Agency researchers say that about 19 million tons of active pharmaceutical ingredients are dumped into the nation's waste stream every year.

The EPA has identified small quantities of more than 100 pharmaceuticals and personal-care products in samples of the nation's drinking water. Among the drugs detected are antibiotics, steroids, hormones and antidepressants. Last year, the Associated Press reported that trace amounts of drugs had been found in the water supplies of 24 major metropolitan areas; water piped to more than a milllion people in the Washington area had tested positive for six pharmaceuticals.

The EPA does not require testing for drugs in drinking water and has not set safety limits on allowable levels. While the minute quantities now being detected appear not to pose an immediate health risk, according to federal authorities, "there is still uncertainty about their potential effects on public health and aquatic life" over the long term, the EPA's water chief, Benjamin Grumbles, told a Senate committee last year. But the impact of long-term exposure of drugs on humans as well as on other species is less clear. Hormone-disrupting pharmaceuticals, for example, are one possible cause of a high incidence of "intersex" fish in the Potomac River basin: male smallmouth bass producing eggs, females exhibiting male characteristics.

Until recently, federal guidelines recommended that surpluses of highly toxic medications be flushed down the toilet; the same advice applied to drugs with a high potential for abuse or "diversion" -- the industry's word for what happens, for example, when kids help themselves to the OxyContin or Percocet in their parents' medicine cabinet. For other drugs, consumers have been directed to adulterate the medication by mixing it with an unpalatable substance -- such as cat litter or coffee grounds -- and put it out with the household trash.

But this spring, concerns about pharmaceuticals in the water supply led the Office of National Drug Control Policy to amend its advisory, telling consumers to avoid flushing unless the label or patient information specifies that method of disposal. The new guidelines still describe the cat-litter method of putting drugs in the trash, but they also encourage consumers to make use of community drug take-back programs.

And that's the problem: In much of the country, including the Washington area, drug take-back sites like the Leesburg Pharmacy are almost impossible to find. An informal survey of the District and 10 surrounding jurisdictions turned up no city- or county-organized drug disposal programs.

"We are farther ahead with recycling our garbage than we are with recycling drugs," said Babs Buchheister, the nursing director of Calvert County.


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