John W. Holaday, PhD

One of the most enlightening statistics about the country’s opioid epidemic comes from a 

 in which researchers compared two populations of patients entering treatment for heroin addiction. Of those patients who began abusing opioids in the 1960s, more than 80% started with heroin. Of those who began abusing opioids in the 2000s, 75% reported that their first opioid was a prescription drug.

Of course, pharmacists cannot control the number of opioid prescriptions being written, but you can help educate patients, providers, and the community about the importance of proper disposal of unused prescriptions. Opioids are not the only concern - many other potentially dangerous medications are stolen from homes and misused or sold. Proper disposal can head off this diversion risk, while also preventing the types of accidental poisonings that send 

 children under age six to the emergency department each year.

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Many well-meaning consumers dispose of medications by flushing them down the toilet or pouring them down the drain. Through increased education efforts, people are now beginning to realize that those disposal methods can be harmful to the environment.

In addition to increasing awareness about the misuse of unused drugs, pharmacists can educate patients about the easy and efficient disposal methods that some major pharmacy chains such as Walmart are offering to consumers. For example, at-home kits that contain a special powder can be combined with water in a bottle of unused medication, rendering the drug unusable and unavailable; the vial can then be disposed of in household trash - a more ecofriendly option than flushing the medication or pouring it down the drain. 

It is widely accepted that the rapid increase in opioid prescriptions since 2000 was the primary driver of the current nationwide epidemic.Consider this: if all patients took all their medication as prescribed, and properly disposed of any unused portions, would the opioid crisis be as severe as it is today? Considering 

 of patients claim to retain leftover prescription opioids for later use, lack of adherence to prescription and disposal guidelines is likely a contributing factor.

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Disposing of unused and expired medications also prevents accidental poisonings, particularly in children. Fatal drug poisonings have increased by 10%since 2000. Similarly, more than 9,000 children every year are hospitalized due to these poisonings. The Poison Prevention Packaging Act of 1970 legislated child-resistant packaging to reduce accidental poisonings and deaths, but 

 of accidental poisonings still involve child-resistant packaging. 

Leftover prescription drugs not only result in poisonings and potential misuse,but when flushed down the toilet or dumped down the drain, they can pollute drinking water. A study of 

 plants found 56 drugs in the water, including oxycodone, hypertension medications and various OTC drugs. 

 of 25 drinking-water treatment plants found that despite the rigorous filtering and cleaning process that occurs at the facilities, traces of carbamazepine, bupropion, cotinine, metoprolol and lithium persisted.

Newer, non-toxic disposal options can significantly reduce the environmental impact by offering an alternative to flushing medications down the toilet or drain. When environmentally conscious consumers have access to an easy-to-usedisposal method that’s also ecofriendly, they will be less likely to hold on to leftover medications. 

Numerous disposal options can be recommended to patients. However, traditional methods such as Take Back Days, kiosks, and mail-back envelopes require patients to transport unused medications to another location or to obtain a special envelope to enclose the drugs and then go to the post office. These extra steps and inconveniences prevent many people from acting as quickly as they should and can lead to keeping medications longer than needed - thereby increasing the risk of diversion and addiction as well as poisonings. In fact, the average length of time that Americans retain a prescription medication is three years. That’s 1,095 days that those pills are at risk for misuse.

By recommending a variety of disposal options to patients, pharmacist can play a pivotal role in fighting the nation’s opioid epidemic - while also protecting children from accidental poisonings and lessening the environmental impact of drug disposal.

Learn more about DEA's National Prescription Drug Take-Back Day

John Holaday, Ph.D., is chairman, founder and CEO of 

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By heading off the misuse of unused medications, pharmacists can play a key role in combatting opioid diversion, accidental poisonings and environmental pollution.

Author | John W. Holaday, PhD

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How Pharmacists Can Encourage the Disposal of Unused Prescriptions