Federal agencies address disposal of unused prescription drugs

Discussions in Washington indicate that proper household disposal of drugs is a pediatric issue. That's because prescription drugs are misused more by teens than any illicit drug other than marijuana, according to the Substance Abuse and Mental Health Services Administration (SAMHSA).

Policymakers currently are reworking recommendations for what to do with old or unused prescription drugs in the home.

Last October, the Office of National Drug Control Policy (ONDCP) updated federal guidelines on the proper disposal of prescription drugs, saying that the FDA Web site lists only 27 specific hazardous drugs that should be flushed down the toilet. Gil Kerlikowske, ONDCP director, said that the drugs on the list are those that are "clearly deemed as absolutely the most dangerous kind of drugs," drugs that can be actually absorbed through the skin.

For other drugs, say the guidelines, people should use community take-back programs. If there isn't such a program available, people should mix the drugs with an undesirable substance such as coffee grounds or cat litter and put them in the garbage in a sealed container.

The ONDCP is focusing on the community take-back programs, including take-back events or disposal programs at local waste sites. The agency is looking specifically at legislation moving through Congress that will make it easier for the programs to operate by allowing people to turn in controlled substances, says Regina LaBelle, senior policy advisor to the ONDCP director. Under the current Controlled Substances Act (CSA), people who are prescribed controlled substances cannot legally transfer them to someone else, as through a take-back program.

At a hearing earlier this year, Joseph Rannazzisi, deputy assistant administrator of the Drug Enforcement Administration, said that the DEA must monitor pharmaceutical take-back programs because any collection of unused drugs would most likely involve controlled substances and noncontrolled substances. "The CSA provides stringent limitations on the circumstances in which it is lawful to procure, distribute, and possess such drugs," he said, when controlled substances are involved.

The Senate passed a bill (S. 3397) on August 3 that would allow transfer for disposal purposes. Similar legislation has passed through a House of Representatives committee. Talks are ongoing between Congressional committees and the agencies about the shape of the proposed legislation. If and when the legislation passes, there will be a rule-making process during which the public can weigh in on the regulations to implement the law.

The take-back programs are "a critical part of our drug control strategy on prescription drugs," says LaBelle. She stresses that prescription drug abuse is the fastest growing drug problem, in part because so many prescription drugs are available to people, and people think legal drugs are safe.

Beyond the legislation on take-backs, Sen Herb Kohl (D-WI), chair of the Senate Special Committee on Aging, has said that he plans to introduce a more comprehensive bill to reduce drug waste and ensure safe disposal. A committee hearing in June included discussions about lawful programs for taking back drugs, among other topics.

In the meantime, says LaBelle, pediatricians "should tell their families they should lock up their prescription drugs and if they can't lock them up to at least monitor them," because many teens abusing the drugs are getting them out of the medicine cabinet.