What do you do with expired tablets and syrups lying in your medicine cabinet? If you have been throwing them along with the household waste, then know that practice can be dangerous and lead to environmental pollution. That’s why the country’s apex drug regulator has asked state drug control departments and chemist and druggist associations to set up ‘drug take-back’ sites where people can drop the expired or unused drugs. The Central Drugs Standard Control Organisation (CDSCO) has issued a guidance document on how to safely dispose of drugs. It has even listed 17 high-risk drugs — including painkillers and anxiety medications — that should be flushed down the toilet to prevent harm to humans, animals and the environment. Why is it necessary to return unused or expired drugs to such “take-back” centres? Improper disposal of medicines can contaminate the soil and water, which can be detrimental to the health of humans, animals as well as the environment. Improperly throwing away unused or expired antibiotics can drive up antibiotic resistance in the surrounding areas. When thrown with household waste, children or scavengers may also come in contact with these medicines. Importantly, improperly disposed expired medicines may be diverted back to markets for resale or misuse. While most drugs become less effective past their expiry date, some may lead to adverse reactions as well. What is the flush list? And, which medicines are on it? The guidance document lists 17 drugs that should be flushed down the toilet or sink if not being used or have expired. These medicines may be especially harmful — sometimes fatal — if used improperly and by those who have not been prescribed them. The flush list has been prepared to immediately dispose of these medicines in order to prevent danger to people or pets in a household. Most of the drugs on the list are strong pain medications called opioids that are used for pain management in cancer patients or those with severe injuries. These include natural opioids such as morphine and synthetic opioids such as fentanyl and oxycodone. The list also includes methadone, which is used for replacement therapy in people addicted to opioids such as heroin. Other drugs on the list are anti-anxiety medicines such as diazepam, ADHD medicine such as methylphenidate and the central nervous system depressant such as sodium oxybate used for the treatment of narcolepsy (a chronic sleep disorder). All of these medicines have a potential to lead to addiction. How should the drugs be ideally disposed of? The guidance document lists specific methods for disposing of different types of medicines. Solid, semi-solid and powder drugs can be sent to the landfill, provided it does not make up more than one per cent of the daily municipal waste. Other than that it can be encapsulated (putting the drugs in a steel or plastic drum and filling the remaining space with materials such as cement, cement-lime mixture, plastic foam or bituminous sand), inertisation (where the pharmaceuticals are mixed with lime, cement and water to form a paste that can be allowed to solidify with municipal waste), or it can be sent for medium to high temperature incineration. Liquid medicines, other than cancer drugs, can be diluted and thrown down the drain. Radioactive drugs have to be buried deep underground. These measures are mainly the responsibility of the manufacturer, who is supposed to take back all unused and expired medicines from the retail stores. Some of the medicines can be disposed of by hospitals that were using them. Or, in some cases where the medicines cannot be returned to the manufacturers, even the retail shops can dispose of them as per biomedical rules, the guidance document says.
