What is the right way to dispose of unused medications?

DEAR DOCTOR K:

I’ve heard that some people dump their unused medicines into the sink or toilet, which then gets into our drinking water. Is this true, and could it affect my health?

DEAR READER:

Unfortunately, it’s true. There is increasing concern about chemicals from unused medications making their way into our drinking water.

Drugs can get into the water in a variety of ways. As you say, some people flush unused or expired drugs down the toilet or pour them down the drain. More surprising, some nursing homes and hospitals do the same. Drug manufacturing facilities contribute to pharmaceutical pollution. Agricultural waste is another issue of growing importance. Poultry and livestock are often given antibiotic- and hormone-laced feed.

Sewage treatment plants and water treatment facilities remove live bacteria and many impurities from our drinking water, but they are not designed to remove pharmaceuticals. As a result, some pharmaceutical pollution does wind up in the water we drink. So far, only trace amounts of drugs have been found in drinking water, far below levels thought to affect humans.

It’s possible that ingesting even tiny amounts of these drugs could, over time, affect our health. But for now, there’s no evidence that drugs in the water are harming us.

The drugs we pour down the drain, however, could be affecting fish. For example, water sources polluted with estrogen and estrogen-like chemicals (from birth control pills and hormone treatments) contain more fish of ambiguous sex. They have both male and female characteristics — when they should have only one or the other. The impact of this on fish breeding is unclear.

New guidelines encourage responsible drug disposal for hospitals and nursing homes. And we can do our part as well:

  • Limit bulk purchases. Big bottles of expired pills are more likely to end up in the water.
  • Do not flush unused medicines or pour them down the drain. This is the most basic thing that we all can, and should, avoid.
  • Instead, throw medications into the trash. Medications disposed of this way are incinerated or buried in landfills. This isn’t ideal, but it’s preferable to flushing or pouring them down the drain.
  • Better yet, use drug take-back programs. These programs allow you to drop off unused medications at specified locations in your community. Drug take-back programs are organized by state and local governments and also by private institutions, including pharmacy chains. There are nearly 6,000 locations around the United States.

While we don’t know of any harm to humans from the current low levels of old drugs in our drinking water, the truth is that we can’t be sure there is no harm. That’s why I urge my patients to use these programs. It’s just one of many ways to help your fellow human beings, and also the fish!

I’ll close as I often do: The reason we don’t have better answers about the dangers of medicines getting into the water supply is because we’re not investing in the research needed to find out.

(This column is an update of one that ran originally in June 2013.)