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CDC 'flush list' promotes human and environmental health risks

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Prescription drug diversion and abuse is a hot topic at FDA, inspiring blog posts, summit speeches, and co-promotion of DEA's annual prescription drug collection event. However, one piece of advice from FDA -- the "flush list" of drugs that the agency recommends flushing down a toilet or pouring down a sink -- stands in sharp contrast to advice given by environmental advocacy groups.

The "flush list" is part of FDA's advice entitled "Disposal of Unused Medicines: What You Should Know," updated most recently in November 2013. In this communication, FDA advises consumers to participate in take-back days, in which law enforcement agencies and pharmacies accept unused prescription medication for safe disposal; mix unused medication with used kitty litter in a plastic bag before disposal via municipal or private garbage pickup; and flush "certain medicines" down a toilet.

"There is a small number of medicines," FDA says, "that may be especially harmful [...] When you dispose of these [...] powerful medicines down the sink or toilet, you help to keep others safe by ensuring that these medicines cannot be used again or accidentally ingested and cause harm." The drugs recommended by FDA for flushing include:

  • morphine sulfate
  • buprenorphine hydrochloride
  • naloxone hydrochloride
  • methylphenidate (also known as Daytrana)
  • diazepam
  • hydromorphone hydrochloride (also known as Dilaudid)
  • meperidine hydrochloride (also known as Demerol)
  • methadone hydrochloride
  • oxycodone hydrochloride
  • oxycodone hydrochloride plus acetaminophen (also known as Percocet)
  • oxycodone hydrochloride plus aspirin (also known as Percodan).

Unfortunately, flushing these drugs or otherwise putting them into municipal sewer systems causes millions of Americans to ingest them accidentally, as well as countless non-human members of our ecosystem. In 2008, an investigation by Associated Press reporters Jeff Donn, Martha Mendoza, and Justin Pritchard found that the drinking water supplies of 41 million Americans were contaminated with pharmaceutical residues. Although drugs that have passed through the human body and are excreted into sewer systems contribute some of the residue, flushing unused pharmaceuticals is also a factor in this virtually untracked pollution problem. According to the AP, the EPA has not set limits for drug residue in drinking water, and does not require testing of drinking water for pharmaceutical products or byproducts.

Although the drugs are generally found at very low levels in drinking water, there is still cause for concern. Mary Buzby of Merck & Co. told the AP that "there is genuine concern that these compounds, in the small concentrations that they're at, could be causing impacts to human health or to aquatic organisms." Sheryl Eisenberg of Natural Resources Defense Council (NRDC), an environmental advocacy group, wrote in 2011 that part of the danger to humans and wildlife stems from the fact that exposure to pharmaceutical residue is long-term and involves a random combination of drugs. NRDC has been campaigning for years to stop the practice of flushing pharmaceuticals. Eisenberg suggests that individuals who have missed the annual prescription drug take-back day -- 2014's event was held on April 26 -- should contact their pharmacies or physicians to ask if they'll accept the unused drugs. "It's worth a call," she says.

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