Down the drain

toilet with raised seat,

Do pharmacies flush unwanted medicines down the toilet? Study reveals consumer confusion about what to do with expired and unwanted medicines

A series of detailed consumer interviews has revealed the quantity of unused medicines currently carried in Australian households, and the confusion among consumers about what to do with them.

In total, 166 patients had 2301 medicines in their houses. Of these 1424 medicines were not in everyday use – being either unused, unwanted, expired or used when required. 

Medicines were often stored in multiple locations, particularly kitchens, the researchers found.

While many respondents identified accidental ingestion in children and pets and decreased efficacy as potential health risks, this did not always translate to appropriate storage, usage or disposal practices, they found.

In fact, individual risk-benefit assessments seemed to be applied to decisions to retain, use or dispose of medicines, including expired medicines. 

As one patients stated: “With the Panadeine [paracetamol 500mg, codeine 8mg] and the Sudafed [pseudoephedrine 30mg] I would normally take them and not worry about the expiry date…The Clexane [enoxaparin sodium] slightly different…I would go visit my doctor and make sure that the Clexane was a valid in stock prescription and I would actually bring the out of date ones back to the chemist…”

Examples of expired medicines being used included analgesics, pseudoephedrine (decongestant), chloramphenicol (antibiotic) eye preparations and topical corticosteroids.

Accepted timeframes for use of expired medicines by participants varied from just expired, to a
year or longer. There was greater use of expired topical medicines reported and expired prescription medicines were associated with higher risks.

Medicine disposal practices varied, with 20% of participants reporting a combination of both returning medicines to the pharmacy and disposing via household garbage or drains.

“Such practice was guided by individual perceptions of health and safety rather than the risk
to the environment,” the authors said.

“Indeed, how consumers dispose of other perishable goods could also influence medicine disposal; liquids were more likely to be poured down the drain similar to other fluids, and tablets placed in the bin like other solids such as food scraps”.

The majority of unwanted or expired medicines in the home were OTC products, leading the authors to suggest that consumers perceive these to be safer than prescription medicines. 

“As over-the-counter medicines traditionally involve less input from health care professionals, e.g. if
purchased in a supermarket, further emphasis on the message that ‘OTC medicines should be treated with the same care as prescribed medicines’ is suggested,” they said.

However, on a positive note, the research revealed increasing consumer awareness of pharmacy services for the disposal of medicines not for everyday use.

“There was significant trust in pharmacists to safely dispose of returned medicines,” they said, however this was “tempered by ambivalence over how this process actually occurs and whether medicines would be reused overseas”.

“[The pharmacy] probably flush it down the toilet or give it back to the manufacturer,” one consumer stated.

“They might be able to make a claim on it…. “

Another said that “I think some medicines would be appropriate [to send overseas]. I don’t think they are completely useless when they’re past their use by date.”

The authors, from the School of Pharmacy at Griffith University, called for health campaigns and grass-roots strategies to focus on awareness of the RUM Project and addressing misconceptions and appropriate medicine storage.

Participants were eligible for the study if they used five or more prescribed, over the counter, and/or complementary and alternative medicines, said the authors.

The study was published in BMC Public Health

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