Drug disposal guidelines on the Food and Drug Administration’s website say you can flush everything from fentanyl patches to oxycodone tablets down the toilet. Meanwhile, another branch of the U.S. government — the Environmental Protection Agency — says flushing pollutes rivers and lakes and causes traces of the drugs to wind up in drinking water.
No wonder people are confused about where to dispose of their unused medications.
“I would not say we’re doing a good job of unifying our efforts around some of those messages of disposal, period,” said Kim Swanson, a clinical psychologist with St. Charles Family Care.
And yet, it’s a crucial message, given the opioid-abuse epidemic that’s hit not only Central Oregon, but the country as a whole. People who are addicted to opioids will go to great lengths to get the drugs, even searching through family members’ or friends’ medicine cabinets.
Swanson chairs the Central Oregon Pain Standards Task Force, a group of providers that advocates for opioid-prescribing limits and safe pain management practices. The group is promoting a recommendation throughout the region: Drop them into a safe drug disposal kiosk.
“It’s a cleaner message to say: Bring your meds to these certified locations,” said Michael Powell, a task force member and pharmacy director for St. Charles Health System.
There are 17 — soon to be 18 — drug disposal locations in Central Oregon, a number that’s grown since the Drug Enforcement Agency in 2014 expanded the types of facilities that can accept unused medications. The new regulations allow hospitals and retail pharmacies to register as disposal sites and set up kiosks inside their facilities. Prior to the recent change, law enforcement agencies were largely people’s only options. (Those agencies still accept unused medications.)
Kyle Mills, another task force member and a clinical pharmacist with Mosaic Medical, said it often feels more natural or comfortable bringing unused medications to the same place they came from.
“Patients feel that medications are best left in a medicalized system versus going to a location that they don’t always associate with positive feelings,” he said.
St. Charles now has kiosks in its Bend and Redmond hospitals, there’s one in the Redmond Walgreens and pharmacies in Sisters and — by the end of the year — La Pine.
It’s important not to flush the drugs down the toilet or wash them down the sink because wastewater treatment plants can’t remove those chemicals from the water, said Kelly Graham, the city of Bend’s program manager for industrial pretreatment. Technology to remove that material may someday develop, she said, but for the time being, it’s passing into the groundwater and, eventually, into drinking water.
“It may take years, but you may be drinking every drug that any person around here has taken,” Graham said. “It’s very scary once you really get to looking at it.”
As an alternative, Graham highlighted the drug disposal kiosks. She also said people can mix the medications with undesirable material such as cat litter or coffee grounds — so no one will try to use it — and place the mixture in the garbage in a plastic bag. Deschutes County’s landfill has a liner that prevents such materials from seeping into the groundwater, she said.
But Powell, St. Charles’ pharmacy director, said it’s important people don’t do that with controlled substances such as opioids, as it won’t necessarily prevent all abusers from trying to use the drugs.
“There are some that just one dose is so dangerous if children, teens or others get into them, that people could have serious outcomes, including death, by misusing them,” he said.
Powell said the issue of drug disposal is even confusing for St. Charles staff members, who also have received conflicting information about flushing or throwing drugs in the garbage. The health system is in the midst of a campaign to change its processes around safely disposing of medications within its facilities so they can’t be diverted or reused, he said.
Walgreens recently installed drug disposal kiosks in 500 of its 8,000 pharmacies nationwide, including the one in Redmond. The company, which also has a location in Bend, doesn’t plan to add more, but that could change depending on how the current kiosks go over, Walgreens spokesman Phil Caruso said.
“We’re going to see how folks are using it, see how the program goes and then evaluate opportunities for expansion over time,” he said.
At the end of the day, nobody wants to believe that their loved ones would go through their belongings to steal their medications, Swanson said. A co-worker recently told her how shocked she was when it happened to her following a surgery: Someone went through her belongings and found her pain medications, she said.
“I’m not telling people to police family and friends,” Swanson said, “but I think there is always the idea that we should be cautious.”
— Reporter: 541-383-0304,