You have just recovered from a particularly nasty bout of flu. Your GP (general practitioner) had kindly loaded you up with decongestants, cough medicine and throat lozenges to help treat your symptoms, but now that you are better, you still have some left over.
What do you do with these remaining medicines?
Our thrifty Asian souls would probably advocate keeping the drugs for the next time we or one of our family members get the flu again.
Some people, however, might opt for throwing the drugs away, especially if the medications have been stored for a while and they are uncertain of the expiry date.
According to a study published in the online Education in Medicine Journal and conducted in Sultanah Aminah Hospital, Johor Bahru, 38.3% of the 438 patients surveyed threw away their unused drugs with the household garbage, while 11.0% flushed them down the toilet or sink.
Disposing of drugs in such a manner can have unintended negative effects.
Says Taylor’s University pharmacy lecturer Dr Yeap Li Ling: “Our sewage system cannot decompose those chemicals, so people are strongly encouraged not to flush drugs down the sink or toilet.”
After being treated at sewage treatment plants, the water from our sewage systems goes back into our rivers.
If we flush drugs down the sink or toilet, the chemicals in them will be dissolved into this water that goes back into the environment, where animals and humans may unwittingly consume them, and plants may absorb them.
Throwing them away into the garbage can have the same effect.
Over half of our garbage goes into landfills. This means that loose pills or tablets can eventually dissolve into our groundwater, which might end up back in our drinking water, or animals or birds might consume them, affecting the food chain.
Dr Yeap says that there is also the issue of landfill scavengers coming across these disposed drugs – especially if the pills or tablets are still in their strips or blisters – and abusing them.
This is especially so in the case of psychotropic drugs and opioids.
Psychotropic drugs are those used to treat mental conditions, which range from anxiety to schizophrenia, while opioids are drugs that act on the nervous system to relieve pain and are potentially addictive.
She adds: “When throwing drugs into the rubbish bin, there is a risk in terms of identity theft.”
She explains that for repeat prescriptions – those that need to be refilled every one or three months, usually for chronic conditions – the patient will normally receive a copy of the prescription to take back with them. This prescription is often kept together with their medications.
“Sometimes, when family members return medicine, the prescription is still in the bag.
“I believe that when they throw the medicine away, they throw the prescription together as well,” she says.
This enables scavengers or anyone who picks it up to take the prescription and claim the drugs from the hospital.
While Dr Yeap thinks that there isn’t anything wrong with keeping your own medications for reuse, there are a few caveats that must be put in place.
When it comes to sharing medicines with family members or friends with similar ailments, she says: “When the doctor prescribes for you, the doctor knows your disease condition – what is your age, whether you have any concomitant diseases – so that the medication is suitable for you.”
Your health condition may not be the same as your relative’s or friend’s, which might affect the suitability and effectiveness of the drug or its dose for them.
She adds: “Sometimes, they might have drug allergies, and sometimes, they might be on some medication where they cannot take the medication you want to share with them.
“For example, antihistamines and decongestants, which are very commonly used for flu and blocked nose, are generally avoided for patients with heart problems.”
Dr Yeap says that, even if the medications are recycled for your own use, she would only encourage the reuse of short-term medications for minor ailments like headache, pain, flu and cough.
In fact, she notes that patients should not have an excess of other types of medications anyway.
She gives the example of antibiotics, which need to be finished, and chronic diseases, like high blood pressure and diabetes, which need to be taken regularly, saying that if patients are compliant in taking their medications as instructed, they will not have any extra.
She also advises patients to observe any stored drugs for changes in colour, texture and smell, before using them.
“If the pill was white when you first got it, make sure it is still white and not yellow.
“Look at the texture of it. Sometimes it becomes soft – maybe because it absorbs moisture – then it’s not safe to use.
“Sometimes, if it has a smell, it might have absorbed moisture or degraded, so you shouldn’t use it anymore,” she says.
The expiry date of the drugs, usually stamped onto one end of the strip, should also be checked.
Return for reuse or disposal
There are also times where, despite a patient’s compliance, they still end up with an excess of medications for chronic conditions.
According to Dr Yeap, this may be because the patient is seeing different specialists for different medical problems, all of whom prescribe medications for all the patient’s diseases, not just the one the patient is seeing them for. This results in the patient having multiple courses of drugs for the same disorder.
She adds that sometimes, the excess supply is because the doctor has decided to put the patient on another drug or different dosage, or stop them altogether – in which case, it is unsafe for the patient to keep the old drugs around as they might mistakenly take them again.
This is especially so for patients who are unaware or unsure of the names and dosages of their drugs.
In such cases, patients can return their extra medications to hospital or clinic pharmacies for either recycling or safe disposal.
For public hospitals and clinics, this comes under the Return Your Medicines Program-me launched in 2010 by the Health Ministry’s Pharmaceutical Services Division.
While this programme is not compulsory for private hospitals or clinics, Dr Yeap notes that some private hospitals will accept unused medications to either send to public hospitals under the Return Your Medicines Programme or donate to non-governmental organisations with medical professionals that provide free clinics, if the medicines are in good shape.
Government pharmacists will also assess the condition of the returned medicines to determine if they should be disposed of or can be reused.
If the medication is still unopened in its original strip or packaging, has not shown any change in colour, texture or smell, has a far-off expiry date and was stored properly by the patient, it can still be given out to other patients.
If not, the drugs are usually collected and given to a clinical waste management company that will incinerate them.
“Actually, disposal of medicines in the hospital is expensive, but we have to take the responsibility of doing the disposal,” says Dr Yeap.
For individuals who prefer to dispose of their extra medications on their own, she advises: “Take out the tablets (from their blisters), mix them with soil or any waste, and put it in a plastic bag and seal it, so that it doesn’t leak into the ground, then put it in the rubbish bin.”
The idea behind mixing it with soil or waste is so that scavengers will be unlikely to want to consume them, especially as they would also be unsure what drugs they are as they are not in their original packaging.
Dr Yeap also reminds patients to remove any identifying information from the drug packaging and prescriptions before throwing them away.