Why It's Important to Get Rid of Unused Medication

The best time to dispose of old meds is Oct. 28: 

National Drug Take Back Day

Consumer Reports /  Ginger Skinner

Last updated: October 26, 2017

When it comes time to dispose of your leftover or expired medicines, you might be tempted to just toss unused pills into the trash—20 percent of people get rid of their meds this way, according to a recent Consumer Reports Best Buy Drugs nationally representative survey of more than 1,000 Americans.

But discarded drugs can contaminate landfill soil and the water supply, according to a study published in 2014 in the journal Environmental Science. And pills can be fished out of the garbage by kids and even pets.

A far better way to dispose of old and unused meds is to drop them off at National Prescription Drug Take Back Day, this Saturday, Oct. 28.

Throughout the U.S., from 10 a.m. to 2 p.m., you can drop off unused pills and liquid medications at designated police departments, fire stations, health clinics, and other facilities in your community for proper disposal. (This doesn’t include inhalers or syringes; see below for how to dispose of those.)

To find a collection site near you, visit TakeBackDay.DEA.gov or call 800-882-9539. Drop-off is free and anonymous.

A Safer Way to Clear Out Old Opioids

To help reduce prescription drug abuse, the Drug Enforcement Administration, in conjunction with the Secure and Responsible Drug Disposal Act of 2010, launched Take Back Day seven years ago. Since then, this twice-yearly event has collected more than 900,000 pounds of medications.

Take Back Day goes a long way toward “eliminating the possibility of a family member or stranger removing your drugs from a medicine cabinet with the intent to misuse or abuse them,” says DEA spokesman Melvin S. Patterson.Many people keep old or unused pills such as opioids in their cabinets because they don’t know how to dispose of them, Patterson says.

Recent research bears that out: According to a survey published last June in JAMA Internal Medicine, 60 percent of people who had been recently prescribed an opioid—Vicodin, Percocet, and others—reported holding on to the drugs for future use. Almost half said that they weren’t aware of how to properly store or dispose of the drugs.Meanwhile, deaths from the use of these drugs have reached epidemic levels—91 people die every day from an opioid overdose, according to the Centers for Disease Control and Prevention.

“Anyone participating in Take Back Day is a welcome part of the solution to a significant problem,” Patterson adds. “It gives everyone an opportunity to take part in ridding our communities of old, unwanted, and potentially harmful drugs.”

The drugs you turn in on Take Back Day are all incinerated—never redispensed or put into landfills, Patterson says.

Other Ways to Dispose

If you can’t participate in Take Back Day this Saturday but still have unused meds to get rid of, follow these steps:

Buy an envelope and mail back your meds. Costco, CVS, and Rite Aid pharmacies sell postage-paid envelopes for a few dollars that allow you to mail any prescription pills or liquids, including opioids and over-the-counter medications, to a disposal facility to be incinerated. (Do not send inhalers or syringes.)

Drop off at a free kiosk in CVS or Walgreens. As part of its initiative to address opioid misuse, CVS this week announced that it plans to offer free, anonymous, secure drug disposal kiosks at 750 pharmacy locations across the U.S. Walgreens already also offers safe drop-off at in-store kiosks. (Medications are incinerated.) To use one, remove your personal information from the bottle or packaging and drop your unwanted or expired medication, including controlled substances, in the slot.

Toss meds in the trash (only if you can’t purchase a mail-back envelope or get to a CVS or Walgreens kiosk). Doing so can contaminate the soil and water supply, so this is not an ideal solution. If you must throw drugs away, first conceal pills (from kids and pets) by mixing them in a bag or another container and mix them with an unappealing substance, like used coffee grounds or kitty litter. Then seal up the container and toss the item into the trash.

Last resort: flushing. This is not ideal because trace amounts of flushed meds can end up in drinking water and possibly harm aquatic life. Our survey found that 17 percent of people said this was their typical disposal method.

The Food and Drug Administration suggests flushing certain drugs, like dangerous opioids, when they are no longer needed, because they could be deadly if accidentally taken by someone else, particularly children.

Disposing of Syringes and Inhalers

You won’t be able to dispose of needles, syringes, or inhalers at National Take Back Day. And it’s not recommended that you throw these items into the trash.

For inhalers, contact your local trash and recycling facility for proper disposal instructions.

For needle disposal, go to safeneedledisposal.org or call 800-643-1643 to find drop-off locations near you. You’ll also find information on pharmaceutical company mail-back programs.

Do Expiration Dates Matter?

Drug manufacturers are required by law to stamp an expiration date on medication bottles, cartons, and tubes; it’s the date the manufacturer can guarantee maximum safety and potency based on testing.

Our medical experts say you can keep most prescription and over-the-counter drugs for about 12 months past the expiration date, with critical exceptions. The antibiotic tetracycline should never be taken after that date, because as tablets break down they can become toxic and cause kidney damage. It’s especially important to keep nitroglycerin and other liquid meds, like insulin and epinephrine (i.e., EpiPens) up-to-date. They lose potency after the expiration date, so they might not work as well or at all in an emergency.

Editor’s Note: This article and related materials are made possible by a grant from the state Attorney General Consumer and Prescriber Education Grant Program, which is funded by the multistate settlement of consumer-fraud claims regarding the marketing of the prescription drug Neurontin (gabapentin).

What You Need to Know About Expired EpiPens

Consumer Reports / Ginger Skinner / August 26, 2016

Are they safe? And will they be effective in an emergency?

Anne McMaster, a retired nurse in Seattle with a serious allergy to bees, used to buy a new EpiPen every year when her current one expired. That stopped about three years ago when her out-of-pocket costs for the potentially life-saving medication spiked and she couldn't afford the higher price. Instead, she just kept her old injector, figuring an expired EpiPen is better than no EpiPen at all.

"I would never tell anyone else to do it because of the risks of it not working," McMaster says. "But for me, it was a risk I had to take."

Although there are some lower-cost alternative injectors on the market, and Mylan, the maker of EpiPen, says it is introducing programs to make the device more affordable for consumers, many Americans are wondering whether it is indeed okay to use expired EpiPens.

It's important to replace your epinephrine injector before the expiration date stamped on the pen. That’s because epinephrine deteriorates over time and relying on an outdated one (past the standard 12- to 18-month expiration date) can leave you with an auto-injector that's less effective, or not effective at all, when you most need it.

But what should you do if you are having an allergic emergency and the only injector you have is an expired one? It's probably better to use it than not, some experts say.

"If a patient were to experience an allergic emergency that required use of epinephrine and the only injector available was an outdated one, I would use it," says Andrew Murphy, M.D., a board-certified allergist at the Asthma, Allergy and Sinus Center in West Chester, Pa. "The risk would be that the epinephrine would have degraded and you may not get an optimal dose."

An April 2015 study in the Annals of Allergy, Asthma & Immunology looked at 35 expired EpiPens and found that injectors that were up to two years past their expiration date could retain 90 percent or more of the initial dose listed on labeling.

Murphy stresses that you shouldn't use any injector, even if it's technically not expired, if the medicine is pink or brown (instead of colorless), cloudy, or contains solid particles. In that case, "the medicine clearly has decayed and the injector should not be used at all," Murphy says.

Murphy also says that anytime you use an auto-injector—expired or not—you should call 911 or go to the emergency room, even if the shot seems to be working. That's because severe allergic reactions can require more than just a shot of epinephrine.

Storing and Disposing EpiPens
Be sure to store epinephrine auto-injector properly. And that doesn't mean in the refrigerator: Extremes of heat or cold can degrade the medicine, as can exposure to light and humidity. So while you might need to carry one around with you, when you are at home or work store it at room temperature in a dry, dark place. And while it might be tempting to keep a spare in the glove compartment of your car, that's probably not a good idea because it can get too hot or cold, in there. If your child needs one while at school, ask the nurse to keep it. Many schools have special lockers for such medicines.

It's also important to properly dispose of expired EpiPens or used injectors, says Barbara Young, Pharm.D., of the American Society of Health-System Pharmacists.

Auto-injectors thrown into in your household trash could prick or injure people or pets in your home. Instead, if you've used the injector, give the device to the healthcare professional you saw afterward. Take expired EpiPens to a doctor’s office, hospital, or pharmacy for disposal, Young says.

You can find a drop-off location near you at SafeNeedleDisposal.org.

A final tip: When filling an EpiPen prescription, ask the pharmacist to give you auto-injectors with the latest expiration date.


Editor's Note: This article and related materials are made possible by a grant from the state Attorney General Consumer and Prescriber Education Grant Program, which is funded by the multistate settlement of consumer-fraud claims regarding the marketing of the prescription drug Neurontin (gabapentin).

The Cost Of A Life-Saving EpiPen Has Increased 400% Since 2007

From Consumerist / August 19, 2016 / By Laura Northrup

If you or someone in your family has severe allergies, the EpiPen is a familiar and essential product. Yet if you have good health insurance, what you may not know is that the cost of the pens has increased significantly since pharmaceutical giant Mylan acquired the drug in 2007.

Different sources list different prices, but the cash price for an EpiPen has increased somewhere between 400% and 600% in the last decade since Mylan acquired the product. A pack of two pens can cost hundreds of dollars at retail.

According to reporting in Bloomberg BusinessWeek from last year (warning: auto-play video at that link), Merck got rid of the EpiPen, which wasn’t a big money-maker at the time, by selling it to Mylan. The auto-injector pen contains about a $1 dose of the drug epinepherine, yet somehow costs 400% more on the wholesale market, and the cost to insurance companies and patients forced to pay retail has probably increased even more.

While the EpiPen is a 25-year-old device, there is no direct generic equivalent. One important money-making strategy for Mylan has been to hand out free pens to familiarize people with the product. The company has also been working to make sure that the pens end up purchased in bulk for schools and in other public places for allergic emergencies…just like the automated defibrillators that are now easy to find. Mylan has even worked with the same consultants as defibrillator-maker Medtronic.

Well, okay, but what can patients actually do about those high prices? For lower-income patients whose insurance doesn’t cover the devices, there’s a patient assistance program, and the company also offers coupons that bring the co-pay down if your insurance does cover the device.

You can also opt out of using Mylan’s product altogether. Dosing your own epinepherine in a syringe isn’t recommended, but there’s another auto-injector on the market that costs less than an EpiPen. Since it isn’t a generic, you can’t just receive one at the pharmacy when your doctor has prescribed EpiPens.

When our colleagues down the hall at Consumer Reports checked prices for the device, they found that the Adrenaclick cost less than half as much as the EpiPen. Another alternative product, Auvi-Q, was recalled and taken off the market earlier this year.

Check with your insurance company, but all of these products should be covered: it’s just that the ubiquity of the EpiPen makes it the first product that doctors and patients both think of. It’s the Kleenex or Band-Aid of lifesaving injector devices.

What’s important is to make sure that everyone knows how to use the alternative device, if your doctor agrees that one of : the allergic person and other household members should know how to administer the drug.

For children, make sure that parents and other caregivers, as well as staff and nurses at the school know that the device is an Adrenaclick and not the more familiar brand.

Though that may not help much either: one parent who spoke to MarketWatch said that her high-deductible health plan means that a two-pack of EpiPens costs $500 with a discount coupon from Mylan, while a two-pack of the Adrenaclick cost $400.

https://consumerist.com/2016/08/19/the-cost-of-a-life-saving-epipen-has-increased-400-since-2007/