California survey points to need for better education on proper medication disposal

Only 47% of pharmacies gave proper instructions on how to dispose of antibiotics, and only 34% gave correct instructions for opioids, according to a small survey conducted in California pharmacies.

Researchers at the University of California San Francisco (UCSF) posed as parents of children who had recently had surgery. They called up roughly 900 pharmacies in California and spoke to employees, asking them what to do with two leftover medications, an antibiotic—sulfamethoxazole-trimethoprim—and an opioid—hydrocodone-acetaminophen. The telephone surveys were conducted in 2018.

"This clearly points to the need for better dissemination of information on proper medication disposal," said Hillary Copp, MD, an associate professor of urology at UCSF and the senior author of the study, in a press release. "The FDA has specific instructions on how to dispose of these medications, and the American Pharmacists Association has adopted this as their standard. Yet it's not being given to the consumer correctly the majority of the time."

In the absence of a takeback program, FDA says antibiotics should be mixed with an unpalatable substance, such as coffee grounds or kitty litter, and disposed of in a sealed container in the trash to keep them from getting into the water supply or inadvertently ingested. For opioids, FDA recommends flushing them down the toilet to avoid any potential abuse or misuse.

Copp said in the press release that improving disposal practices will require educating patients more thoroughly as well as expanding disposal programs.

"A pharmacy is a place where medications are dispensed, so it is natural for people to look to this same location for advice on how to dispose of unused medications," Copp said. She added that managing leftover medication is complex, however, and it shouldn’t be the sole responsibility of the pharmacy but instead addressed from multiple angles.

The study was published on December 30, 2019, in Annals of Internal Medicine.