Don't throw in the bin, please flush it! CDSCO dictum for these 17 medicines

The list, detailed in Annexure D of the guidance titled "Guidance Document on Disposal of Expired/Unused Drugs (WI/01/DCC-P-25)," is part of a broader initiative to minimize public health risks associated with unregulated pharmaceutical waste.

“This list provides the details of expired, unwanted or unused medicines containing the Active ingredients as mentioned... the general public should flush down the sink or toilet to help prevent danger," CDSCO notes.

The 17 drugs recommended for flushing are Fentanyl, Fentanyl Citrate, Morphine Sulfate, Buprenorphine, Buprenorphine Hydrochloride, Methylphenidate, Meperidine Hydrochloride, Diazepam, Hydromorphone Hydrochloride, Methadone Hydrochloride, Hydrocodone Bitartrate, Tapentadol, Oxymorphone Hydrochloride, Oxycodone, Oxycodone Hydrochloride, Sodium Oxybate and Tramadol.

These medications are primarily narcotics, sedatives, and stimulants regulated under the Narcotic Drugs and Psychotropic Substances (NDPS) Act and the Drugs and Cosmetics Act. Even trace amounts can cause fatal poisoning, particularly in children or pets.

Why Flushing?

While flushing medicines is generally discouraged due to environmental concerns, CDSCO makes an exception for these specific drugs, stating:

“There is a small number of medicines that may be especially harmful and, in some cases fatal with just one dose if they are used by someone other than the person for whom the medicine was prescribed.”

The flushing method is meant as a last-resort safety mechanism when no other take-back or disposal mechanism is available. The guidance notes that this list is “dynamic” and may be revised in the future.

Drug Take-Back Programs Encouraged

CDSCO has also urged state regulators and local authorities to establish “‘Drug take back’ site or program at designate[d] locations, where people can drop expired or unused drugs from their homes.” These collection centers, ideally operated in collaboration with chemist associations, are expected to route returned medicines through licensed biomedical waste handlers.

The agency warns that “Unscientific disposal of unused or expired drugs is considered as one of the primary reasons for environmental pollution,” and links careless disposal of antibiotics to antimicrobial resistance.

Broad Guidelines for All Stakeholders

The guidance lays out detailed procedures for disposal by retailers, wholesalers, hospitals, manufacturers, and even drug inspectors. Retailers, for instance, must return expired stock to suppliers within 30 days and maintain records as per Annexure A. Manufacturers must ensure that “No drugs should be available in supply chain after 6 months of expiry.”

For special categories like radioactive and cytotoxic drugs, the guidance prescribes isolation and treatment protocols. It warns:

“Anti-neoplastics... should not be disposed off in a landfill other than after encapsulation or inertization... No low or medium temperature incineration.”

Similarly, it cautions that “controlled substances... shall be disposed off adhering to... NDPS Rules, 1985,” and only after appropriate intimation to authorities.