Disposing Of Old Prescriptions Is Tricky

I’ve heard people say this about something that is a waste of money, “You might as well just flush your money down a toilet.”

That isn’t always the best way to dispose of something – even excess money.

Recently there was a major national “event” where people take back and dispose of drugs free of charge. It was supposed to have something to do with publicity. Since I am constantly trying to be the most up-to-date of anyone who prescribes psychotropic drugs, I have to conclude that the publicity is unlikely to have been extremely effective.  My patients sometimes exchanges prescriptions with friends or family — or steal them — and when I tell people they are only intended for the person whose name is written on the label, they get angry at me.

Sometimes if I am lucky they steal Seroquel, which I have just learned is (currently) the most popularly prescribed psychotropic medication across the U.S. It is not totally harmless (nothing is) but when one person recently stole some from his sister, he slept soundly through the night on a relatively low dose, and asked for his own prescription.  Kind of a try-before-you-buy program. I will admit that I broke down and prescribed it.

I remember reading some data a long time ago that for antidepressants (and perhaps in a lesser manner, for anti-psychotics) that if someone responded to a medication well, then a first degree relative would be more likely to respond to that same drug than to anything else.

This is the kind of assertion that makes cosmic sense, and I have certainly gone with this assumption successfully.

We know that everyone seems to have (qualitatively) similar but different (quantitatively) sets of enzymes and such. So even though we have some tests that may predict an individual’s response to medication, I certainly am not aware of anybody who feels like paying for them and a “first degree relative” guess may well be justified. Of course, if it does not, we are left with a bunch of useless but paid for pills.  The top ten … ummm … excuses I hear are:

“I left them at a party last week by mistake” (“It must have been an interesting one. I’ll bet people were trying each other’s prescriptions.”)

“The dog ate them” (I watch the expression on their face when they respond to a question asking them to describe their dog’s subsequent behavior.)

“Someone broke into my place and stole them all.” (” I hope you put this on the police report.”)

These folks really mean that they are hoarding extra pills, or maybe selling them on the street. Some of my more vociferous patients who believe that selling their excess pills – and possibly illegal drugs — is a good career move have actually bragged to me about their levels of marketing acumen and sales prowess. They often tell me they are quite sure they make more money than I do, and I probably believe them.  The idea that people are starting off on the wonderful — but scary — road to substance abuse by checking out family ‘scripts in the medicine cabinet is disturbing, but thoroughly believable. What I have trouble believing, however, is that children easily open allegedly child-proof caps. I can’t, usually. If I want to do a pill count, or even see if the medication in the bottle is generic or even the one that is supposed to be there, I will usually get the patient to open the bottle.  My patients — well, several have asked me to dispose of drugs for them, and we can usually find a pharmacy that will help with this for free. Many patients have told me that pharmacies charge for this service. They say it is expensive, and it probably is.  You can’t just throw them in a dumpster or flush them down the toilet – it’s the law.

There are lots of tricky ways to do this – here’s one I thought especially clever.

First, remove all name and prescription information from the bottle, shred and dispose of the label, then pour a little milk into the bottle and seal it. The milk will curdle, dissolving the pills and making the bottle’s contents especially unappealing.

Some public pharmacies have a lock-box where people can drop pill bottles that are no longer needed and the pharmacy will dispose properly of the pills.  This is a safe and secure way, and an easy way if you have access to traveling to the pharmacy.  Call ahead first and ask if they have such a service.

The reason we don’t want to put prescription drugs down a drain — we don’t need manic (or contaminated dead) fish.

We are all so eco-sensitive, we may actually be worrying more about the environment here than we do about what happens when we take psychotropics to the interior environment of our own bodies.