This Saturday, October 24, is the next National Prescription Drug Take-Back Day. These events are held to provide a safe, convenient, and responsible way to dispose of unused or expired medications. The scheduled times are from 10 am to 2 pm. To keep everyone safe, all collection sites will follow local COVID-19 guidelines and regulations.
National Take-Back Days are held twice annually, usually occurring in the spring and the fall. The first event was held in 2010 and four days following this event, Congress approved legislation amending the Controlled Substances Act and provided the DEA with the authority to make this event permanent, allowing people a safe way to dispose of extra medication.
Last fall, Americans turned in nearly 883,000 pounds of prescription drugs at nearly 6,300 sites operated by the DEA and almost 5,000 of its state and local law enforcement partners. DEA, along with its law enforcement partners, has now collected nearly 6,350 tons of expired, unused, and unwanted prescription medications since the inception of the National Prescription Drug Take-Back Initiative in 2010.
Included in the list of take-back items are e-cigarette products and vaping devices. The change is one of the steps the DEA is making to help with vaping health issues being reported across the country. On the official Drug Take-Back website, e-cigarettes and vaping devices are listed under "paraphernalia."
There are a number of reasons why disposing of medications is important. Without a doubt, the opioid epidemic has certainly driven much of this but there are other medications that are in a senior’s medicine cabinet that can also be abused and are being done so, often right under the nose of the family because most are only aware of the dangers of opioids. Let’s look at these.
We all are painfully aware of the dangers of this class of drugs. These medications include codeine, hydrocodone (Vicodin), morphine (MS Contin), oxycodone (Oxycontin and Percocet), hydromorphone (Dilaudid), and fentanyl (Duragesic).
Opioids are prescribed to treat pain. With prolonged use, pain-relieving effects may lessen and pain can become worse. In addition, the body can develop dependence. Opioid dependence causes withdrawal symptoms, which makes it difficult to stop taking them and abuse can cause other medical issues for seniors.
Beyond the dangers of addiction, opioids can pose serious risks for seniors. Common side effects include constipation, breathing problems, confusion, and problematic interactions with other medications. Seniors taking opioid medications are also four to five times more likely to suffer a fall or fracture than those taking non-opioid pain medication.
The most common medications prescribed in this class are alprazolam (Xanax), diazepam (Valium), clonazepam (Klonopin), and lorazepam (Ativan).
Benzodiazepines act on the central nervous system, produce sedation and muscle relaxation, as well as lowering anxiety levels. According to WebMD, more than 2,000 different benzodiazepines have been produced, only about 15 are currently FDA-approved in the United States. They are usually classified by how long their effects last.
The abuse of benzodiazepines is partially related to the toxic effects that they produce and also to their widespread availability. They can be chronically abused or, as seen more commonly in hospital emergency departments, intentionally or accidentally taken in overdose. Death and serious illness rarely result from benzodiazepine abuse alone since overdoses tend to occur when mixing with alcohol or other medications. The combination of benzodiazepines and alcohol can be lethal. Benzodiazepine abuse can also cause symptoms similar to dementia in older people and can result in a misdiagnosis.
The Z-drugs, which include Lunesta, Ambien, and Sonata, are benzodiazepine receptor agonists. That means they work in a similar way to the benzodiazepine drugs inside the brain and are prescribed for insomnia.
The non-benzodiazepine “z-drugs” were developed to have the same medical effect as benzodiazepines without the same hazardous and habit-forming properties those drugs are known for. The makers of these drugs designed and marketed them as a less addictive alternative to benzos for people with acute insomnia.
The physical dependence on "z-drugs" can form in as little as two weeks, whether the user is following a prescription or abusing the drug. This dependence is characterized by tolerance, whereby the user requires larger amounts of the medication to feel the same effect, and withdrawal symptoms will appear if the user stops taking the drug or reducing their dosage.
These drugs are rarely prescribed for seniors but are used to treat attention-deficit/hyperactivity disorder (ADHD) and certain sleep disorders such as narcolepsy. The most common medications prescribed are methylphenidate (Ritalin, Concerta, others), amphetamine (Adderall XR, Mydayis), and dextroamphetamine (Dexedrine).
Although there is a molecular distinction between amphetamines (such as Adderall) and methylphenidates (such as Ritalin), the effects of abusing these stimulants are essentially the same. Patients are prescribed either amphetamines or methylphenidates depending on the potency and duration needed.
Because the above medications are the most commonly abused prescription drugs does not mean they are the only ones that can be abused by seniors or their loved ones who may find them in the medicine cabinet. Let's look at some more.
Centrally acting skeletal muscle relaxants are also potential drugs of abuse. Although skeletal muscle relaxants are rarely the primary drug of abuse, they are often used along with other central nervous system depressants, such as narcotics or alcohol. The major toxic effects are respiratory depression and coma.
The most popular drugs in this class are carisoprodol (Soma) and cyclobenzaprine (Flexeril). Soma’s ability to be addictive is well known, as is its tendency to be combined with opiates and benzodiazepines for a heroin-like high. This combination has its own street name, the Houston Cocktail because this combination was common in the Houston area. Flexeril is also a drug of abuse and is addictive.
Psychotropics (Psychiatric Meds)
Although it seems like an odd choice for abuse, there are many psychiatric medications that can be abused, mostly by those with an existing habit. One of the most popular is Seroquel, prescribed for those with mood disorders. Those who abuse it tend to do so for its calming effects or to ease the discomfort of withdrawal or the side effects of illicit drug use.
Seroquel is a prescription atypical antipsychotic medication used in the treatment of disorders like depression, bipolar disorder, and schizophrenia. Over a one-year period of time, American doctors wrote more than 54 million prescriptions for antipsychotics like Seroquel according to prescribing records.
Known as Susie Q, Squirrel, Quell, and baby heroin on the street, many of those who abuse Seroquel will crush and snort the drug. Others will dissolve Seroquel into water-based solutions and inject it intravenously. This multiplies the risk of dangerous outcomes. The potential for overdose is greater in these cases as well.
Barbiturates are some of the most addictive substances on earth. Although individuals of high school age or younger abuse these drugs, they are more commonly prescribed to older people versus younger people and can be found in their medicine cabinets.
Barbiturates prescribed may have the following names: amobarbital (Amytal), secobarbital (Seconal), butabarbital (Butisol), pentobarbital (Nembutal), phenobarbital (Donnatal), combinations include butalbital/acetaminophen/caffeine (Esgic, Fioricet), and butalbital/aspirin/caffeine (Fiorinal Ascomp, Fortabs).
Barbiturates are a class of drugs known as sedative-hypnotics, which generally describes their sleep-inducing and anxiety-decreasing effects. These drugs can be extremely dangerous because the correct dose is difficult to predict. Even a slight overuse can cause coma or death. Barbiturates can also cause a life-threatening withdrawal syndrome.
Gabapentin (Neurontin) is an anticonvulsant that comes in a capsule, tablet, and oral solution. These medications are often used to manage certain seizure disorders, as well as the neuropathic pain phenomenon known as post-herpetic neuralgia (lasting nerve and skin pain caused by an attack of shingles) and comes in an extended-release formulation of gabapentin (Horizant) is used to treat restless leg syndrome (RLS).
Like opiates, there has been a marked increase in gabapentin overdoses attributed to the increase in prescribing this medication in the place of opiates to manage some types of pain. Unlike opiates, there is no antidote that you can administer in the case of an overdose. Because this drug has a very long half-life*, immediate medical attention is necessary to manage the complications associated with a toxic amount of this drug.
Expiration and Potency
One of the other concerns about other medications sitting in the cabinet is the potency of the drug. Although research seems to indicate that this is less of a problem than first thought (a research study in 2012 by the Journal of the American Medical Association found that many medications, even four decades past their expiration date, retained their potency), this is a matter that continues to be debated.
But what is of no debate is that many seniors will “save” medications that are not used in order to treat similar symptoms in the future in an attempt to manage limited financial resources. The problems with this are obvious, the symptoms that are presenting may not be the same illness or condition for which the medications were prescribed. Also of concern is that medications currently being used since the original prescription was written may be different, resulting in the potential for serious and perhaps deadly drug interactions.
When it comes to concerns about using leftover drugs in the medicine cabinet, none have sparked concerns more than the overuse of antibiotics and the long term impact of this on infections developing a resistance to these medications. Although most view these drugs as harmless or even "fix-alls", taking antibiotics without medical advice can have potentially dangerous outcomes.
Using antibiotics when they are not indicated can lead to more serious illnesses and antibiotic resistance resulting in the growth of dangerous bacteria that can no longer be treated effectively by many of the most commonly prescribed medications.
Overusing antibiotics can result in the elimination of “good bacteria” in the gastrointestinal tract and cause diarrhea and yeast infections. And because seniors have weaker immune systems or for those with compromised immune systems, the development of an extremely dangerous infection called C. difficile or C-diff can occur. This is a bacterium that can cause symptoms ranging from explosive diarrheal episodes to life-threatening inflammation of the colon. Severe C. difficile infection may also cause enlargement of the colon (also called toxic megacolon) and sepsis.
C. difficile is extremely contagious and spreads mainly on hands from person to person, but in a hospital or nursing home setting can be found on cart handles, bedrails, bedside tables, toilets, sinks, stethoscopes, thermometers — and even telephones and remote controls.
Disposal of Medication
As stated earlier, this event occurs twice annually, but it is good practice to dispose of any medication that is no longer needed or may have expired. At one time, flushing meds was considered an appropriate way to do this but today, many municipalities have outlawed this practice due to environmental concerns.
Here are simple steps to dispose of medications in a safe and environmentally friendly manner:
Mix the medicines (do not crush tablets or capsules) with an unpalatable substance such as dirt, kitty litter, or used coffee grounds. This prevents the diversion of medicines from the trash.
Then, place the mixture in a container such as a zip-lock or sealable plastic bag, and throw the container away in your household trash.
Remove the label and/or scratch off all personal information on the label when disposing of a prescription vial.
Take advantage of pharmacy “take-back” programs or solid waste programs to dispose of unused or expired medicines.
Remember, keeping medicines after they are no longer needed creates an unnecessary health risk in the home, especially if there are young children or teenagers present. Even with child-resistant containers, remember the operating word here is resistant and not child-proof, problems can and do occur. In a study that looked at cases of accidental child exposure to a grandparent’s medicine, 45% of cases involved medicines stored in child-resistant containers.
So we urge you to take advantage of the event this Saturday and dispose of these medications for the safety of all concerned.
Don Drake is the behavioral health presenter for Connelly Law Offices, Ltd.'s Community Education Series. He is a retired licensed clinician (LADCI) in the Commonwealth of Massachusetts and has over thirty years of providing staff and community training in human services and correctional issues, licensing preparation, program and organizational development, and curriculum development. He has served as Program Director, Administrator, and clinical trainer at facilities in Boston, Hartford, Providence, and Philadelphia where he supervised and trained staff in providing behavioral and addictions treatments to adolescent, adult, and senior clients, including those with HIV/AIDS. He has worked as a trainer for the Massachusetts Department of Public Health presenting the Question, Persuade and Refer (QPR) Suicide Prevention training, the Massachusetts Council on Compulsive Gambling, a non-profit health agency dedicated to reducing the social, financial, and emotional costs of a gambling disorder and as a certified trainer for the Crisis Prevention Institute, an international training organization that specializes in the safe management of disruptive and assaultive behaviors and was also a Certified Hepatitis C Educator with the Commonwealth of Massachusetts. His email address is firstname.lastname@example.org.