If you have old or expired medicines at home, think twice before throwing them away. India’s drug regulatory agency has issued new guidelines to help the public safely dispose of unused medicines. The guidelines recommend flushing certain drugs down the sink or toilet to prevent accidental harm to others, including pets.

The “flush list" includes 17 drugs, primarily powerful opioids and controlled substances such as fentanyl, fentanyl citrate, morphine sulfate, buprenorphine, diazepam, tramadol, methadone hydrochloride, and oxycodone. These substances can be fatal even in small doses if misused. They are typically used under medical supervision for pain management, mental health, or neurological disorders and carry a high risk of addiction, misuse, or accidental overdose, necessitating special disposal precautions.
“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 document states. It provides a list of expired, unwanted, or unused medicines containing specific active ingredients that the public should flush down the sink or toilet to prevent danger to people and pets at home.
 

The 15-page guidance document includes directives for a select group of medicines that are particularly dangerous if accidentally ingested by someone other than the prescribed user. These medicines are listed under the “flush list," and the public is advised to flush these drugs to prevent accidental harm. This list is dynamic and may be updated periodically based on emerging risks and safety data.

To assist the public in disposing of expired drugs, state drug control departments and local chemists and druggists’ associations are encouraged to launch “drug take-back programmes". These initiatives will establish designated sites where citizens can safely drop off old medications. The collected drugs will be responsibly disposed of by registered external agencies under the supervision of the state drug licensing authority.

“Unscientific disposal of unused or expired drugs is considered one of the primary reasons for environmental pollution," the document explains. Initially, state drug control departments and concerned chemists and druggists’ associations may jointly launch drug take-back programmes at designated locations where people can drop off expired or unused drugs from their homes. These drugs will then be disposed of by the associations, with notification to the state drug licensing authority and with the help of registered or licensed external agencies under the Biomedical Waste Management Rules, 2016.
 

These steps are significant in combating pharmaceutical pollution and ensuring public safety, responding to growing concerns over the environmental impact of improper drug disposal. According to the guidance document released by the Central Drugs Standard Control Organisation (CDSCO), unscientific disposal of expired drugs is a key contributor to environmental pollution.

“The safe and proper disposal of expired/unused medicines is crucial for protecting the environment and public health. Improper disposal of these drugs may be hazardous to public health, animal health, and the environment. It is also a significant factor in the growth of antimicrobial resistance (AMR)," Rajeev Singh Raghuvanshi, the drug controller general of India (DCGI), wrote to states and union territories while introducing the guidelines.