Photos go to relatives and the knickknacks might go to a garage sale, but who wants to deal with the array of unused pills when grandma passes away?
Some politicians do.
In the last year, state legislators across the country have proposed bills aimed at curbing the disposal of unused medication. Colorado, Maine, Minnesota, Maryland and Washington have all proposed legislation that in one way or another tries to address the issue ofmedicines that end up in landfills and watersheds every year.
Bills in some states, such as Colorado, want nursing homes to be free to donate the unused medication to charities that help developing countries. Bills in other states attempt to divert unused medication back to manufacturer -- and are facing resistance from pharmaceutical companies.
But whoever is fighting over the unused medicine, all involved hope that no one flushes them down the toilet.
"Probably about 50 percent of the medications that are sent to my nursing home from the pharmacy end up having to be destroyed," said Maxine Roby, an administrator at Rowan Community -- a 66-bed nursing home facility in Denver, Colo.
Roby said the waste at her nursing home is not unusual. In fact, by regulation it's often unavoidable. When a doctor writes a prescription at a nursing home, the pills aren't dispensed as they would be from a local pharmacy.
The pills are shipped from the pharmaceutical company on 30-day supply cards -- each pill snugly in its own "bubble" so the nurse can pop it out. But, Roby explained, if a patient has a bad reaction to the medicine after one day and stops taking it, or even passes away, nurses are required to get rid of the whole card.
"They [pharmaceutical manufacturers] will not take the drugs back, I don't even know why. Once they give it to us, where stuck with them," said Roby.
"A lot of people would just flush them," said Roby. But "we were notified by the Denver Water board, that they have no way to filter medications out of the drinking water."
Since water treatment plants across the country have no way of filtering out pharmaceutical waste -- which can come from bodily fluids as well as unused medicine -- more and more environmental groups are encouraging people to dispense of the medication in the trash and hospitals to incinerate leftover medicine.
To Donate or Flush?
The home alternative to flushing is to follow the U.S. Environmental Protection Agency guidelines. Mixed unused medication with something unsavory -- like kitty litter -- to keep it away from animals and seal it in a container for the landfill so it does not dissolve and leach into groundwater.
"That's a big issue. That's why they're telling people put your medicine in kitty litter, or in coffee grounds and throw them away," said Colorado Democratic state Senator Lois Tochtrop who co-sponsored the bill, HB 10-1061, Colorado Medical Donation Program.
Tochtrop had no clear estimation of exactly how much medication could be saved through his bill. Few estimates of how much medical waste is generated have even been done. A 2009 investigation by The Associated Press estimated that at least 250 million pounds of pharmaceuticals and contaminated packaging is generated in medical facilities each year.
Tochtrop noted whatever medicine is saved, will go not only to international charities such as Project Cure, but also local ones.
"The need is endless in the developing world. One of the largest things they ask for is medications, and it's the hardest to ship," said George Roberge, vice president of operations at Project Cure.
Of course not all medicines can be donated, even from nursing homes where packaging would make it easier to safely keep medicine. Roberge noted that Project Cure can't accept open packaging, liquids, expired medicine, narcotics or even medicine that's is not expired but that stayed at a nursing home longer than a year.
But Tochtrop and Roby, who testified before the state legislature in support of the Colorado bill, think every little bit will help.
The medicines that are thrown away, "are going to our landfills then those medications will leach into our ground water eventually," said Tochtrop.
But across the country in Maine, a measure meant to reduce medical waste is shaping into a bit of a public debate about the dangers in landfills.
What About the Take Back Approach?
Often called "take back" programs, state legislators in Maine, Minnesota and Washington are proposing, the medicines from homes (not nursing homes) should be the responsibility of pharmaceutical companies. Rather than encouraging citizens to flush unused medications or throw them away, the waste could be picked up along with other hazardous waste such as mercury, and disposed of at the pharmaceutical companies' expense.
The Pharmaceutical companies are resisting this kind of legislation. "We know that it [unused medicine] does not leech from landfills," said Marjorie Powell, senior assistant general counsel for Pharmaceutical Research and Manufacturers of America, PhRMA.
PhRMA has come out in opposition to many of the bills that require pharmaceutical companies be responsible for the disposal of unused medications. However, Powell said that PhRMA began looking into the fate of unused medication years ago.
"When PhRMA learned that there were trace amounts of compounds in [water] we were approached by the U.S. Fish and Wildlife Service," said Powell. "They said 'why are these there?', and we said we think it's because people have a habit of flushing unused medicine down the toilet."
But, Powell argued rather than having medicine shipped to the pharmaceutical companies for disposal, more public education on how to properly throw away medication would solve environmental concerns.
"We think they (take back programs) cause more environmental harm than they solve, we think they're unnecessary," Powell said of the bills.
However, Scott Cassel, executive director at the Product Stewardship Institute, disagreed with Powell's assertion that dissolved medicine would not leech out of landfills. He also questioned whether having pharmaceutical companies dispose of the medication would be a challenge, since the industry already incinerates leftover medication from pharmacies in private take back programs.
What Really Happens To Unused Medicine?
"Putting it in the trash, in the landfills doesn't mean that it won't get in the water," said Cassel.
The EPA is unsure and has funded a plethora of studies to track pharmaceuticals contamination from hospitals, from farms, and from human waste.
"Recent studies have documented the presence of various pharmaceutical chemicals and metabolic by-products in surface waters and groundwater in the United States, and the issue of pharmaceutical use and management has become increasingly important," the EPA wrote on its Web site in its proposal to add pharmaceuticals to the Universal Waste Rule. "EPA is conducting research on the presence of pharmaceutical compounds in water bodies and any ecological effects the compounds may be causing, as well as research directed towards improving water treatment capabilities."
Cassel said the Product Stewardship Institute has attempted to facilitate talks between state government and pharmaceutical industry representatives to address the problem. He said both sides can agree not to tell people to flush medicine down the toilet.
But, "it's too expensive for the local governments to take it back," Cassel noted. "They feel like they want to do something, they want to protect their citizens but they don't have the funding to do it."
"At this point we got a lot of work ahead of us, I think this bill might have a chance at really making it all the way through," said Maine state Senator Anne C. Perry , a Democrat, who introduced the measure in Maine. "It's still not a definite, and we got a lot of work to do."