Not in the bin, down the drain: Why India’s drug regulator wants you to flush these 17 expired medicines immediately

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India’s apex drug regulatory body has issued an urgent appeal to the public: flush certain expired or unused medicines down the toilet instead of throwing them in the trash. The Central Drugs Standard Control Organisation (CDSCO), in its newly released Guidance Document on Disposal of Expired/Unused Drugs, has flagged a list of 17 high-risk medicines that could seriously harm or even kill people or animals if misused.

The list includes powerful prescription drugs such as tramadol, tapentadol, diazepam, oxycodone, and fentanyl – commonly used for managing pain, anxiety, and related conditions. These drugs, the regulator warns, are especially dangerous if used by someone other than the person for whom they were prescribed.

These medicines “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 CDSCO said, according to PTI.

Why flushing, not trashing?

According to the CDSCO, disposing these drugs in household bins is not only ineffective – it can be life-threatening. Children, pets, or even waste pickers may accidentally consume them, while unsecured landfills may allow the drugs to be diverted or misused.

“Improper disposal of expired/unused drugs is detrimental to human, animal and environment and may be hazardous if it leads to contamination of water supplies or local sources used by nearby communities or wildlife. Expired drugs may come into the hands of scavengers and children if a landfill is insecure,” the guidance document stated, as per PTI.

“Pilfering from a stockpile of waste drugs or during sorting may result in expired drugs being diverted to the market for resale and misuse,” it added.

What are expired and unused drugs?

The CDSCO explains that expired drugs are those that have crossed the expiry date on the label, while unused drugs are medications that were prescribed but never taken.

“Most pharmaceuticals past their expiry date become less efficacious and a few may develop a different adverse drug reaction profile. There are some categories of expired drugs or defective disposal practices that carry a public health risk,” the CDSCO warned.

Protecting public health and the environment

The document outlines that safe disposal of medicines is crucial for protecting public health, animals, and the environment, especially with growing concerns over antimicrobial resistance and pharmaceutical contamination of soil and water.

“Ensuring the quality, safety and efficacy of these products is a critical aspect which contributes significantly to strengthening the assurance in public health system, including healthcare professional and other stakeholders,” the CDSCO noted.

“Improper disposal of expired/unused drugs may be hazardous to public health, animal health and environment,” it added.

Drug take-back programs and state coordination

To offer a safer alternative to household disposal, the CDSCO has urged state drug control departments and chemists' associations to set up ‘Drug Take-Back’ programmes. These will allow the public to drop off expired or unused medicines at designated sites for proper disposal.

“The objective of this guidance document is to provide clear and comprehensive instructions in accordance with the Drugs and Cosmetics Act and Rules and other laws as applicable for the safe disposal of expired and unused drugs,” CDSCO said.

The guidance also aims to “achieve the compliance with legal requirements and minimise environmental impact and mitigate public health risk, including antimicrobial resistance.”