Medications Never to Put in Household Trash: A Safety List

Putting old pills in the trash might seem harmless-until it isn’t. Every year, children, teens, and even adults accidentally-or intentionally-take medications they find in household bins. The results can be deadly. The flush list from the U.S. Food and Drug Administration (FDA) exists for one reason: to stop preventable deaths. These aren’t just guidelines. They’re lifesaving rules for specific drugs that can kill in a single dose.

Why Some Medications Must Be Flushed

Not all expired or unused medications need to go down the toilet. But for certain powerful drugs, flushing is the only safe option. The FDA’s flush list includes medications that are highly addictive, easily abused, and deadly in small amounts. These aren’t your typical painkillers or antidepressants. These are drugs like fentanyl patches, oxymorphone tablets, and methadone-substances so potent that a single patch or pill can stop someone’s breathing.

The CDC reported over 107,000 drug overdose deaths in the U.S. in 2021. Nearly 70% of those involved opioids. Many of those deaths didn’t come from users themselves-they came from kids finding a patch in the trash, a teenager grabbing a bottle from a neighbor’s bin, or someone stealing pills from a discarded container. The FDA’s flush list was created because the risk of accidental exposure outweighs the environmental risk of flushing.

The Exact Medications on the FDA Flush List

Here’s the full list of medications that must be flushed immediately, not thrown away:

• Any product containing buprenorphine (BELBUCA, BUAVAIL, BUTRANS, SUBOXONE, SUBUTEX, ZUBSOLV)
• Any product containing fentanyl (ABSTRAL, ACTIQ, DURAGESIC, FENTORA, ONSOLIS)
• Hydromorphone (EXALGO)
• Meperidine (DEMEROL)
• Methadone (DOLOPHINE, METHADOSE)
• Morphine (ARYMO ER, AVINZA, EMBEDA, KADIAN, MORPHABOND ER, MS CONTIN, ORAMORPH SR)
• Oxymorphone (OPANA, OPANA ER)
• Tapentadol (NUCYNTA, NUCYNTA ER)
• Sodium oxybate (XYREM, XYWAV)
• Diazepam rectal gel (DIASTAT, DIASTAT ACUDIAL)
• Methylphenidate transdermal system (DAYTRANA)

These aren’t random picks. Each one has been proven to cause death from a single exposure. Fentanyl, for example, is 50 to 100 times stronger than morphine. A patch meant for chronic pain can kill a child who doesn’t even know what it is. The FDA doesn’t say flush everything. They say: flush only these.

What to Do With Everything Else

If your medication isn’t on the flush list, don’t flush it. Don’t toss it in the trash either-unless you follow the right steps. The FDA’s safe disposal method for non-flush drugs is simple:

1. Take the pills or liquid out of their original bottles.
2. Don’t crush tablets or capsules-just leave them as they are.
3. Mix them with something unappetizing: used coffee grounds, kitty litter, or dirt.
4. Pour the mixture into a sealable plastic bag or container.
5. Throw it in your household trash.

This makes the drugs unappealing and hard to recover. It’s not perfect, but it’s the safest option if you don’t have access to a take-back program. Never pour pills down the sink or toilet unless they’re on the flush list. That’s when you create environmental harm without preventing harm to people.

Why Flushing Isn’t the Environmental Nightmare You Think

You’ve probably heard that flushing meds pollutes waterways. That’s true-for most drugs. But the FDA’s position is clear: for these specific medications, the risk to human life is far greater than the risk to aquatic life.

Studies show wastewater plants remove only 30-90% of pharmaceuticals. Some, like carbamazepine, barely get filtered at all. But here’s the key: the amount of fentanyl or methadone flushed from a single patch is microscopic compared to the number of lives saved by keeping it out of trash bins.

Dr. John Scott from the EPA put it plainly: the environmental impact of flushing one fentanyl patch is negligible compared to the potential for multiple fatalities if that same patch ends up in a child’s hands. The EPA and FDA both agree: for these 11 medications, the toilet is the safest place.

Real Stories Behind the Rules

A mother in Ohio found her 8-year-old son unconscious after he chewed on a fentanyl patch she’d thrown in the trash. He survived, but barely. A teenager in Minnesota died after finding a bottle of oxymorphone in a neighbor’s recycling bin. These aren’t rare cases. The American Association of Poison Control Centers recorded over 8,900 single-exposure cases involving fentanyl in 2022-42% of them in children under five.

In one heartbreaking case, a pharmacy technician shared that a patient’s 12-year-old granddaughter had taken two doses of methadone from a trash bag. She was rushed to the hospital in cardiac arrest. The grandmother didn’t know she was supposed to flush it. She thought she was doing the right thing by throwing it away.

These stories aren’t outliers. They’re why the flush list exists.

What You Can Do Right Now

1. Check your medicine cabinet. Look for any of the 11 medications on the flush list. If you find them, don’t wait. Flush them now.

2. For everything else, mix with coffee grounds or kitty litter, seal it in a bag, and toss it in the trash.

3. Find a take-back location. Many pharmacies, police stations, and hospitals have drop-off boxes. Walgreens and CVS have over 3,800 kiosks across the U.S. You can search for one near you through the DEA’s website.

4. Ask your pharmacist. If you’re unsure whether a medication belongs on the flush list, ask. Most pharmacists know the list by heart. Don’t guess.

5. Teach others. Share this with family, friends, and neighbors. Especially those with elderly parents or teens at home.

The Bigger Picture

The problem isn’t just about disposal-it’s about how we treat powerful drugs. Many people don’t realize that unused prescriptions are a public safety issue. The Secure and Responsible Drug Disposal Act of 2010 was passed because of cases just like these. Now, manufacturers are required to fund take-back programs. Some pharmacies even give out free disposal kits-powder packets that turn pills into gel when mixed with water.

But the most effective tool is still awareness. If you know which drugs to flush and which to mix with coffee grounds, you’re already helping prevent a tragedy.

What’s Changing Soon

New legislation like the SNIPED Act, introduced in 2023, would require doctors to give disposal instructions with every prescription for Schedule II drugs. Some states are already requiring special packaging-like envelopes with activated charcoal-to reduce improper disposal by over 60%.

The market for safe disposal products is growing fast. But until every pharmacy has a drop box and every household knows what to do, your actions matter. Flushing the right meds. Mixing the rest. Teaching others. These small steps save lives.