If you've got leftover pills _ say, powerful opiates from a recent surgery or antibiotics needed to fight an infection _ chances are a pharmacy employee in California will tell you the right way to dispose of them about half the time.
The rest of the time they're wrong _ dead wrong, a new study concluded.
Improper medication disposal can have deadly or harmful consequences, contributing to antibiotic resistance or poisoning if misused. Published in the Annals of Internal Medicine, the study is the result of a "secret shopper" survey conducted throughout the state between February and April 2019.
Researchers interviewed employees at close to 900 pharmacies in the state to determine how often pharmacists and pharmacy technicians gave consumers the right drug disposal information. The study tested knowledge of U.S. Food and Drug Administration guidelines for getting rid of medications.
They found that 42% provided the correct antibiotic disposal information and 19% provided the correct opioid disposal instructions. Consumers often received better information during weekdays; rural pharmacies performed better than those in urban areas; pharmacists gave accurate information more often than technicians, although only marginally.
"It was not completely surprising that about half gave correct antibiotic information but we were surprised by how few gave correct opioid information," said Dr. Rachel Selekman, the lead author of the study and a pediatric neurologist at Children's National Hospital in Washington DC.
It was also unexpected how few pharmacies offered prescription drug takeback programs, Selekman said. So-called chain pharmacies _ those with 10 or more locations _ gave proper instructions for disposing of opioid drugs about 58% of the time compared to the 66% of independent pharmacies.
"We know that in 2014 these pharmacies were given the ability to take them back safely and we were surprised by how few _ about 1 in 10 pharmacies _ do offer that service," she said.
Attempts to reach officials at the California Pharmacists Association were unsuccessful.
MEDICINE DISPOSAL ADVICE
In an effort to stop prescription drug abuse, federal lawmakers allowed certain pharmacies, hospitals and clinics, among others, to discard unused medicines.
Starting in 2014, the federal law recommended two ways consumers should get rid of unwanted prescription drugs: take them to a dropoff location or, for about a dozen different substances, flush them down the sink or toilet.
The medications on the "flush list" are said to be more harmful if diverted or exposed to others and include many of the most potent opioids like fentanyl and hydrocodone.
Selekman said the FDA's guidelines are a little difficult to understand.
"In order to interpret them carefully, one needs to first look at those guidelines for disposal and then understand that there are some medications that are on this flush list that should be disposed of in a separate fashion and most Schedule II drugs, most opioids, are on that flush list," Selekman said.
"But that requires a separate understanding; one first needs to know what the FDA guidelines are and then separately needs to understand the flush list and what's on that flush list. Perhaps that education needs to be improved upon in order to provide that information correctly."
