Groups differ on how to dispose of medications

Medical Matters

April 27, 2007|By Judy Foreman | Judy Foreman,Special to the Sun

How should I dispose of unneeded or expired medicines?

That depends on whom you ask.

Last year, for instance, the Harvard Heart Letter, a publication of Harvard Medical School, said neither flushing old drugs down the toilet nor putting them in the trash was a good method, because people and animals can get into the trash and drugs flushed away might end up in the water supply.

But this year, the White House Office of National Drug Control Policy contradicted much of that with new guidelines telling people to throw old medicines in the trash.

It suggested mixing leftover drugs with undesirable substances like coffee grounds or kitty litter (it did not specify whether the kitty litter should be used or unused) and putting the result into containers so drugs could not be "diverted" to unsavory use.

The federal guidelines also said some drugs should be flushed down the toilet, among them painkillers like Actiq and Duragesic Transdermal patches. But that's anathema to environmentalists.

"We recommend not flushing any [medications] down the toilet," said Athena Bradley, a projects manager at the Northeast Recycling Council, a nonprofit group with 10 member states. Instead, the group advocates community "take-back" centers or events that allow people to bring unused drugs to collection centers, an approach the government also likes.

Whatever you do, don't try to return controlled substances such as the sleeping pill Ambien to a pharmacy, said Karen Ryle, supervisor of outpatient pharmacy at Massachusetts General Hospital. Pharmacies are not allowed to accept them because of rules on how drugs should be destroyed and accounted for.

Are injectable joint lubricants an alternative to knee surgery?

They seem to help with knee pain, but only to a limited extent, for a limited time and in certain patients.

Injections can delay knee replacement surgery for as long as a year or two, said Dr. Donald T. Reilly, an attending orthopedic surgeon at New England Baptist Hospital in Boston. That's a decided advantage since artificial knees, like real ones, eventually wear out, he said.

And the injections "seem to help" if osteoarthritis caused by wear and tear on a joint isn't too severe. They're not designed for rheumatoid arthritis.

Unfortunately, "the science behind this is not great," Reilly added. "The actual mechanism of the supplements is not clear."

The injections seem to boost one of the constituents of synovial fluid, hyaluronic acid, but not other components.

The medications, with names like Synvisc, Orthovisc and Hylan G-F20, are supposed to supplement the thick or viscous synovial fluid found in normal knees for lubrication and cartilage nourishment. They can cost several hundred dollars for a series of three or more injections and may not be covered by insurance.

Overall, the benefits appear to be modest, said Dr. Paul Romain, chief of rheumatology at the Cambridge Health Alliance. But the injections are worth asking about, he said, if you are unable to have surgery.

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