Prescription Drug Policy

In North Carolina Operation Medicine Cabinet is leading the charge for safe disposal of unwanted medication. Operation Medicine Cabinet is a statewide initiative for establishing a consistent statewide public health message regarding the safekeeping and safe disposal of Rx and over the counter drugs in North Carolina. Much attention has been focused in local communities concerning Rx drug misuse and abuse.  NC Operation Medicine Cabinet brings to the forefront the environmental effects of this issue in our natural waters, and in turn, the environmental impacts to our water systems. Both issues, environmental and substance abuse, ultimately impact the health of our children and the communities in which they live. The following is from the Operation Medicine Cabinet Fact Sheet.  To learn more or to get involved contact OPERATION MEDICINE CABINET.



  • The average North Carolinian fills 14 prescriptions annually, adding up to over 128 million prescriptions each year:  Health Costs & Budgets
  • 40% of prescription drugs dispensed are never used, leaving most people with several bottles of unused drugs in their homes.
  • In 2004, the USGS identified 100 different pharmaceuticals in surface water, including acetaminophen, caffeine, codeine, antibiotics and warfarin (a common blood thinner). They also found that an antibiotic, a drug used to treat bipolar disorder and nicotine had contaminated aquifers.
  • Most recently, an AP investigation found pharmaceuticals in the drinking water supply of 41 million Americans.

Improper Disposal

  • In a recent survey, 89% of respondents disposed of medications in the garbage or flushed medications down the toilet or sink, a practice which can lead to water contamination. Many health-care professionals tell patients to flush unused drugs and flush medications themselves. The AP estimated that at least 250 million pounds of pharmaceuticals are flushed by health care facilities every year. One of the two methods of drug disposal advocated by the North Carolina Board of Pharmacy Investigations and Inspections is flushing into sewer systems.
  • Current federal guidelines recommend that consumers dispose of medication through a drug take-back or household hazardous waste programs if available (not in NC).

Health Dangers

  • In North Carolina, poisonings are the second leading cause of unintentional injury deaths and prescription and non-prescription pain medicines (analgesics) were the most frequently involved substances in poisoning exposures.
  • The 2007 North Carolina State Risk Behavior Survey indicated that 25 percent of high school students in Western North Carolina reported having used prescription drugs recreationally at least once. Nationwide, teens abuse prescription drugs more than any other drug, except marijuana. 70% of prescription drug abusers report they get them right out of the medicine cabinets of family or friends.
  • Important that unused drugs are promptly disposed of in a safe, environmentally-friendly manner. No method currently exists.

Environmental Effects

  • Our rivers and streams are particularly vulnerable to impacts from pharmaceutical contamination because aquatic species’ exposure is constant and occurs during crucial developmental life stages. Such contamination has been found here in North Carolina and in over 80% of waterways tested.
  • While the environmental consequences of pharmaceutical contamination is only beginning to be investigated, researchers found that exposure to small amounts of drugs commonly found in waterways caused indicator species like earthworms and zooplankton to die.
  • Studies have linked reproductive problems in fish and frogs to pharmaceutical hormone exposure. In a USGS study of 9 river basins the percentage of intersex largemouth bass per site ranged from 8 to 91 percent nationally and was most prevalent in the southeastern United States. The Pee Dee River at Bucksport, S.C., contained the highest percentage of intersex fish (91 percent), with high percentages occurring elsewhere in the Yadkin-Pee Dee basin in North and South Carolina.
  • Pharmaceutical hormones are also linked to a lowered immune response in fish, causing large numbers of fish to die off in the Potomac and Shenandoah Rivers. Other pharmaceuticals appear to be increasing mussel mortality, inducing reproduction in certain shellfish and stunting the growth of snails.

Potential Policy Changes

  • Support Collection Events
  • Outlaw dumping of drugs by hospitals, enact fine for those caught dumping.
  • Apply for DEA exemption to have drop-boxes at pharmacies
  • Install drop-boxes at law enforcement offices (no DEA exemption required)
  • NCDA&CS applied for DEA exemption to take controlled substances at Household Hazardous Waste Collection Days (3 years ago). Still waiting.

Path to Policy Change

  • Build partnerships. Develop informational campaign covering human and enviro risks.
  • Provide information to community and health care providers/pharmacists on proper storage and disposal.
  • Hold collection events. Events draw media, political and community attention to issue.
  • Build consensus among stakeholders for policy ask

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