The Limited Role of the Food and Drug Administration's Flush List

EPA regulations prohibit the flushing of hazardous waste pharmaceuticals by healthcare facilities and reverse distributors. In addition, EPA strongly discourages flushing all waste pharmaceuticals from any source or location (with few exceptions, such as sterile water and saline solution). This recommendation against flushing pharmaceuticals includes households, except in the relatively rare situation when a drug take-back option is not readily available and when households are specifically directed by FDA guidance to flush certain potentially dangerous drugs down the toilet (as noted on pharmaceutical packaging) to help ensure that they are not misused or accidentally ingested or touched.

The list of potentially dangerous drugs that FDA maintains, is frequently referred to as FDA’s “Flush List.” It is important to note the limited role of FDA’s Flush List:

• The FDA Flush List consists of only 13 active pharmaceutical ingredients (10 of which are opioids) that are placed on the list because they can be lethal in low doses, and

• The FDA Flush List is only intended for households where children or pets may access the medicines if they are placed in the household trash. And even for items on the FDA Flush List, FDA’s primary recommendation is to use a take-back program. 

Instead of flushing, both EPA and FDA recommend that households follow these guidelines for disposing of unwanted household medicines (in order of preference):

1. Use a drug take-back event or program, or mail-back envelope, whenever available.
2. If a drug take-back option is NOT available and if the drug is NOT on the FDA flush list, dispose of unwanted medicine in household trash, after mixing them with an unpalatable substance such as dirt, cat litter, or used coffee grounds and placing in a sealed container.
3. If a drug take-back option is NOT available and if the drug is on the FDA flush list, flush the unwanted medicine down the toilet.