Putting old pills in the trash might seem harmless-until it isn’t. Every year, children, teens, and even adults get sick or die because they find unused medications in household trash. The flush list from the FDA isn’t a suggestion-it’s a life-saving rule for 11 specific drugs that must never go in the trash. If you’re unsure whether your medicine belongs on this list, you’re not alone. Most people don’t know the difference between what can be tossed and what must be flushed.
Why Some Medications Must Be Flushed
Not all expired or unwanted medicines are the same. Most can safely go in the trash if you mix them with coffee grounds or kitty litter. But a small group of drugs is so dangerous that even one pill or one patch can kill. These are the ones on the FDA’s flush list. They’re powerful opioids and controlled substances that can stop breathing in minutes if someone takes them by accident-or on purpose. The CDC recorded over 107,000 drug overdose deaths in 2021. Nearly 70% of those involved opioids. Many of those deaths came from people getting pills from friends, family, or trash cans. The FDA created the flush list because trash isn’t secure. A child rummaging through the bin, a teenager looking for a buzz, or someone struggling with addiction can find these drugs and die before help arrives.The FDA Flush List: Exact Medications You Must Flush
The FDA’s list isn’t long, but it’s deadly serious. If your medicine contains any of these active ingredients, flush it immediately-don’t wait, don’t mix it, don’t throw it away:- Buprenorphine (brands: SUBOXONE, SUBUTEX, BELBUCA, BUTRANS)
- Fentanyl (brands: DURAGESIC, ABSTRAL, ACTIQ, FENTORA)
- Hydromorphone (brand: EXALGO)
- Meperidine (brand: DEMEROL)
- Methadone (brands: DOLOPHINE, METHADOSE)
- Morphine (brands: MS CONTIN, KADIAN, EMBEDA, MORPHABOND ER)
- Oxymorphone (brands: OPANA, OPANA ER)
- Tapentadol (brands: NUCYNTA, NUCYNTA ER)
- Sodium oxybate (brands: XYREM, XYWAV)
- Diazepam rectal gel (brands: DIASTAT, DIASTAT ACUDIAL)
- Methylphenidate transdermal system (brand: DAYTRANA)
What Happens If You Don’t Flush?
Real stories show why this isn’t theoretical. In 2023, a 3-year-old in Florida pulled two fentanyl patches from the trash and stuck them to his skin. He went into respiratory arrest. He survived, but only after two days in the ICU. The same year, a 16-year-old in Ohio found OPANA ER pills in a neighbor’s trash. He died within an hour. His parents didn’t know those pills couldn’t be thrown away. The American Association of Poison Control Centers logged over 8,900 cases of fentanyl exposure in 2022. Nearly half involved kids under five. These aren’t statistics-they’re parents’ worst nightmares. And they’re preventable.What About the Environment? Isn’t Flushing Bad for Water?
Yes, flushing medicine can end up in waterways. Studies show wastewater plants remove only 30-90% of pharmaceuticals. Some, like carbamazepine, barely get filtered at all. Fish in rivers show hormonal changes from trace drugs. Drinking water has been found to contain traces of antidepressants and painkillers. But here’s the catch: the EPA and FDA agree that for these 11 drugs, the risk of death from accidental exposure is far greater than the risk from environmental contamination. Dr. John Scott from the EPA told Congress in 2022: “The environmental impact of flushing one fentanyl patch is negligible compared to the potential for multiple fatalities if it’s left in the trash.” Think of it like this: you don’t throw gasoline in the trash. You take it to a hazardous waste center. These drugs are the pharmaceutical equivalent. Flushing them is the least bad option when the alternative is a child dying.
What Do You Do With Other Medications?
If your medicine isn’t on the flush list, don’t flush it. Instead, follow the FDA’s trash disposal method:- Take pills or liquids out of their original bottles.
- Mix them with something unappetizing-used coffee grounds, cat litter, or dirt.
- Put the mixture in a sealed plastic bag or container.
- Throw it in your household trash.
Best Alternative: Take-Back Programs
The safest way to get rid of any medicine-flush list or not-is through a take-back program. Walgreens has over 2,000 disposal kiosks. CVS has nearly 1,800. Many police stations, fire departments, and pharmacies have drop boxes. Minnesota alone has over 300 locations. In Florida, you can find drop boxes at pharmacies in Tampa, Orlando, and Jacksonville. These programs are free, secure, and environmentally responsible. They collect everything: opioids, antibiotics, antidepressants, even controlled substances. If you’re not sure where to go, visit the DEA’s website (or call your local pharmacy). They’ll tell you the nearest drop-off point. No need to drive far-many are in grocery stores or gas stations.Why So Many People Get It Wrong
A 2022 study found only 43% of patients could correctly identify which medicines needed flushing. Most people think everything should go in the trash. Others hear “flushing is bad for the environment” and assume that applies to all drugs. Pharmacists say patients often ask: “Can’t I just mix it with kitty litter and throw it away?” The answer is: only if it’s not on the flush list. Confusion is deadly. Even worse, some online guides still tell people to crush pills or flush everything. That’s outdated-and dangerous. The FDA updated its guidelines in 2023 to clarify this. Don’t rely on old blogs or hearsay.
What’s Changing in 2025?
New laws are pushing for better disposal. The SNIPED Act, introduced in 2023, would require doctors to give disposal instructions with every prescription for Schedule II drugs. Some pharmacies now give out “dispose-ready” envelopes with activated charcoal that neutralize pills when water is added. University of Florida trials showed these cut improper disposal by 63%. Companies like DisposeRx are selling single-use powder packets for $1.50 that turn pills into a gel you can throw away. Over 1,200 pharmacies now offer them. But the flush list remains unchanged. It’s still the fastest, most reliable way to keep deadly drugs out of the wrong hands.What to Do Right Now
Check your medicine cabinet. Look for these names:- Suboxone, Duragesic, Opana, MS Contin, Nucynta, Xyrem
- Any patch labeled “fentanyl” or “buprenorphine”
- Any pill with “ER” (extended release) or “SR” (sustained release)
What If You’re Not Sure?
Call your pharmacist. They’re trained to know the difference. Or visit the FDA’s website and search “Drug Disposal.” They have a full list with brand names and generic names. Print it out. Keep it on your fridge. You don’t need to be a doctor to save a life. You just need to know what not to throw away.Can I flush any old medicine down the toilet?
No. Only medications on the FDA’s flush list should be flushed. That’s 11 specific drugs with high abuse potential and lethal doses. For all other medications, flush them only if no take-back program is available-and even then, mixing with coffee grounds and throwing them in the trash is preferred. Flushing anything else contributes to water pollution without adding safety.
What if I can’t find a take-back location near me?
If no drop box is nearby, follow the FDA’s trash disposal method: remove pills from their container, mix them with used coffee grounds or kitty litter, seal in a plastic bag, and throw it in the trash. Do not crush tablets or capsules. For flush-list drugs, flush them immediately-even if no take-back is available. Your priority is preventing accidental exposure.
Are there any medications that should never be flushed or thrown away?
No medication should be flushed unless it’s on the FDA’s official flush list. All other drugs should go in the trash after mixing with an unappealing substance. The only exception is injectable drugs or sharps-those require special disposal through medical waste services. Never pour liquid medications down the drain unless instructed by a pharmacist or the FDA.
Why can’t I just throw away pills in their original bottle?
Leaving pills in their original bottle makes them easy to find and misuse. Someone could pick up the bottle, read the name, and take them. The FDA requires you to remove pills from their containers and mix them with something gross-like dirt or coffee grounds-so they look like trash, not medicine. Always scratch out your name and prescription info on the bottle before recycling it.
Do I need to flush all my opioid painkillers?
Only if they’re on the FDA’s flush list. Not all opioids are on it. For example, oxycodone (OxyContin) is not on the list-so mix it with coffee grounds and toss it. But fentanyl patches, morphine ER, and oxymorphone (Opana) must be flushed. Always check the brand name against the FDA’s list. If you’re unsure, call your pharmacy.
Written by Guy Boertje
View all posts by: Guy Boertje