Medications Never to Put in Household Trash: A Safety List

Every year, people throw away old or unused medications in the trash without thinking twice. But for some drugs, that simple act can be deadly. The FDA flush list exists for one reason: to prevent accidental poisonings and overdoses that happen when children, teens, or others find powerful medications in the garbage. These aren’t just rare cases. In 2022, over 8,900 single-exposure incidents involving fentanyl were reported to poison control centers - and 42% of those involved children under five. If you have any of these medications at home, you need to know which ones must go down the toilet - not the trash.

What the FDA Says About Flushing Medications

The U.S. Food and Drug Administration (FDA) doesn’t normally recommend flushing pills or patches. In fact, they warn against it - unless your medicine is on their official flush list. Why the exception? Because some drugs are so dangerous in even tiny amounts that the risk of environmental contamination is outweighed by the risk of someone dying from a single dose. This isn’t theoretical. Fentanyl, for example, is 50 to 100 times stronger than morphine. A single patch left in a child’s reach can kill. The same goes for methadone, oxymorphone, and other opioids on the list.

The FDA’s guidelines, updated in 2023, are clear: “Don’t flush your medicine unless it is on the flush list.” That means if your medication isn’t on that list, you should dispose of it differently - usually by mixing it with dirt, coffee grounds, or cat litter, sealing it in a plastic bag, and tossing it in the trash. But for the medications on the list? Flush them immediately. No waiting. No storing. No hoping someone won’t find them.

The 11 Medications You Must Flush

Here’s the exact list of medications that should never go in your household trash. If you have any of these, flush them right away:

• Buprenorphine - found in BELBUCA, BUAVAIL, BUTRANS, SUBOXONE, SUBUTEX, ZUBSOLV
• Fentanyl - in ABSTRAL, ACTIQ, DURAGESIC, FENTORA, ONSOLIS
• Hydromorphone - in EXALGO
• Meperidine - in DEMEROL
• Methadone - in DOLOPHINE, METHADOSE
• Morphine - in ARYMO ER, AVINZA, EMBEDA, KADIAN, MORPHABOND ER, MS CONTIN, ORAMORPH SR
• Oxymorphone - in OPANA, OPANA ER
• Tapentadol - in NUCYNTA, NUCYNTA ER
• Sodium oxybate - in XYREM, XYWAV
• Diazepam rectal gel - in DIASTAT, DIASTAT ACUDIAL
• Methylphenidate transdermal system - in DAYTRANA

These aren’t random picks. Each one has been linked to fatal overdoses from single exposures. In 2021, opioids were involved in over 70% of the 107,622 drug overdose deaths in the U.S. Many of those cases started with someone finding a pill or patch in a home trash can. A teenager in Ohio died in 2021 after pulling OPANA ER from a neighbor’s trash. That case led to new local laws requiring special disposal for Schedule II drugs.

Why Flushing Is the Only Safe Option for These Drugs

You might be thinking: “But what about the environment? Won’t flushing hurt rivers and drinking water?” It’s a valid concern. Studies show that wastewater plants remove only 30% to 90% of pharmaceuticals - and some, like carbamazepine, barely make it out at all. The EPA admits that traces of medications are now found in 80% of U.S. waterways.

But here’s the trade-off: The FDA, CDC, and EPA all agree that for these 11 medications, the risk of death is far greater than the risk of water contamination. Dr. John Scott from the EPA’s National Homeland Security Research Center testified in 2022 that the environmental impact of flushing one fentanyl patch is negligible compared to the chance of multiple deaths if it’s left in the trash. The same logic applies to methadone, oxymorphone, and buprenorphine - all of which can kill in minutes if ingested by someone who isn’t prescribed them.

Real cases prove this. A nurse posted on Reddit in February 2023 about a child who got into fentanyl patches from household trash. The child was rushed to the hospital and barely survived. That’s not an anomaly - it’s exactly why the flush list exists.

What to Do With Medications Not on the List

If your medication isn’t on the flush list, you still need to dispose of it safely. Don’t just toss it in the trash. Here’s what the FDA recommends:

1. Remove pills or liquids from their original bottles.
2. Don’t crush tablets or capsules - leave them whole.
3. Mix them with something unappealing: used coffee grounds, cat litter, or dirt.
4. Put the mixture in a sealed plastic bag.
5. Throw the bag in your household trash.

This makes it harder for someone to fish out pills or extract liquid. It also makes the mixture smell bad and look unappetizing. Never flush non-listed drugs - they can still pollute water supplies. And never flush them down the sink either. The toilet is the only approved disposal method for the flush list - everything else belongs in the trash, properly mixed.

Where to Find Take-Back Programs

Flushing is only for the 11 medications on the list. For everything else, take-back programs are the best option. Many pharmacies, hospitals, and police stations now offer free, secure drop-off bins.

Walgreens has over 2,000 medication disposal kiosks across the U.S. CVS Health operates nearly 1,800 more. In Minnesota, there are more than 300 collection points - including sheriff’s offices and pharmacies. The FDA and DEA support these programs because they’re safer for the environment and reduce the chance of misuse.

But here’s the problem: Only about 15% of people actually use them. Why? Many don’t know they exist. Others think it’s too much trouble. But if you’re worried about the environment, this is the best way to dispose of medications - no flushing required.

If you’re not sure where to go, search for “medication take-back near me” or check with your local pharmacy. Some cities, like Alameda County in California, accept non-controlled drugs at household hazardous waste facilities. Always call ahead - rules vary by location.

Why People Get Confused - And What You Can Do

A 2022 study found that only 43% of patients could correctly identify which medications needed flushing versus which didn’t. Pharmacists report that patients often ask: “Is this one okay to flush?” or “I thought all pills should go in the trash.” The confusion is real.

One reason? Packaging doesn’t always tell you. A bottle of oxymorphone might look like any other pain pill. A fentanyl patch looks like a Band-Aid. Without clear labeling, people assume it’s safe to toss.

Here’s what you can do:

• Check the label - if it says “Do not flush,” then follow the trash method.
• Look up the generic name - if it’s on the FDA list above, flush it.
• When in doubt, ask your pharmacist. They’re trained to handle this.
• Keep a printed copy of the flush list on your fridge or near your medicine cabinet.

Some companies are trying to fix this. DisposeRx makes single-use powder packets that turn pills into a gel when mixed with water. Over 1,200 pharmacies now use them. The University of Florida tested envelopes with activated charcoal - they cut improper disposal by 63%. These innovations are promising, but they’re not everywhere yet. Until then, you need to know the rules.

What’s Changing in 2026

The FDA updated its flush list in January 2023 to include newer versions of existing drugs. The EPA’s new Unregulated Contaminant Monitoring Rule 5, which started in 2023, now requires water systems to test for 30 pharmaceutical compounds - including some on the flush list. Congress is also considering the SNIPED Act, which would force doctors to give disposal instructions with every prescription for Schedule II drugs.

But the core message hasn’t changed: For the 11 medications on the list, the toilet is the only safe option. Everything else? Use take-back programs or mix with coffee grounds. Don’t guess. Don’t wait. And don’t assume someone else will handle it.