NACWA Hosts Discussion on FDA Pharmaceutical “Flush List”

(March 5, 2019) - NACWA hosted a February 27 meeting of water sector associations and other groups interested in advocating for changing the Food & Drug Administration’s (FDA) recommended disposal options for certain pharmaceuticals. 

The FDA recommends that certain prescription medications be immediately flushed down the toilet “when no longer needed and a take-back option is not readily available.” This “flush list” is for medications that are particularly harmful if taken improperly, and it includes fentanyl patches. 

Since wastewater treatment facilities are not designed to remove pharmaceuticals from wastewater, clean water agencies have long advocated for “drug take-back” programs to provide a safe disposal option other than flushing.  In addition, fentanyl patches do not disperse in wastewater, potentially contributing to clogs when flushed.  

NACWA, along with other water sector associations, utilities, and stakeholder groups signed a letter in 2016 urging the FDA to end its recommendation to flush certain medications.  Since this time, the Drug Enforcement Administration (DEA) has changed certain rules, enabling drug take-back programs to proliferate.  Home-use drug deactivation pouches have also been developed, and this may be another viable drug disposal option for situations where take-back programs are easily used. 

During the February 27 meeting, the water sector associations reaffirmed their interest in preventing unused medications from being flushed.  The group discussed potential advocacy actions, including an updated letter to FDA and working with members of Congress and EPA to also deliver this message to the FDA. 

NACWA members with an interest in this issue are encouraged to contact Cynthia Finley, NACWA’s Director, Regulatory Affairs.