Map of life expectancy at birth from Global Education Project.

Wednesday, November 18, 2009

The FDA works in mysterious ways

No, I don't quite understand this myself. The FDA has long recommended that you dispose of left-over medications by mixing them with something disgusting, e.g. used kitty litter, putting them in a zip-lock bag, and tossing them in the household trash. This may not be the absolutely ideal thing to do but it seems practical. They'll end up in a landfill and pretty much just sit there till the last ding dong of doom, is the idea.

But now they have decided that there are some drugs which are just so horrifically dangerous that you should introduce them into your septic tank or municipal sewer system via the ceramic throne. All but three of the drugs on this list are opioids. For some reason the most commonly prescribed opioid, hydrocodone (commonly sold in combination with acetaminophen as Vicodin) is not on the list.

One of the other three is methylphenidate (Ritalin) which as you probably know is widely prescribed to children who don't like to sit quietly for hours on end concentrating on boring tasks. Its mechanism of action is similar to that of cocaine.

The other two items are kind of peculiar, and rarely prescribed. Diastat is diazepam (Valium) in the form of a suppository, which is prescribed for people with a rare pattern of seizures. Xyrem is gamma-hydroxybutyric acid, also known in some circles as GHB, liquid ecstasy, or the date rape drug. It is prescribed to people with narcolepsy.

The FDA doesn't really explain why you should flush these particular drugs and no others. They say something about them being especially dangerous to have around the house, but why that means you should flush them instead of doing the kitty litter thing -- well, it doesn't seem to follow. And if Ritalin is so dangerous to have in a household with children that it requires urgent disposal, uhh, well, it's normally prescribed to children and they normally carry it around with them. Hmm.

A more plausible theory is that your kids might take these drugs with them to a party, or sell them in the schoolyard, but the FDA doesn't want to say that out loud. Somebody might just be tempted to pick them out of the kitty litter for those purposes, hence the flushing. The exception would seem to me to be the Valium suppository, which I can't see having a great deal of recreational appeal but maybe I'm just unimaginative. But then we would have to ask why the more common Valium pills aren't included.

Personally, unless there is something more the FDA isn't telling us, I think this is basically nuts. I don't suppose we'll ever get high enough concentrations in the water to zonk out the fish, but I don't think we really know what the environmental effects might be. Meanwhile, assuming my guess about their real motivations is correct, this does point to an underrecognized problem. We have an epidemic of prescription drug abuse among young people in this country, fueled in part by pilfering from the medicine cabinet. Unfortunately, some kids get hooked. The street price of these drugs is high, so many of them end up turning to heroin, which is very cheap since the U.S. invaded Afghanistan and the country resumed exporting its number one cash crop.

Interesting bit of Kremlinology here, that's all I can say.


roger said...

i wonder what the epa has to say about flushing drugs. or the dea.

Cervantes said...

It will get ugly if we wind up with a lot of stoned fish.

kathy a. said...

i think generally they don't want unwanted drugs flushed, because a lot of those are things like antibiotics, and/or maybe BC pills, plus the mix of whatever is out there, and in concentrations those are not good to have floating around the water supply.

they have to be worrying about risk of abuse, and/or the street value of certain drugs. if that's the case, vicodan is up there -- but it is so commonly prescribed, maybe they think too much will end up in the drink?

i'm generally anti-flushing, but the day my nephew died, i was very worried about his mother wanting to go with him, and about all the drugs in the house including a bunch of morphine. the hospice nurse took charge and said she had to dispose of all the meds immediately, and she flushed them. for which i am forever grateful.

the kitty litter idea is good. dog knows, nobody really wants to go there.