FDA-Approved Medications You Can Flush: What’s on the List and When to Do It

Most people think flushing medication down the toilet is bad for the environment-and they’re right. But there’s a small, critical exception. The FDA flush list exists for one reason: to prevent deaths. If you have certain powerful painkillers or sedatives at home and can’t get them to a take-back program, flushing them might be the safest thing you can do.

Why Flushing Is Normally a Bad Idea

Flushing pills, patches, or liquids into the sewer system doesn’t make them disappear. Pharmaceuticals end up in rivers, lakes, and even drinking water supplies. The EPA and scientists have found traces of medications in waterways across the U.S. for decades. That’s why federal guidelines say: never flush unless absolutely necessary.

But here’s the catch: some drugs are so dangerous that the risk of keeping them in the house is greater than the risk of flushing them.

The FDA Flush List: Only 15 Active Ingredients

The FDA doesn’t list brand names. It lists active ingredients. And only 15 of them are on the official flush list as of April 2024. These aren’t your everyday prescriptions. These are drugs that can kill someone-sometimes in minutes-if a child, pet, or stranger finds them in the trash.

Here’s exactly what’s on the list:

• Buprenorphine (in brands like SUBOXONE, BELBUCA, BUTRANS)
• Fentanyl (ABSTRAL, ACTIQ, DURAGESIC patches, FENTORA)
• Hydromorphone (EXALGO extended-release)
• Meperidine (DEMEROL)
• Methadone (DOLOPHINE, METHADOSE)
• Morphine (ARYMO ER, AVINZA, EMBEDA, KADIAN, MORPHABOND ER, MS CONTIN)
• Oxymorphone (OPANA, OPANA ER)
• Tapentadol (NUCYNTA, NUCYNTA ER)
• Sodium oxybate (XYREM, XYWAV)
• Diazepam rectal gel (DIASTAT, DIASTAT ACUDIAL)
• Methylphenidate transdermal system (DAYTRANA)

That’s it. Only these. No ibuprofen. No antibiotics. No antidepressants. No blood pressure pills. If it’s not on this list, don’t flush it.

Why These Drugs? The Real Danger

These medications aren’t dangerous because they’re strong. They’re dangerous because they’re deadly in tiny doses.

A single fentanyl patch can kill a child. One dose of methadone can stop someone’s breathing. A child who finds a used patch stuck to the floor, or a pill in the trash, might not even know what it is-but their body will react fast.

Between 2010 and 2022, the FDA recorded 217 cases of accidental fentanyl exposure in children. Nine of them died. In one case, a toddler found a discarded patch on a playground slide. In another, a teenager took a leftover pill from a relative’s medicine cabinet.

The FDA’s own environmental review in 2021 concluded: for these 15 drugs, the risk of accidental death outweighs the risk of water contamination.

When to Flush: The Three-Step Rule

You should never flush just because it’s convenient. Here’s the official order of what to do:

1. Use a take-back program. This is always the first choice. The DEA runs National Take Back Days twice a year-in April and October. You can also find year-round drop-off sites at pharmacies, hospitals, or police stations. Search the DEA’s website for the nearest location.
2. If no take-back is available, and the drug is on the FDA flush list, flush it. This applies only if you’re in a home with children, pets, or visitors who might access the medicine. If you live alone and the meds are locked up, you don’t need to flush.
3. If the drug isn’t on the list, mix it with dirt, coffee grounds, or cat litter, seal it in a plastic bag, and throw it in the trash. Don’t crush pills. Don’t dissolve them. Just mix and seal.

Special Rules for Patches

Fentanyl, buprenorphine, and methylphenidate patches are especially risky. They still contain medicine even after use.

If you’re flushing a patch:

• Fold it in half, sticky side to sticky side.
• Flush it immediately.
• Don’t let it sit in the sink or trash.

This prevents accidental contact. A used patch stuck to a floor or couch can still deliver a lethal dose.

What About Empty Packaging?

Before tossing the bottle or box in the trash, remove or scratch out your name, prescription number, and any other personal info. Identity thieves have been known to steal empty pill bottles to forge prescriptions.

What’s Not on the List? (And Why You Shouldn’t Flush It)

You might be tempted to flush:

• Antibiotics
• Antidepressants
• Birth control pills
• Cholesterol meds
• Insulin

Don’t. None of these are on the FDA flush list. Flushing them adds to water pollution without preventing deaths. Mix them with kitty litter or coffee grounds. Seal them. Toss them.

What’s Changed Recently?

The FDA doesn’t keep this list static. In 2021, they removed 11 medications because newer versions had abuse-deterrent features-like pills that turn to gel when crushed, making them harder to misuse.

In early 2024, the FDA announced it’s reviewing whether to add new transdermal forms of buprenorphine after 17 accidental exposures in children last year. They’re also considering removing three drugs by 2025 if safety improvements make flushing unnecessary.

What If You Can’t Find a Take-Back Site?

In rural areas, take-back sites are rare. One site per 50,000 people isn’t uncommon. If you’re in one of those areas and have a drug on the flush list, flushing is the FDA’s official backup plan.

But don’t give up. Check:

• Your local pharmacy-many now have drop boxes.
• Your city or county health department website.
• The DEA’s online locator: dea.gov/takeback

If you still can’t find one, flush.

What About Other Countries?

This advice applies only to the United States. New Zealand, Canada, and the EU have different rules. In New Zealand, for example, pharmacies offer free return programs for all medications. No flushing is ever recommended.

If you’re outside the U.S., check your local health authority. Don’t assume U.S. rules apply.

What Happens If You Flush the Wrong Thing?

Flushing non-flushable meds won’t get you in legal trouble. But it contributes to long-term environmental harm. The EPA estimates that pharmaceutical pollution affects aquatic life, disrupts hormone systems in fish, and may contribute to antibiotic resistance.

It’s not about punishment. It’s about responsibility.

Final Reminder: This Is a Last Resort

The FDA’s message is clear: Take-back is always better. Flushing is only for when there’s no other option-and only for the 15 drugs on the list.

If you’re unsure, call your pharmacist. They know the list. They know your meds. They’ve seen the consequences of improper disposal.

Don’t guess. Don’t assume. Don’t flush unless you’re certain.

One wrong pill in the wrong hands can be fatal. The FDA flush list exists to stop that.