07 March 2025

The Dangers of Expired Medication and Safe Disposal Methods

Using expired medication and disposing of it improperly can lead to serious health, economic, and environmental risks, warns pharmacy Professor Renier Coetzee, vice-president of the Pharmaceutical Society of South Africa.

Expiration dates are determined through stability testing, ensuring that medicines remain safe and effective under proper storage conditions. Over time, medications degrade, losing potency and potentially becoming harmful.

This is particularly concerning for antibiotics, as subtherapeutic doses (too weak to treat infections effectively) can contribute to antimicrobial resistance. This makes infections harder to treat, increasing the risk of disease spread, severe illness, and even death.

Chronic disease medications, such as insulin and heart medications, may also lose potency over time, leading to serious health risks. Some medications, like ciprofloxacin (an antibiotic used to treat respiratory and urinary infections), can break down into toxic compounds that may harm the kidneys and pose environmental risks if not disposed of correctly.

Storage conditions also play a role. Exposure to heat, humidity, and light can accelerate the breakdown of active ingredients. Even common medicines like paracetamol can become less effective over time, potentially leading to delayed treatment or overdose risks if users take higher doses to compensate for reduced potency.

Liquid medications, such as cough syrups and eye drops, are particularly vulnerable to contamination after expiry, as their preservatives weaken, increasing the risk of bacterial growth and infections.

Throwing expired or unused medicine in the trash or flushing it down the toilet is strongly discouraged by pharmacy professionals and regulatory bodies like the Pharmaceutical Society of South Africa and the South African Pharmacy Council.

Improper disposal can lead to environmental contamination, as active pharmaceutical ingredients can leach into soil and groundwater, polluting drinking water sources. Medications flushed into sewage systems can bypass wastewater treatment processes, entering aquatic ecosystems and posing risks to both wildlife and human health.

Trace amounts of pharmaceuticals in water supplies have been linked to antimicrobial resistance and endocrine disruption—interfering with hormones and potentially causing adverse health effects.

The best way to dispose of expired or unused medications is through drug take-back programmes or authorised collection sites. In South Africa, only authorised personnel, such as pharmacists, are permitted to handle medication disposal, with a certificate of destruction required for record-keeping.

Despite regulations, studies show that only 23.5% of healthcare professionals in South Africa properly dispose of medicines in their facilities, highlighting the need for better education and enforcement of pharmaceutical waste disposal practices.

In many African countries, formal medication take-back programmes are limited. If no authorised disposal options are available, one alternative is to mix expired medication with undesirable substances (such as used coffee grounds or cat litter) before sealing the mixture in a plastic bag and discarding it in the trash. This method helps prevent accidental ingestion by children or animals and reduces environmental contamination.

Ensuring the safe use and disposal of medications is crucial to protecting public health and the environment.