FDA-Approved Medications You Can Flush Down the Toilet (And Which Ones You Should Never Flush)

Most people think flushing pills down the toilet is a bad idea. And for the vast majority of medications, it is. But there’s a small, critical exception - one that could save a child’s life. The FDA has a short list of medications that, under very specific conditions, should be flushed immediately if you can’t get them to a take-back program. This isn’t about convenience. It’s about preventing death.

Why Flushing Is Usually a Bad Idea

You’ve probably heard it before: don’t flush medications. That’s because pharmaceuticals in water systems can harm fish, wildlife, and even drinking water over time. The EPA and environmental scientists have spent decades studying this. They’ve found traces of drugs in rivers and lakes across the country. That’s why most disposal guidelines say: throw meds in the trash, mix them with coffee grounds or kitty litter, seal them in a bag, and toss it.

But here’s the problem with that advice - for some drugs, it’s not enough.

A single fentanyl patch, left in the trash, can kill a toddler who finds it. A single dose of methadone or oxymorphone can be fatal to someone who doesn’t need it. These aren’t just strong painkillers. They’re deadly in the wrong hands. And kids, pets, and even curious teens don’t know the difference between a pill and candy.

The FDA Flush List: What’s on It?

The FDA’s Flush List is not long. It’s only 15 active ingredients, and each one is tied to a specific, high-risk medication. As of April 2024, these are the only medications the FDA says you should flush if no take-back option is available:

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

That’s it. Not every opioid. Not every painkiller. Not every controlled substance. Just these. The FDA has removed 11 drugs from this list since 2021 because safer formulations became available. They’re constantly reviewing it. If a new version of a drug has abuse-deterrent features - like a coating that makes it hard to crush - it might be taken off the list.

What About Fentanyl Patches? There’s a Special Rule

Fentanyl patches are especially dangerous. They still contain potent doses of the drug even after they’ve been used. If you throw one in the trash, it can stick to the bottom of a bag, get picked up by a child or pet, and cause a fatal overdose.

The FDA’s guidance is clear: fold the patch in half, sticky sides together, then flush it immediately. Don’t wait. Don’t try to wash off the adhesive. Don’t cut it. Just fold it, flush it. This prevents accidental exposure and reduces environmental contamination compared to leaving it in the trash.

This isn’t theoretical. Between 2010 and 2022, the FDA recorded 217 accidental fentanyl exposures in children - nine of them fatal. One user on Reddit reported finding a used fentanyl patch stuck to a playground slide. That’s not a rare event. It’s a preventable one.

Hand flushing three FDA-approved dangerous medications down toilet

What Should You Do First? Always Check for Take-Back Options

The FDA’s number one rule is this: use a drug take-back program whenever possible. Flushing is the last resort.

There are over 12,000 authorized take-back locations across the U.S. - pharmacies, hospitals, police stations, and community centers. The DEA runs National Take Back Days twice a year (April and October), but you don’t have to wait. Use the DEA’s online locator to find year-round drop-off sites near you.

But here’s the hard truth: 78% of patients told pharmacists they didn’t know where to take old meds. Rural areas are especially underserved - one take-back site for every 50,000 people. In those cases, flushing may be the only way to keep someone safe.

What If Your Medicine Isn’t on the List?

If your medication isn’t on the FDA Flush List - do not flush it. Instead:

Remove the pills from their original bottle.
Mix them with something unappetizing - used coffee grounds, cat litter, or dirt.
Put the mixture in a sealed plastic bag or container.
Toss it in your household trash.
Before throwing away the empty bottle, scratch off or tear up any labels with your name, prescription number, or doctor’s info.

This makes it harder for someone to fish out pills or misuse your information. It’s not perfect, but it’s safer than flushing.

Community members using pharmacy take-back bin under dusk lighting

Why Doesn’t the EPA Like This?

The EPA doesn’t want you flushing anything. They regulate hazardous waste, and pharmaceuticals fall under that. Hospitals, nursing homes, and pharmacies are strictly forbidden from flushing meds. But the EPA understands the FDA’s position: for households with children or pets, the risk of accidental overdose outweighs the environmental risk for these specific drugs.

In 2022, the EPA published a report titled “The Limited Role of the FDA’s Flush List.” Their message was clear: this is a narrow exception, not a green light. They still encourage take-back programs and warn that flushing anything else contributes to water pollution.

What’s Changing? The Future of Medication Disposal

The FDA is actively reviewing the Flush List. In early 2024, they announced they’re evaluating whether to add new transdermal formulations after 17 cases of accidental buprenorphine exposure in 2023. They’re also considering removing three drugs from the list because newer versions have abuse-deterrent features that make them safer in the trash.

The Bipartisan Infrastructure Law gave $15 million to expand take-back programs. Between 2021 and 2023, the number of registered collection sites grew by 37%. More pharmacies are now offering year-round drop-off bins. And by 2025, nearly all prescription labels will include clear disposal instructions - no more guessing.

Environmental scientists at the USGS still detect trace amounts of Flush List drugs in waterways, but at levels thousands of times lower than what’s needed for a human dose. The real danger isn’t in the water - it’s in the trash can.

What to Do Right Now

If you’re reading this and have old medications at home, here’s your action plan:

Check your medicine cabinet. Find any pills or patches on the FDA Flush List.
Call your local pharmacy or visit the DEA’s website to find the nearest take-back location.
If you can’t get there within a day or two - and you have kids, pets, or visitors who might rummage through your trash - flush the medication immediately.
For fentanyl patches: fold them in half, sticky sides together, then flush.
For everything else: mix with coffee grounds, seal in a bag, throw in the trash, and remove labels.

Don’t wait until someone gets hurt. The FDA didn’t create this list to make disposal easier. They made it because people were dying. And you can help stop that.

Can I flush any prescription drug if I don’t have a take-back option?

No. Only medications on the FDA’s official Flush List should be flushed - and even then, only if you can’t get them to a take-back program. Flushing any other drug contributes to water pollution and is against EPA guidelines. Always check the list first.

What if I accidentally flushed a drug not on the list?

If you flushed a medication not on the FDA list, don’t panic. One-time accidental flushing won’t cause major environmental harm. But from now on, follow the proper disposal method: mix with coffee grounds or kitty litter, seal in a bag, and throw it in the trash. Remove personal info from the bottle first.

Are over-the-counter drugs like ibuprofen or Tylenol on the flush list?

No. Over-the-counter pain relievers like ibuprofen, acetaminophen, and aspirin are not on the FDA Flush List. They should be disposed of by mixing with an unappealing substance and throwing them in the trash. Flushing them is unnecessary and harmful to the environment.

How do I know if my medication is on the FDA Flush List?

Check the medication’s packaging - many now include disposal instructions. You can also search the FDA’s official website for the current Flush List. If you’re unsure, ask your pharmacist. They have access to the most up-to-date guidelines and can confirm whether your drug is on the list.

Why does the FDA allow flushing at all if it harms the environment?

The FDA’s priority is preventing immediate harm to people. For drugs like fentanyl or methadone, one dose can kill a child. The environmental risk from flushing these specific drugs is far smaller than the risk of accidental overdose from leaving them in the trash. The FDA weighs human safety first - and only allows flushing for the most dangerous drugs when no other option exists.

Can I flush expired medications?

Only if they’re on the FDA Flush List and you can’t access a take-back program. Expiration doesn’t make a drug safer - expired opioids or benzodiazepines can still be deadly. If it’s on the list, flush it. If not, mix it with coffee grounds and throw it away.

What about liquid medications or inhalers?

Liquid medications and inhalers are not typically on the Flush List. For liquids, mix them with an absorbent material like cat litter or flour, seal in a container, and throw in the trash. Inhalers should never be punctured or thrown in the fire - return them to a pharmacy for safe disposal. Always check the label for specific instructions.

Do I need to flush the whole bottle or just the pills?

Only flush the medication - not the bottle. Empty the pills or patches out, flush them, then recycle or throw away the bottle after removing your personal information. Don’t flush plastic containers - they don’t break down and can clog pipes or harm wildlife.