FDA-Approved Medications You Can Flush Down the Toilet (And Which Ones You Shouldn’t)

Most people think flushing pills down the toilet is bad for the environment - and they’re right. Almost all medications should never go down the drain. But there’s a small, dangerous exception. The FDA has a short list of drugs that, under very specific conditions, you’re supposed to flush - not because it’s convenient, but because not doing it could kill someone.

Why Flushing Is Usually a Bad Idea

You’ve probably heard the advice: don’t flush your old meds. That’s because pharmaceuticals in water systems can harm fish, wildlife, and even enter drinking water supplies. The EPA has spent decades trying to reduce this pollution. For years, people flushed leftover painkillers, antidepressants, or antibiotics because they didn’t know what else to do. Now, we know better. Most drugs should go to a take-back program, mixed with coffee grounds or cat litter in the trash, or returned to a pharmacy.

But here’s the problem: what if your child finds a fentanyl patch in the trash? Or your dog eats a bottle of oxymorphone pills you forgot to throw away? These aren’t hypotheticals. Between 2010 and 2022, the FDA recorded 217 cases of accidental fentanyl exposure in children - nine of them fatal. Many of those cases happened because the drugs were left in accessible trash.

That’s why the FDA created the Flush List.

What Is the FDA Flush List?

The FDA Flush List is not a suggestion. It’s a safety protocol. It includes only medications that can cause death or serious harm with a single dose if someone else takes them - especially children, pets, or people who misuse prescription drugs.

The list was first published in 2007 and has been updated since. The most recent version came out on April 23, 2024. It’s small - only 15 active ingredients - and the FDA is constantly reviewing it. In 2021, they removed 11 drugs from the list because safer alternatives became available. They’re now evaluating whether three more might be removed by 2025.

The rule is simple: Only flush these if you have no other option. Take-back programs are always the first choice. But if you can’t get to one, and the drug is on this list, flushing is the safest thing you can do.

Which Medications Are on the FDA Flush List?

Here are the exact medications the FDA says you can flush - and only when take-back isn’t available:

• Buprenorphine - found in BELBUCA, BUAVAIL, BUTRANS, SUBOXONE, SUBUTEX, ZUBSOLV
• 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, OPANA ER
• Tapentadol - NUCYNTA, NUCYNTA ER
• Sodium oxybate - XYREM, XYWAV
• Diazepam rectal gel - DIASTAT, DIASTAT ACUDIAL
• Methylphenidate transdermal system - DAYTRANA

That’s it. No more. No less.

If your medication isn’t on this list, don’t flush it. Even if it’s strong. Even if it’s old. Even if you’re frustrated. Flushing anything else is against federal guidance and increases environmental risk.

How to Flush Safely - Step by Step

Flushing isn’t just about dropping a pill in the bowl. There’s a correct way to do it - especially for patches.

1. Check the label. Look for the active ingredient. If it matches one on the list above, proceed.
2. Confirm no take-back option exists. Use the DEA’s website to find a collection site near you. Many pharmacies, hospitals, and police stations offer year-round drop-off. National Take Back Days happen twice a year - April and October.
3. For pills or liquids: Remove them from the original bottle. Flush them down the toilet immediately. Don’t wait. Don’t store them.
4. For fentanyl or other transdermal patches: Fold the patch in half, sticky sides together. This prevents accidental contact. Then flush it. Do not throw it in the trash, even if it looks “used.”
5. Dispose of packaging safely. Remove any personal info from the bottle or box before throwing it in the trash. Use a marker or scissors to destroy your name, address, and prescription number.

The FDA emphasizes: Flush immediately after removing the medication from its container. Don’t let it sit on the counter. Don’t put it in a drawer. The moment you decide not to use it, act.

Why Take-Back Programs Are Still Better

Even if your drug is on the Flush List, the FDA’s #1 recommendation is always: Use a take-back program.

Why? Because flushing still adds pharmaceuticals to water. The U.S. Geological Survey found detectable levels of eight flush-list drugs in 23% of tested streams. But here’s the key: those levels were far below what’s harmful to humans or aquatic life. The risk from flushing is tiny compared to the risk of someone accidentally ingesting the drug.

Take-back programs collect medications and incinerate them safely - no water contamination, no accidental exposure. The Bipartisan Infrastructure Law of 2021 gave $15 million to expand these programs. Since then, DEA-registered collection sites have grown by 37%. There are now over 12,000 locations nationwide.

But access isn’t equal. In cities, you might have one drop-off point every 15,000 people. In rural areas, it’s one per 50,000. That’s why the Flush List exists - to cover the gaps.

What Happens If You Flush the Wrong Drug?

Flushing a drug not on the list won’t hurt you legally - but it’s still wrong. You’re adding unnecessary chemicals to the water supply. The EPA doesn’t fine individuals for flushing, but they do regulate pharmacies, hospitals, and manufacturers. And if you’re flushing antidepressants, antibiotics, or blood pressure pills, you’re contributing to a problem that’s been studied for decades.

A 2023 survey by the National Community Pharmacists Association found that 42% of Americans admit to flushing medications not on the FDA list. That’s nearly half of all households. Many do it out of confusion - or because they think “it’s just one pill.” But every pill adds up.

And here’s a real-world consequence: in January 2024, a Reddit user in the r/pharmacy subreddit shared that they found a used fentanyl patch stuck to a playground slide. That patch could have killed a child. If it had been flushed properly, that wouldn’t have happened.

What About Over-the-Counter Drugs?

None of the over-the-counter medications - Tylenol, ibuprofen, antihistamines, etc. - are on the Flush List. Even if they’re expired. Even if they’re in large quantities. Don’t flush them.

Instead, mix them with something unappealing: used coffee grounds, cat litter, dirt. Put them in a sealed plastic bag. Throw them in the trash. That’s the standard recommendation for all non-flush-list drugs.

The same goes for vitamins, supplements, and herbal products. They’re not regulated like prescription drugs. Flushing them does nothing but pollute.

What’s Changing in 2025?

The FDA is actively reviewing the Flush List. In 2023, there were 17 reported cases of accidental buprenorphine exposure - mostly from patches left in trash. That’s why they’re considering adding more transdermal formulations to the list.

They’re also evaluating whether newer abuse-deterrent formulations of opioids - like those that turn to gel when crushed - might be safe enough to remove from the list. Early data suggests three drugs could be taken off by 2025.

Meanwhile, the FDA is pushing for standardized disposal instructions on all prescription labels. Right now, only 87% of controlled substance packaging includes disposal info. That’s improving, but not universal.

Final Rule: When in Doubt, Don’t Flush

If you’re unsure whether your medication is on the Flush List, don’t flush it. Check the FDA’s official website. Call your pharmacist. Look up the active ingredient online. There’s no rush.

The goal isn’t to make disposal easy. It’s to make it safe. Flushing is a last resort - not a shortcut. And if you’re ever tempted to flush something because you’re tired of keeping it around, remember: that bottle in your cabinet is safer than a patch on a playground slide.

The FDA didn’t create this list to make your life easier. They created it because people died because of careless disposal. Don’t be the reason someone else does.