September 12, 2025

Welcome to UH EMS-I’s Pharmacy Phriday. Last week, we looked at the KitCheck™ system and referenced the importance of proper disposal or wasting of unused medicines. Over the next few weeks, we will dive into the proper disposal of various medications and supplies. 

Improper disposal of medications can have untoward outcomes. One of the obvious concerns is possible drug diversion, defined as the potential for a medication to be redirected from its intended use to unauthorized users or for purposes such as abuse or sale to others. Improper wasting of medication can also lead to accidental exposures or environmental contamination, such as contamination of water supplies. 

University Hospitals are active in preventing negative consequences from improper medication disposal. Within the communities UH serves, participation involves being a part of the United States Drug Enforcement Administration’s (DEA) National Prescription Drug Take Back Day. The next Drug Take Back Day will be October 25, 2025. University Hospitals also provide locations with year-round collection kiosks. Find a collection site near you by clicking here. 

Within the hospitals and clinical sites, UH has developed policies and procedures to meet regulations that exist to ensure proper disposal of medications. These practices and resources are also available to our EMS partners. 

One of those resources is the Rx Destroyer™. The Rx Destroyer, sometimes referred to as a “drug buster,” is typically found in the med-rooms of our emergency departments. It is used to deactivate and dispose of controlled substances and non-controlled substances that are a diversion risk and is an important step in following specific DEA protocols to render them "non-retrievable." Once full, UH has the container incinerated as non-RCRA (Resource Conservation and Recovery Act) pharmaceutical waste. 

Examples of medications that we carry within our prehospital drug boxes that would fall into this category of controlled substances include: 

• Fentanyl 

• Hydromorphone 

• Ketamine (or any “substitute” for these controlled substance medications) 

• Midazolam 

• Rocuronium (for those squads permitted to complete Rapid Sequence Intubation [RSI]) 

Following patient administration and upon arrival at the ER, unused portions of these medications would be poured into an Rx Destroyer canister, neutralizing the medication on contact. Remember, the procedure must be witnessed by another appropriate level provider and documented on the “Drug Box Accountability Reports.” 

It is also important to note that any needles would then be placed in a sharp’s container, and syringes and vials would be placed in purple top bins (to be discussed in an upcoming edition). NEVER place these items back into the drug box! 

On your next transport to one of our facilities, look for the location of these resources.  

Until next time, stay safe! 

Sincerely, 

The UH EMS-I Team 

University Hospitals