Unwanted medicines collected by Teleosis.

Medication return pilot projects can be found from Washington to Maine. Marin County, just north of San Francisco, has one of the few publicly funded medication return programs in the country.

Senior environmental health specialist Robert Turner piggybacked medication return onto a successful syringe return program. Local independent pharmacies and several chains participate voluntarily. Pharmacies collect meds returned by patients and the county pays for shipping to a hazardous waste disposal site. Most developed countries already have return programs, Turner said, typically funded by the drug industry.

If return facilities are not available, consumers should mix the medication with water, then with some unpalatable solids such as coffee grounds or cat litter, and dispose it in household trash. "We went berserk when we read that," said Susan Oglesby, spokes-woman for the British Columbia Pharmacy Association. "Dissolving your birth control pills in water, mixing with sawdust, and dumping the whole mess in a landfill is as environmentally nasty as flushing the pills. All you've done is put hormones in the water table instead of directly in the waterway that takes sewage treatment outflow."

APhA policy, reviewed in 2007, calls on the Environmental Protection Agency (EPA) to "continue research exploring any connection between the disposal of discarded prescription and OTC medications and contamination of the water supply." The association also calls for the development of programs for medication disposal and encourages appropriate government entities to accept financial responsibility for disposal.

British Columbia started a pharmacy-based Medications Return Program in 1996. Pharmacies accept all Rx, OTC, and herbal products. Returns are stored in five-gallon buckets, which are collected and incinerated. Environment Canada, Canada's equivalent of the EPA, classifies unused medications as hazardous waste, Oglesby added. The BC program got a significant boost this year when Vancouver banned medications from landfill and curbside recycling.

Elephant and other San Francisco-area pharmacies, veterinary offices, and physician practices are part of the Teleosis Institute's Green Pharmacy Program. So is Kaiser Permanente, which is piloting the program in one pharmacy. Teleosis inventories returns to generate data on the types and volume of medications returned.

Koshland said accepting medication returns is a minor pharmacy burden. In St. Louis, Nicole Gattas, clinical pharmacy coordinator for Schnucks, a 60-store grocery/pharmacy chain, agreed.

Twenty Schnucks stores are taking medication returns once a month in an 18-month, $150,000 pilot project funded by EPA. Returns are accepted by pharmacy students on rotation and a pharmacy technician. "We're looking for data on the medications that need proper disposal as well as the true costs involved," Gattas said. "We don't have the industry funding that is available in other developed countries. We are probably the largest producer of unused medications in the world; we just don't have the same level of attention paid to the problem."