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How To Discard Of Expired Or Unused Medications

I usually go through all my medications during National Pharmacy Month in September since that’s when I usually remember to do so. It’s also the month I make time to reorganise my drug cupboard. However, this year I have seen many of you start off the new year by decluttering your homes and doing a little bit of “spring cleaning”.

If you are doing this then I definitely recommend going through your medicine box because if you are anything like me, you probably have lots of half used medications that have probably expired.

HOW SAFE ARE MEDICATIONS PAST THEIR EXPIRY DATE?

It seems an absolute waste to throw away medications that are unused or even only half used. Interestingly, a study done by the FDA found that most drugs are actually still safe and effective to use as many as 15 years past their expiry date.

The expiry date is really a guarantee from the manufacturer that the drug will maintain its full potency and effectiveness up until said date. The overall effectiveness of a drug depends on the potency of all its individual ingredients and how the drug is stored in your home. This makes it difficult to determine how long a drug will truly be effective for, outside of a controlled laboratory environment. This is why it’s better to just adhere to the expiry date and discard of your medicines once this date has been reached. You really don’t want to be giving your child a less potent antibiotic, which may result in antibiotic resistance, or a less potent antiepileptic and then your child develops a breakthrough seizure.

SAFE MEDICATION DISPOSAL – WHAT’S RECOMMENDED VS. THE REALITY

Worldwide, the recommended and safest way to dispose of medication is simply to return them to your pharmacy. In South Africa, this is actually the only recommended method of disposal. Pharmacies are by law required to take back your expired or unused medications. I do not know however how well this law is being enforced because as a healthcare professional I did not know about it. In fact on questioning some of my colleagues they confessed to simply just throwing their medications away with their general trash.

I am pretty sure many of us are guilty of this and in some countries it’s not totally wrong, if done properly. This is an alternative used in the US, if you are unable to take back the medication to the pharmacy. What you need to do first is try and disguise them so that they are less appealing to children and even pets if they come across them before you throw them away.

Remove all drugs from their original containers and blister packs and mix them with something like coffee grounds, sand or even kitty litter, this includes liquids. This helps disguise the medication. Put this mixture into a sealable bag and throw into the trash, preferably a bin outside of your house. It is not advisable to crush pills or empty capsules beforehand because of the risk of exposure to the drug through your skin and even by breathing in the dust. Drugs are usually released slowly into the body and by exposure through crushing the immediate dosage may be much higher than normal and can be toxic.

People also like to flush drugs down the drains and toilets, especially liquids. The problem with disposing of drugs in the trash or flushing them down the drain is that at some point they will end up in a landfill or a water system, where they can be harmful to the environment; plants, animals and even humans since they will inevitably find their way back into our food chain. Interestingly though, some medications do actually indirectly end up in our water systems, without us even realizing, since the drugs we take pass through our systems, and the byproducts are eventually excreted in our urine or faeces.

In the US again they actually do allow some drugs to be flushed down the drain if they cannot be taken back to a pharmacy. These are mostly your Opioids and its derivatives, as well as the Benzos such as Valium. The risk of these getting into the wrong hands far outweighs the negative effects on the environment.

There are some special considerations with inhalers. These devices use gases to propel the medication out of the canister. Unfortunately some of these gases are powerful greenhouse gases so these definitely need to be returned to the pharmacy because if not the canisters will end up on some landfill somewhere and continue to release these gases if not completely empty.

You can also check the packaging and drug information leaflets before disposing of the medication. There may be instructions for disposal of that particular drug. Apparently such guidelines are going to be implemented in South Africa in the near future.

IS MEDICATION PACKAGING RECYCLABLE ONCE EMPTY? 

Some glass and plastic medicine bottles can be recycled depending on what type of glass and plastic resin they are made up of. The plastic parts of inhalers can usually be recycled. You should be able to confirm this with your local recycling plants. There are also lots of ways to repurpose old medicine bottles and get crafty with your little ones.

Blister packs are a little trickier because they are a combination of foil and plastic and are therefore not readily recycled in this form. You can however try to separate the parts by peeling away the foil carefully from the plastic (I actually tried this the other day and I found it almost impossible). But the plastic recycling may still be a problem because one can never (or rarely) identify the type of plastic resin used. The foil is readily recycled and so are the paper boxes that house the blister packs. Always remember to remove all personal identifiers on prescription labels before throwing packaging away.

RESOURCES

https://www.bbc.com/news/health-50215011

https://earth911.com/living-well-being/health/recycling-blister-packs/

https://www.fda.gov/consumers/consumer-updates/where-and-how-dispose-unused-medicines

https://www.guild.org.au/news-events/news/forefront/volume-7-issue-1/safe-disposal-of-unwanted-medicines

https://www.hpcsa.co.za/Uploads/Legal/legislation/medicines_and_related_sub_act_101_of_1965.pdf

https://www.iol.co.za/lifestyle/health/expired-medicines-safety-effectiveness-and-disposal-11224738

https://psnc.org.uk/services-commissioning/essential-services/disposal-of-unwanted-medicines/

 

Gas or Wood? How To Safely Keep Warm This Winter.

We are now well into winter and definitely feeling the chill! South African homes are not well equipped to withstand the cold and we have to resort to various heating appliances to stay warm during winter. This is why structural fires and carbon monoxide poisoning are so common during the winter months. Below, I outline some safety tips on keeping warm in the home.

WHEN USING A GAS HEATER

  1. Always make sure the gas heater and especially the cylinder is completely turned off before going to bed or leaving the house.

  2. Always keep the room well ventilated to avoid carbon monoxide (CO) build up.

  3. Do not use outdoor gas heaters indoors, as they may produce more CO.

  4. Make sure all components of the heater are well maintained. Ensure the gas bottle is safely secured with no leaks.

  5. Natural gas is odourless. In order to identify leaks more easily manufacturers add chemicals to give it that distinctive rotten eggs smell.  If you smell gas in your home turn off the gas cylinder and do not use an electric fan to try and remove the gas.

  6. When switching your gas heater on always start by first turning on a match or lighter and then opening the gas supply. When switching the heater off always turn the gas cylinder off first.

  7. Never move a gas heater whilst in use.

  8. Do not place anything on or over the heater, such as damp laundry items. This can result in a fire. Do not ever sit on a gas heater either as it could fall over.

  9. Do not use flammable liquids and/or aerosols near a gas heater. Do not use a gas heater in a room that has recently been painted.

  10. Make sure to keep all flammable items a safe one-metre away.

  11. Have smoke and CO detectors installed and test them regularly.

  12. Always keep a fire extinguisher in your home.

 

WHEN USING A FIREPLACE 

  1. Keep a window slightly open.  This will help prevent the room filling up with smelly smoke. It also prevents the build up of carbon monoxide (CO).

  2. Make sure the damper of your chimney is open so that the smoke can leave the house. Only close the damper once the fire is completely extinguished.

  3. Use dry wood and not wet or green wood. Wet and green wood cause more smoke.

  4. Clean out any ash from the previous fire. Thick layers of ash restrict the air supply to the fire and cause more smoke. 

  5. Use smaller pieces of wood because these create less smoke.

  6. Remember to have your chimney cleaned once a year before the winter season. Animal nests and excess soot can block the escape of smoke.

  7. Never leave a fire in the fireplace unattended. Always make sure it is completely extinguished before going to bed and/or leaving the house.

  8. Make sure the area around the fireplace is clear of potentially flammable items such as books, curtains and furniture. Keep a safe one-metre distance.

  9. Keep fireplace tools and accessories such as firelighters, matches and lighters out of a child’s reach.

  10. Use safety screens so your children can’t get burnt by hot flying embers or by touching the hot glass of a closed fireplace.

  11. Have smoke and CO detectors installed in your house and test them regularly.

  12. Always keep a fire extinguisher in your home!

CARBON MONOXIDE POISONING

It may seem counter-productive to keep a window open when you are trying to keep your home warm, but this is extremely important if you are burning a fuel, such as gas, paraffin, coal or wood to generate heat.

Carbon monoxide (CO) is a colourless and odourless gas produced by the incomplete combustion of these carbon-containing fuels. When there is too much CO in the air your body replaces the oxygen attached to red blood cells in the blood, with carbon monoxide. This is because the affinity between haemaglobin (Hb) (in the red blood cells) and carbon monoxide is much stronger than the affinity between Hb and oxygen. This can be extremely dangerous and lead to hypoxia, irreversible brain damage and eventually death.

Symptoms of carbon monoxide poisoning include:

  • Tiredness
  • Shortness of breath
  • Headache
  • Dizziness
  • Nausea or vomiting
  • Weakness
  • Confusion
  • Loss of consciousness

If carbon monoxide poisoning is suspected you need to move the victim into fresh air, either by opening all the doors and windows or getting the person outside. This will allow some oxygen to start displacing the carbon monoxide. Definitive management is however in hospital with high flow 100% oxygen so you need to call an ambulance right away.

ELECTRIC HEATERS

Some of you may have electric heaters in your homes. These are safer than using gas and fire but still not 100% safe. Electric heaters use a lot of electricity so they can easily overload circuits and cause power failures or fires.

You should never plug in more than one electrical device into the same outlet as the heater to prevent overheating and overloading. To prevent electric shocks electric heaters should not be used in rooms where moisture builds up such as bathrooms and kitchens. There is also a fire risk if flammable items such as fabric come into contact with electric heaters that have hot elements and the electric bar heaters pose an additional burn risk.

Whatever heating methods you use this winter none of them are guaranteed safe, so remember to take the necessary precautions. It is important that you teach your children about fire safety from a young age. If your little ones do get thermal burns from poking fires and other heating elements follow the principles of first aid.

To find out more about management of thermal burns you can read my previous post: https://www.oneaid.co.za/baking-with-your-little-ones-safety-and-tips-to-taking-care-of-thermal-burns/. It is also recommended that you develop a fire escape plan and make sure your children know how to safely get out of the house in the event of a fire.

RESOURCES

https://www.betterhealth.vic.gov.au/health/healthyliving/gas-heating-health-and-safety-issues

https://www.healthychildren.org/English/safety-prevention/all-around/Pages/Fire-Safety.aspx

https://www.nhs.uk/conditions/carbon-monoxide-poisoning/ https://riseandshine.childrensnational.org/how-to-protect-children-around-fireplaces/

First Aid Tips Every Mom Should Know

10 First Aid Tips Every Mom Should Know

I was recently asked by All4Women to put together my top 10 first aid tips for moms. I wanted to share these with all of you in this blog post. You can find more tips in my MiniKit Pocket Guide (https://www.oneaid.co.za/product/minikit/).

  1. Keep emergency numbers on speed dial: Every parent should know who to call in an emergency. You should also teach this to your children. Write the numbers down and stick them on your fridge or somewhere near the phone.
  2. Cuts and scrapes: Stop any bleeding by pressing firmly on the wound with a gauze or cloth. Then rinse the wound under cool running water before applying a dressing such as a plaster. Tap water is perfectly fine, you don’t need fancy antiseptic solutions.
  3. Burns: Rinse burns under cool running water for up to 20 minutes. This will prevent any further damage and reduce pain. Do not use freezing cold water or ice
  4. Bee stings: Remove the stinger if still attached and apply an ice pack to reduce swelling. Don’t use tweezers as this may squeeze out more poison. Rather scrape the stinger off with a flat-edged object such as a bankcard.
  5. Nosebleed: Lean your child forward so they don’t swallow any blood and pinch the nose closed just below the bony part. Blood can irritate the stomach and cause nausea and vomiting.
  6. Broken bones: If you suspect a broken bone don’t move the limb or apply any weight. Splint the injured limb to prevent any movement before going to the emergency room.
  7. Seizures: Never put anything into the mouth of a child who is having a seizure. This includes medicines for fever if your child is having a febrile convulsion. Roll your child onto his or her side and wait for the seizure to stop.
  8. Heat exhaustion: Get your child out of the heat and elevate his or her legs. Prevention is key so make sure your child drinks plenty of fluids before and during any activity in hot weather.
  9. Poisoning: If you suspect your child has swallowed a potentially harmful substance do not make them vomit or give them anything to eat or drink unless told to do so by emergency services. Here are 10 essential tips to prevent poisoning in your home (https://www.oneaid.co.za/10-essential-tips-to-prevent-poisoning-inyour-home/).
  10. Be prepared: Always have a well stocked first aid kit on hand so you can manage minor injuries without delay and reduce the risk of infection or severity of injury.

Be sure to follow me on Instagram @oneaidsa

Top Choking Hazards For Babies and Toddlers

We recently went to a very popular restaurant for lunch and to my astonishment there were vending machines with gumballs and other small toys, right next to the jungle gym. This is a disaster waiting to happen!

Children under 3 are at the highest risk of choking because their airways are so small. Plus, chewing and swallowing is a lot more difficult for them. They also love to put foreign objects in their mouths. There is a cylindrical tool in the US used to measure toy parts that is the same size as a young child’s throat. If a toy part fits into this cylinder it’s a choking hazard and a warning label has to appear on the toy packaging. Therefore any object smaller than 3 cm wide is a choking hazard for small children.

WHAT IS A CHOKING HAZARD?

Any object that can get caught in a child’s throat and block the airway is a choking hazard.

TOP 10 HOUSEHOLD CHOKING HAZARDS

Once your baby starts to crawl and explore, choking hazards are all of a sudden everywhere.

  1. Coins
  2. Small caps of bottles e.g. juice and water bottles
  3. Small round batteries
  4. Jewellery
  5. Buttons
  6. Toys and toy parts
  7. Balloons (uninflated or popped)
  8. Garden pebbles
  9. Nails and screws
  10. Stationary e.g. staples, paper clips and pen lids

If you have older kids too, you should keep their toys separate and make sure they learn to pack their toys away.

There are countless more choking hazards. You should probably get down on your knees and have a look at your child’s eye level. How many more choking hazards can you find?

TOP 10 FOOD CHOKING HAZARDS

Hotdogs, grapes and popcorn are the top 3 causes of choking in children under the age of 3. Young children have a hard time chewing their food since they lack the proper dentition (canines for tearing and molars for grinding). They are still trying to coordinate chewing, and as a result, often just swallow their food whole. This makes smooth, slippery, round and hard foods especially dangerous.

The foods in the list below are not recommended for children under 4 years of age. The American Academy of Pediatrics (AAP) goes even further and recommends that hotdogs, grapes and popcorn not be given to children until they are at least 5 years old.

If you do however want to give your children some of these foods, then cut them in such a way that you change their round shape. Hotdogs should be cut lengthwise before slicing and skins of other sausages removed. Grapes and other round fruit should be cut into quarters.

  1. Whole grapes, cherry tomatoes and other round balls of fruit (blueberries are ok for toddlers as they are soft to chew)
  2. Hot dogs and other sausages
  3. Popcorn
  4. Tough, large pieces of meat
  5. Fruit pips and stones
  6. Nuts and seeds
  7. Hard round sweets and caramels
  8. Raw vegetables, especially carrots
  9. Marshmallows
  10. Chewing gum

BE CAREFUL

  • Children can trip and choke more easily if playing and eating at the same time. Your child should not walk, run or lie down while eating. Children should not be distracted whilst eating. They must sit upright and concentrate on what they are doing.
  • It is also not advisable to have your young child eat in their car seat whilst you’re driving. You might not even notice if they’re choking.
  • You should always supervise your child when they are eating.

It’s important that all parents and caregivers learn first aid for choking and CPR. There are many training academies that offer such courses around the country that are usually done over one day and will make you feel more confident when dealing with childhood emergencies.

RESOURCES

Altkorn, R. et al. (2008) Fatal and non-fatal food injuries among children (aged 0–14 years). International Journal of Pediatric Otorhinolaryngology, [online] 72 pp. 1041—1046. Available from: https://www.sciencedirect.com/science/article/pii/S0165587608001298 [Accessed 24 October 2018].

CDC (2018) Choking Hazards [online]. Available from: https://www.cdc.gov/nutrition/infantandtoddlernutrition/foods-and-drinks/choking-hazards.html [Accessed 24 October 2018].

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