Pharmaceutical waste in health care is a significant and complex problem. Pharmaceutical waste disposal is heavily regulated. Whereas certain types of unused pharmaceuticals, such as controlled substances or chemotherapy have generally been disposed of following a specific protocol, nurses have historically disposed of other types of unused pharmaceuticals by flushing them down a sink drain or toilet, disposing of them in a sharps container or in “red or yellow bag” containers. A 2008 Associated Press article reported health care facilities flush 250 million pounds of unused pharmaceuticals annually down the drain. In 2002, the US Geological Survey study found contaminants, including pharmaceuticals, in 80% of the 139 streams they tested. Proper pharmaceutical disposal is a challenge that federal, state and local regulators, as well as health care professionals, need to address. Unused pharmaceuticals may fall under many different categories such as regulated medical waste, hazardous waste, and controlled substances. One way to deal with this issue at a health care facility is to carefully segregate and appropriately dispose of the unused pharmaceuticals by well-trained employees, be it by nurses, pharmacy staff or other designees. Segregation of unused pharmaceuticals could occur at the generation site or in a central area. Labeling, education and training regarding unused pharmaceutical waste segregation and disposal would be key. Many environmental professionals agree that the best ultimate disposal is appropriate incineration. Although far from ideal, as some waste will escape in the ash and smoke, this method appears to be a common practice currently if the pharmaceutical cannot be redistributed. As always, follow all local, state and federal regulations regarding proper pharmaceutical waste disposal.