Flushing controlled drugs Is still the best way to dispose. Unless you dissolve them in water and mix with cat litter, etc.

The pollution of fresh water is a concern. The first contaminations of waterways with drugs were found in Europe and Switzerland. It was the antibiotic Cipro and fibrates for cholesterol that I recall.

Here in Nevada they found estrogen in Lake Meade.

The technology does not exist yet to clean sewage to remove drugs.
More drugs are probably in the water supply system from human urine, not flushing excess directly.

Some drugs are not metabolized by the body at all or much at all.
Neurontin, Lyrica, Lisinopril are examples. Some drugs are excreted thru the bile, and end up in the stool. Some drugs have active metabolites, others not.

If you want to know in detail what is happening to drugs you are swallowing,
www.rxlist.com has a section called pharmacology for each drug you search.
If you scroll down, to "elimination" it will tell you.

I would think the estrogen load has gone down somewhat with the revelation of HRT being not totally safe anymore. But the birthcontrol use of hormones has not changed. Estrogen in our waterways is getting alot of attention, due to contaminants also --many chemicals have estrogenic actions. Scientists are using fish that can change to either sex as markers for this pollutant.

This whole topic has grown alot just within the last five years or so.

Interesting about the hormones from birth control and such.

Wow, maybe another reason to consider some of the new IUDS, or if it applies for someone -a more permanent option