The occurrence and fate of pharmaceuticals in landfills has been largely neglected. Once discarded in municipal solid waste (MSW), pharmaceuticals within a landfill may undergo degradation, adsorption, or enter the leachate and eventually exit the landfill. The active pharmaceutical ingredient (API) concentration of MSW was predicted using available statistics on medication usage and directly measured by a MSW composition study. Estimation calculations resulted in a potential concentration of APIs from 7.4 to 45 mg/kg of MSW, varying with the percentage of dispensed medications assumed to become unused. Direct measurement resulted in the collection of 22 APIs comprising a total of 22,910 mg. This resulted in a final concentration of 8.1 mg/kg within MSW. Additionally, 45 empty medication containers were collected which potentially contained 33 differing APIs upon disposal.