The authors use the Institutional Collective Action Framework to analyze the barriers, opposition, and opportunities for residential pharmaceutical disposal programs in the United States via a case study on a series of take-back programs pioneered in the state of Washington by local and state governments, as well as the corresponding backlash from federal agencies. While successful in some ways, these innovative solutions directly challenged the competing federal policy regimes controlled by the Drug Enforcement Agency (DEA), and, to a lesser extent, the Environmental Protection Agency (EPA). Findings from case studies suggest that functional dilemmas created by existing institutions with entrenched regulatory regimes are a key challenge to finding efficient solutions to vertical ICA dilemmas. Conclusions, then, connect to the broader ICA research agenda, and implications for multi-level governance issues.