Safe disposal of pharmaceuticals a growing concern

A growing public health concern is the presence of potentially harmful pharmaceuticals in drinking water, the result of improper disposal of waste prescription drugs. It is estimated that more than four billion prescriptions are written annually in the United States and up to 40% of drugs dispensed outside hospitals go unused, generating approximately 200 million pounds of pharmaceutical waste each year.^1,2 They are the source of both safety and environmental problems:

• Unused pharmaceuticals are a leading cause of accidental poisonings, contributing to an 80% increase in U.S. deaths from accidental overdose of narcotics between1999 and 2005.³
• Unused medications enter the water by being flushed through sewer systems that cannot, with current technology, remove them. There are no federal testing requirements or safety standards for pharmaceuticals in water, and the risks posed to the water supply are largely unknown. However, studies have found waste pharmaceuticals in the drinking water of more than 50 million Americans, and the U.S. Environmental Protection Agency is now studying 200 chemical contaminants - including 125 pharmaceuticals or related chemicals - at 50 drinking-water treatment plants, to determine whether regulations are needed.⁴

In 2007, the White House Office of National Drug Control Policy issued the first consumer guidance for the proper disposal of prescription drugs, encouraging disposal-by-mail options. These are designed to enable individual consumers and community-care facilities to dispose of unused medications, using containers of various sizes and returning packaging with prepaid postage to an authorized incineration facility. They can also be used in “take-back” programs, through which unused pharmaceuticals are returned to designated collection points, which then employ disposal by mail.

According to a 2010 Associated Press survey, at least 20 states now have collection programs for unused medications.⁵ These are among the most recent initiatives:

• California: Passed in 2009, SB 996 requires the California Department of Resources, Recycling and Recovery to develop criteria and procedures for model programs to collect and properly dispose of pharmaceutical waste, including collecting and disposing of home-generated pharmaceuticals. The board is required to report to the Legislature by December 1, 2010, on its evaluation of the cost and effectiveness of participating model programs.⁶
• Illinois: On January 1, 2010, the Safe Pharmaceutical Disposal Act (Public Act 096-0221) went into effect, prohibiting healthcare providers from disposing of unused medication in solid form into any wastewater collection system regulated by the Illinois Environmental Protection Agency. A second law approved at the same time (Public Act 096-0121) requires the state EPA and Department of Health to collaborate on a program through which people can drop off unused pharmaceutical products (including products sold by prescription and over the counter) at state-approved locations.⁷
• Iowa: In 2009 the Iowa Legislature approved the Iowa TakeAway program, allowing the Iowa Board of Pharmacy, the Iowa Pharmacy Association, and landfill operators to cooperate on disposal of unused medications. Funded with $165,000 from the Iowa Department of Natural Resources Solid Waste Alternatives Program Fund (SWAP fund), the program - which began in November 2009 - allows Iowa residents to turn in unused medication at participating pharmacies, where it is collected and then shipped to a disposal facility.^8,9
• Maine: Spurred by a state Bureau of Remediation and Waste Management study that showed prescription drugs present in the wastewater leachate at three Maine landfills, there is new impetus behind a bill carried over from the last legislative session that would require drug companies that distribute medication in Maine to collect and properly dispose of unwanted drugs in medical waste incinerators.¹⁰

The greater use of such programs requires the reeducation of the community to raise awareness of the dangers and of the solutions to the problem of waste pharmaceuticals. The more convenient the options for disposal of most medications, the more likely they will be disposed of properly. As awareness grows about the environmental and health problems that improper disposal can cause, safe and practical disposal programs are likely to continue to expand.

References

1. Laura Landro, “Incentives Push More Doctors to E-Prescribe.

Wall Street Journal

, January 21, 2009.
2. Jeff Donn, Martha Mendoza, Justin Pritchard, Associated Press. “Health facilities flush estimated 250M pounds of drugs a year.”

USA Today

website (

Flushed drugs

). Posted September 14, 2008.
3. Victoria Stagg Elliott, “FDA, CDC scrutiny follows surge in accidental opioid overdoses.”

American Medical News

. AMA website (

Opiod overdoses

). Posted February 9, 2009.
4. Jeff Donn, “Feds mull regulating drugs in water.” Associated Press. December 22, 2009. (Article posted on Yahoo News; no longer available.)
5. Mike Stark, Associated Press. “More states took in expired meds in 2009.”

Washington Post

, January 19, 2010.
6. Burton J. Kunik, “Unused pharmaceuticals: A waste management time bomb.” MSW Management website (

Waste management time bomb

). Nov.-Dec. 2009.
7. Lawrence W. Falbe, Douglas Swill, Melissa A. January, Yesenia Villasenor-Rodriguez. “No more pills down the drain: Illinois bans disposal of unused pharmaceuticals in wastewater treatment systems.” Drinker Biddle website (

Illinois ban

). August 2009.
8. SF 467 - Agriculture & Natural Resources Budget (Status: Signed/Line-Item Vetoed). (

SF467

).
9. “Iowa DNR Waste Management 2009 Legislative Update, SF 467: Ag and Natural Resource Budget Bill – Line item of $165,000 for a Pharmaceutical Collection and Disposal Pilot Program; source of funding is SWAP” (

Iowa legislative update

).
10. Susan Sharon, “DEP tests show prescription drugs leaching from landfills.” Maine Public Broadcasting Network website (

Landfill leaching

). Posted January 14, 2010.

Dr. Burton J. Kunik is Chairman and Chief Executive Officer of Sharps Compliance Corp. (www.sharpsinc.com), a provider of cost-effective disposal solutions for medical and pharmaceutical waste generated outside the hospital setting.Dr. Kunik can be reached at 713-432-0300 or at bkunik@sharpsinc.com.