Advice Veers Away From Flushing Unused Pills
At the Leesburg Pharmacy, located in a Loudoun County strip mall, a big, round fish tank sits atop the prescription counter. There are no fish inside, not even any water: The tank is a repository for unused medications. People can drop off the Vicodin that didn't get used once the pain of a root canal subsided. Or the heart pills remaining after a grandmother's death. Or an asthma inhaler that had passed its expiration date. Or an antidepressant that turned out to have unpleasant side effects.
Once a week, the tank is emptied; the drugs are packed in cartons by pharmacy personnel and ultimately incinerated by a commercial waste firm.
"Our customers are thrilled because they had no idea what else to do with this stuff," said Cheri Garvin, chief executive of the employee-owned pharmacy.
These are customers who are trying to do the responsible thing. Over the years, Americans have been alerted to the dangers of a lot of problematic waste materials -- paint thinner, batteries, air conditioners. But leftover pills can seem so small, so easily disposable, that many people routinely flush them down toilets, wash them down sinks or throw them in trash that goes to a landfill.
And then they often end up in places where they shouldn't be, like the public water supply.
The average American takes more than 12 prescription drugs annually, with more than 3.8 billion prescriptions purchased each year, according to the Kaiser Family Foundation. The most commonly cited estimates from Environmental Protection Agency researchers say that about 19 million tons of active pharmaceutical ingredients are dumped into the nation's waste stream every year.
The EPA has identified small quantities of more than 100 pharmaceuticals and personal-care products in samples of the nation's drinking water. Among the drugs detected are antibiotics, steroids, hormones and antidepressants. Last year, the Associated Press reported that trace amounts of drugs had been found in the water supplies of 24 major metropolitan areas; water piped to more than a milllion people in the Washington area had tested positive for six pharmaceuticals.
The EPA does not require testing for drugs in drinking water and has not set safety limits on allowable levels. While the minute quantities now being detected appear not to pose an immediate health risk, according to federal authorities, "there is still uncertainty about their potential effects on public health and aquatic life" over the long term, the EPA's water chief, Benjamin Grumbles, told a Senate committee last year. But the impact of long-term exposure of drugs on humans as well as on other species is less clear. Hormone-disrupting pharmaceuticals, for example, are one possible cause of a high incidence of "intersex" fish in the Potomac River basin: male smallmouth bass producing eggs, females exhibiting male characteristics.
Until recently, federal guidelines recommended that surpluses of highly toxic medications be flushed down the toilet; the same advice applied to drugs with a high potential for abuse or "diversion" -- the industry's word for what happens, for example, when kids help themselves to the OxyContin or Percocet in their parents' medicine cabinet. For other drugs, consumers have been directed to adulterate the medication by mixing it with an unpalatable substance -- such as cat litter or coffee grounds -- and put it out with the household trash.
But this spring, concerns about pharmaceuticals in the water supply led the Office of National Drug Control Policy to amend its advisory, telling consumers to avoid flushing unless the label or patient information specifies that method of disposal. The new guidelines still describe the cat-litter method of putting drugs in the trash, but they also encourage consumers to make use of community drug take-back programs.
And that's the problem: In much of the country, including the Washington area, drug take-back sites like the Leesburg Pharmacy are almost impossible to find. An informal survey of the District and 10 surrounding jurisdictions turned up no city- or county-organized drug disposal programs.
"We are farther ahead with recycling our garbage than we are with recycling drugs," said Babs Buchheister, the nursing director of Calvert County.
Fairfax and Prince William counties have prepared safe-disposal information for residents, available on county Web sites. Their advice echoes the new federal recommendations. "Like a lot of jurisdictions, we're keeping an eye on chemicals and drugs that may be in our water," said Brian Worthy, a Fairfax County spokesman. "That's the reason we're encouraging people not to flush their medications."
The Washington Metropolitan Council of Governments has studied a regional drug take-back program, according to Steve Bieber, a staff water resources manager. "It is a complicated issue, and there are a lot of potential hurdles," Bieber said. "It's just not something that's gotten to the point that we have any ideas ripe for regional consideration."
A major hurdle in any take-back program is what to do with controlled substances -- for example, morphine -- which constitute about 10 percent of all prescription medications in this country. Under Drug Enforcement Administration rules, a third party -- beyond the patient and pharmacist -- may not legally have possession of such drugs. Thus, a family member or caregiver cannot return an unused portion of a controlled substance to a take-back program on the patient's behalf. And any take-back program must have a DEA-registered representative -- a pharmacist or a law enforcement officer -- present to accept the drug.
The problem of disposal becomes especially acute for hospice providers, who often are confronted with a medicine cabinet full of painkillers after a patient dies or when a drug regimen is changed.
"There is a very delicate balance with an immediate need to avoid abuse potential versus the long-term need to protect the environment," said Catherine J. Woods of ExcelleRx, a Philadelphia medication management company that serves 800 hospices nationally. "They are both legitimate needs." Woods said hospice workers often feel forced to flush the drugs simply because there is no other convenient alternative.
Clarifying the chain-of-custody rules is one of the key changes in the Safe Drug Disposal Act, introduced in February by Rep. James P. Moran Jr. (D-Va.). The bill, co-sponsored by Rep. Jay Inslee (D-Wash.), is intended to foster state take-back programs. The bill would allow caregivers as well as the patient to turn over regulated medications for disposal in DEA-approved, government-run programs. The bill also would bar pharmaceutical companies from independently recommending flushing as a disposal method.
The goal of the bill is to eliminate obstacles to getting unwanted medication out of circulation. The growing problem of drug diversion to illicit users "makes the issue all the more compelling," said Julie Simpson, an aide to Moran. The measure would require the DEA to create five take-back models from which states may choose.
For now, instituting a take-back program requires determination and persistence. When environmental concerns led Cheri Garvin of Leesburg Pharmacy to see what she could set up, she found bureaucratic roadblocks everywhere.
"The problem with this whole take-back issue, the minute you want to do it, there are all these agencies telling you why you can't," Garvin said. "I got indignant. I said I'd find a way."
Garvin struck a deal with a company known in the industry as a reverse distributor, which already collected unsold and expired medications from her drugstore and returned them to the manufacturer for credit. Under the deal, the company would also collect medications returned by customers (which, unlike unsold drugs, cannot be returned to the manufacturer) and incinerate them at a waste-to-energy facility. (She had to scramble to find a new reverse distributor after discovering that a company she first used was putting the waste in a landfill.)
At least for now, the reverse distributor is making enough money from the credit to cover the cost of incineration. But the cost of collection and disposal is a commonly cited obstacle to setting up take-back programs. In Washington state, pending legislation would have the costs borne by the pharmaceutical industry. In Maine, which began a groundbreaking mail-back program this year, the costs are borne by a federal grant, supplemented with state funds.
Meanwhile, Garvin's fish tank stays on the counter, and customers fill it up; she believes the chain-of-custody registry she maintains complies with DEA regulations. She estimates that for every three cartons of unsold medications from her pharmacy, there are 10 from customers, which are hauled away every two months.
The program has been running for a year and a half. "People come in with grocery bags full [of drugs]," Garvin said. "They've been saving them for years, not knowing what to do. And to think, we're just a small pharmacy in Northern Virginia."
Comments: [email protected].
For Old Drugs, New Tricks
Advice Veers Away From Flushing Unused Pills
By Susan Q. Stranahan
The Washington Post
Tuesday, May 5, 2009
http://www.washingtonpost.com/wp-dyn/content/article/2009/05/01/AR2009050103243.html
At the Leesburg Pharmacy, located in a Loudoun County strip mall, a big, round fish tank sits atop the prescription counter. There are no fish inside, not even any water: The tank is a repository for unused medications. People can drop off the Vicodin that didn't get used once the pain of a root canal subsided. Or the heart pills remaining after a grandmother's death. Or an asthma inhaler that had passed its expiration date. Or an antidepressant that turned out to have unpleasant side effects.
Once a week, the tank is emptied; the drugs are packed in cartons by pharmacy personnel and ultimately incinerated by a commercial waste firm.
"Our customers are thrilled because they had no idea what else to do with this stuff," said Cheri Garvin, chief executive of the employee-owned pharmacy.
These are customers who are trying to do the responsible thing. Over the years, Americans have been alerted to the dangers of a lot of problematic waste materials -- paint thinner, batteries, air conditioners. But leftover pills can seem so small, so easily disposable, that many people routinely flush them down toilets, wash them down sinks or throw them in trash that goes to a landfill.
And then they often end up in places where they shouldn't be, like the public water supply.
The average American takes more than 12 prescription drugs annually, with more than 3.8 billion prescriptions purchased each year, according to the Kaiser Family Foundation. The most commonly cited estimates from Environmental Protection Agency researchers say that about 19 million tons of active pharmaceutical ingredients are dumped into the nation's waste stream every year.
The EPA has identified small quantities of more than 100 pharmaceuticals and personal-care products in samples of the nation's drinking water. Among the drugs detected are antibiotics, steroids, hormones and antidepressants. Last year, the Associated Press reported that trace amounts of drugs had been found in the water supplies of 24 major metropolitan areas; water piped to more than a milllion people in the Washington area had tested positive for six pharmaceuticals.
The EPA does not require testing for drugs in drinking water and has not set safety limits on allowable levels. While the minute quantities now being detected appear not to pose an immediate health risk, according to federal authorities, "there is still uncertainty about their potential effects on public health and aquatic life" over the long term, the EPA's water chief, Benjamin Grumbles, told a Senate committee last year. But the impact of long-term exposure of drugs on humans as well as on other species is less clear. Hormone-disrupting pharmaceuticals, for example, are one possible cause of a high incidence of "intersex" fish in the Potomac River basin: male smallmouth bass producing eggs, females exhibiting male characteristics.
Until recently, federal guidelines recommended that surpluses of highly toxic medications be flushed down the toilet; the same advice applied to drugs with a high potential for abuse or "diversion" -- the industry's word for what happens, for example, when kids help themselves to the OxyContin or Percocet in their parents' medicine cabinet. For other drugs, consumers have been directed to adulterate the medication by mixing it with an unpalatable substance -- such as cat litter or coffee grounds -- and put it out with the household trash.
But this spring, concerns about pharmaceuticals in the water supply led the Office of National Drug Control Policy to amend its advisory, telling consumers to avoid flushing unless the label or patient information specifies that method of disposal. The new guidelines still describe the cat-litter method of putting drugs in the trash, but they also encourage consumers to make use of community drug take-back programs.
And that's the problem: In much of the country, including the Washington area, drug take-back sites like the Leesburg Pharmacy are almost impossible to find. An informal survey of the District and 10 surrounding jurisdictions turned up no city- or county-organized drug disposal programs.
"We are farther ahead with recycling our garbage than we are with recycling drugs," said Babs Buchheister, the nursing director of Calvert County.
Fairfax and Prince William counties have prepared safe-disposal information for residents, available on county Web sites. Their advice echoes the new federal recommendations. "Like a lot of jurisdictions, we're keeping an eye on chemicals and drugs that may be in our water," said Brian Worthy, a Fairfax County spokesman. "That's the reason we're encouraging people not to flush their medications."
The Washington Metropolitan Council of Governments has studied a regional drug take-back program, according to Steve Bieber, a staff water resources manager. "It is a complicated issue, and there are a lot of potential hurdles," Bieber said. "It's just not something that's gotten to the point that we have any ideas ripe for regional consideration."
A major hurdle in any take-back program is what to do with controlled substances -- for example, morphine -- which constitute about 10 percent of all prescription medications in this country. Under Drug Enforcement Administration rules, a third party -- beyond the patient and pharmacist -- may not legally have possession of such drugs. Thus, a family member or caregiver cannot return an unused portion of a controlled substance to a take-back program on the patient's behalf. And any take-back program must have a DEA-registered representative -- a pharmacist or a law enforcement officer -- present to accept the drug.
The problem of disposal becomes especially acute for hospice providers, who often are confronted with a medicine cabinet full of painkillers after a patient dies or when a drug regimen is changed.
"There is a very delicate balance with an immediate need to avoid abuse potential versus the long-term need to protect the environment," said Catherine J. Woods of ExcelleRx, a Philadelphia medication management company that serves 800 hospices nationally. "They are both legitimate needs." Woods said hospice workers often feel forced to flush the drugs simply because there is no other convenient alternative.
Clarifying the chain-of-custody rules is one of the key changes in the Safe Drug Disposal Act, introduced in February by Rep. James P. Moran Jr. (D-Va.). The bill, co-sponsored by Rep. Jay Inslee (D-Wash.), is intended to foster state take-back programs. The bill would allow caregivers as well as the patient to turn over regulated medications for disposal in DEA-approved, government-run programs. The bill also would bar pharmaceutical companies from independently recommending flushing as a disposal method.
The goal of the bill is to eliminate obstacles to getting unwanted medication out of circulation. The growing problem of drug diversion to illicit users "makes the issue all the more compelling," said Julie Simpson, an aide to Moran. The measure would require the DEA to create five take-back models from which states may choose.
For now, instituting a take-back program requires determination and persistence. When environmental concerns led Cheri Garvin of Leesburg Pharmacy to see what she could set up, she found bureaucratic roadblocks everywhere.
"The problem with this whole take-back issue, the minute you want to do it, there are all these agencies telling you why you can't," Garvin said. "I got indignant. I said I'd find a way."
Garvin struck a deal with a company known in the industry as a reverse distributor, which already collected unsold and expired medications from her drugstore and returned them to the manufacturer for credit. Under the deal, the company would also collect medications returned by customers (which, unlike unsold drugs, cannot be returned to the manufacturer) and incinerate them at a waste-to-energy facility. (She had to scramble to find a new reverse distributor after discovering that a company she first used was putting the waste in a landfill.)
At least for now, the reverse distributor is making enough money from the credit to cover the cost of incineration. But the cost of collection and disposal is a commonly cited obstacle to setting up take-back programs. In Washington state, pending legislation would have the costs borne by the pharmaceutical industry. In Maine, which began a groundbreaking mail-back program this year, the costs are borne by a federal grant, supplemented with state funds.
Meanwhile, Garvin's fish tank stays on the counter, and customers fill it up; she believes the chain-of-custody registry she maintains complies with DEA regulations. She estimates that for every three cartons of unsold medications from her pharmacy, there are 10 from customers, which are hauled away every two months.
The program has been running for a year and a half. "People come in with grocery bags full [of drugs]," Garvin said. "They've been saving them for years, not knowing what to do. And to think, we're just a small pharmacy in Northern Virginia."
Comments: [email protected].
For Old Drugs, New Tricks
Advice Veers Away From Flushing Unused Pills
By Susan Q. Stranahan
The Washington Post
Tuesday, May 5, 2009
http://www.washingtonpost.com/wp-dyn/content/article/2009/05/01/AR2009050103243.html
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![:\](https://bluelight.org/xf/BL_Images/Orig_Emoji/wrygrin.gif "wry grin :\")
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