Published on : June 22, 2010

Pharmaceutical Waste-A New Healthcare Challenge

Pharmaceutical Waste-A New Healthcare Challenge

Chemicals in our environment have been a concern for many years. Images of leaking drums, oil spills, and smoke stacks, with billowing plumes, provides visual triggers and public outcry. Only recently has the overwhelming body of evidence about pharmaceuticals become a public health concern. Images of wildlife, with extra limbs, eyes and significant changes to their hormone regulation, are the new visual triggers for public outcry.

Let’s define what a pharmaceutical is. One common definition is as follows: A pharmaceutical drug, also referred to as medicine, medication, or medicament, can be loosely defined as any chemical substance intended for use in the medical diagnosis, cure, treatment, or prevention of disease . For this article, we will focus on hospital based drugs but the issues of environmental contamination include common items like toothpaste, deodorants, perfumes and other common household items.

Where do the pharmaceuticals polluting our environment come from and how are they getting there?

By some estimates roughly 30 percent of all pharmaceutical wastes derive from hospitals directly, with the remainder dispensed for use at home. This type of estimation is complicated due to the significant amount of material excreted from humans. This may seem like an easy problem to fix but it’s not a simple problem nor is it a small problem as sales for pharmaceuticals continues to grow. In 2006, global spending on prescription drugs topped $643 billion.

Are there regulations to prevent this? 

There are some but again, it’s not that easy. In the United States the creation of RCRA (Resource Conservation and Recovery Act)  through the US EPA in 1976, many chemicals were now regulated to prevent environmental pollution. The challenge with pharmaceuticals though is that RCRA was designed mostly for large volumes of chemicals such as rail tanker cars and 55 gallon drums. Only a handful of the chemicals considered pharmaceuticals were listed in the original regulation and many of today’s pharmaceuticals did not exist when RCRA was created. 

Similar issues occur in other countries as different regions of the world all grapple with the issues and impacts of pharmaceutical disposal. Because of the continued and growing threats to the environment and public health, many state and local governments have participated in rule-making to address the widening gap between RCRA and current scientific studies showing the risk.
An interesting variant on disposal regulations occurs with donation of medications during times of war or natural disasters, leading agencies, and countries to develop guidelines to prevent donations which will lead to unintended disposal costs.

How do we fix this?

There are a number of different strategies to address this problem and three different mechanisms to support resolution.

1.    Prevention should always be the first step in managing waste.
So how does one prevent pharmaceutical waste when we need medications? For many years, pharmaceutical companies would give free samples by the box full to market their product over competing medications. This often led to either a disposal issue in the physician’s office or at home later when patients tried the free samples and decided not to continue using them.

This has been replaced in many cases in recent years with a coupon system which physicians can dispense to their patients. These coupons are for smaller volumes and substantially reduce the amount of unwanted medications in the public waste stream.

2.     Hospitals should manage the pharmaceutical products as the hazardous substances they often are.

Many hospitals are now recognizing the need for compliance and environmental stewardship and are managing pharmaceutical waste as hazardous waste but many more still need to adopt this philosophy.

3.    There is a need for public education both for prevention and management.
Because only some of the pharmaceutical waste is sourced from hospitals, it is vital that the public be educated on how to properly dispose of waste. For many years, the advice has been to flush extra pills down the drain or mix with kitty litter and throw it in the trash. Unfortunately, both of these options create additional pollution. Landfill disposal leads to the potential for leachate reaching groundwater supplies and disposal down the drain places an impossible burden on wastewater treatment plants to filter the pollutants out. Drug-take-back efforts are in place or being developed in the United States and have also been happening in Europe, Canada, and Australia. In the United States, many different models are being employed but groups face funding challenges not just from disposal costs themselves but from the added requirement of participation by law enforcement staff as a requirement of the US DEA (Drug Enforcement Agency), over the risk of controlled substances being mishandled.

In addition to concerns about pollution, prevention of accidental poisoning from unused medicine has driven law enforcement and public healthcare agencies to participate in better education on disposal options.

How to get started

Many hospitals and clinics are now taking pharmaceutical waste disposal seriously, motivated both by regulatory attention and a concern for the environment. Choosing the best way to implement a management system is best done with a multidisciplinary team including the pharmacy, waste management staff, purchasing, and nursing. The team will need to start by reviewing the formulary against regulatory requirements. Once that has been done, the team will address how to collect the materials once dispensed to clinical areas, how to label the individual pharmaceuticals to make collection easy, how to choose and manage a disposal company and which methods of disposal they want to select.

In just a few short years, the number of alternatives available to hospitals and clinics has grown substantially. In the United States, there are now many choices of very knowledgeable consulting firms who can help guide or directly manage the process and there are a growing number of disposal companies who can handle the disposal end as well as help guide the internal implementation of a collection system.

The future-Green chemistry

Another very promising area is being explored by the pharmaceutical industry. Most of the large pharmaceutical companies are now testing the use of green chemistry in making their new products. This is resulting in a significantly smaller footprint per product. These companies are also investigating ways to make medications that are more readily biodegradable in the environment.

What can you do?

  • Ask your healthcare facility how it manages pharmaceutical disposal.
  • Dispose of your pharmaceuticals at home properly.
  • Use all antibiotics as prescribed by your doctor.
  • Ask your public health agency about drug-take-back programs.
  • Buy only as much as can reasonably be used before the expiration date.
  • When your doctor prescribes a new medication, ask the doctor to prescribe only enough to see if the medication will work for you and at the lowest dose advisable. That way, if the medication doesn't suit you, there is less to waste. Do the same for your pet's medications.
  • Wash and clean with plain soap and water, which has been demonstrated to be as effective as using antibacterial soaps.

Examples of Some RCRA regulated pharmaceuticals

Chemical name

Common medical use

 

Warfarin (Coumadin)

Used as an anticoagulant

 

Epinephrine

Used as stimulant in treating cardiac arrest, anaphylaxis

 

Nicotine

Used in smoking cessation

 

Chloral Hydrate

Sedative, hypnotic

 

Lindane

Treatment for lice and other pests

 

Phenol

Precursor to many drugs, used to treat sore throat and mouth lesions

 

Silver

Used in burn treatments for antibiotic capacity

Selenium

In medications for dry scalp and dermatitis

About the author and Badrick Consulting:

Tom Badrick is President of Badrick Consulting specializing in healthcare sustainability program design and implementation. Tom is a leader and recognized speaker in the healthcare sustainability field. Tom successfully crafted and directed the nationally recognized and award winning sustainability program for a large health system and has guided and assisted many other organizations to create or expand successful programs, as well as partnering with suppliers.

Tom has a background in Environmental, Health and Safety management, in biotech/chemical manufacturing, and the electronics industry. Badrick Consulting offers a wide range of services from program creation/development to partnering in management of specific components of a sustainability program ranging from waste management to climate change initiatives.

The Badrick Consulting web page is www.badricksustainability.com and Tom can be reached via email at tbadrick@aol.com.

1 http://en.wikipedia.org/wiki/Pharmaceutical_drug

2 http://www.epa.gov/lawsregs/laws/rcra.html