Proper drug disposal becomes priority

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Tuesday, May 31, 2011
— Coprostanol. Dehydronifedipine. Tetracycline.

The words sound nasty enough that you barely want them rolling off your tongue let alone ending up in your water.

Pharmaceutical compounds and hormones are considered to be “toxics of emerging concern” because they are finding their way into the nation’s water supply, said Barb Bickford, medical waste coordinator for the state Department of Natural Resources.

Drugs enter the water when people flush them down the toilet or when they leave the body as urine. Drugs thrown into the trash could leak into the groundwater from landfills.

Wastewater treatment systems are not designed to remove pharmaceutical components from the water, so a fair amount passes into the Rock River, said Dan Lynch, Janesville’s utility director.

As residents become aware of the concerns, more effort is being made to keep pharmaceuticals out of the waste disposal stream. That means not flushing them down the toilet or putting them into the landfill, said Melissa Boehm, pharmaceutical waste project coordinator for the UW-Extension.

In Janesville, three 24-hour drop boxes for unwanted drugs will be installed within weeks. Surrounding communities such as Milton, Evansville and Beloit already have them operating.

County health and utility officials have sponsored periodic drug collections. Since June 2008, about 3,300 pounds of drugs have been collected from 2,500 people in Janesville, Lynch said.

The collections have been popular.

“People will say, ‘I’ve been saving these drugs for years and didn’t know what to do with them because we didn’t want to flush them down the toilet,’ ” Lynch said.

Officials say it’s a good idea to get the drugs out of homes to keep them from the wrong hands—young children who might ingest them, teens who might sell them or use them recreationally or criminals who might steal them.

Once collected, the drugs are kept at a police station, where the narcotics are separated from the other drugs.

The narcotics are taken to a St. Louis incinerator under police guard in a partnership with other southern Wisconsin counties.

The cost for disposal is about $2 per pound, said Rick Wietersen, groundwater program manager for Rock County.

Congress recently approved legislation that might make drug disposal easier by relaxing regulations on who can take ownership of them. Now, it is illegal for anybody but the patient whose name is on the prescription to possess a prescription drug. The federal Drug Enforcement Administration is revising regulations to adjust for the law changes.

Bickford said the 1970 federal Controlled Substances Act has hamstrung efforts to more easily dispose of drugs.

“They were so focused on preventing diversion that they didn’t even think about the disposal,” Bickford said. “But they are hearing it now.”

“All of the laws that we have now make it really complicated, and it really shouldn’t be,” Boehm said.

Boehm is working with a program funded by a two-year federal grant that allows participants to mail their drugs to an incinerator in Maine in a pre-paid envelope.

The program will be available in July for residents of 36 counties in the Lake Michigan watershed.

Others are working on a “product stewardship” program to make drug companies responsible for drug disposal.

Other programs allow unopened cancer and chronic disease drugs to be redistributed to lower-income people.

“We’re all waking up to this, and we realize we’ve got to do something,” Bickford said.

Marshfield sponsored Wisconsin’s first drug roundup in 2006, and now the state has 78 drug drop-offs, she said.

“We’ve got action on the federal level, and we could see state legislation,” Bickford said.

“Things don’t change overnight. I’m very enthusiastic.

“So much has changed in the last three years.”

Hospices continue flushing, dumping drugs

While volunteers work to round up unwanted drugs to keep them out of the water supply, a nurse across town might be flushing medications down a toilet.

Three hospice organizations in the area—HospiceCare, Mercy Hospice and Beloit Regional Hospice—all flush drugs or throw them in the trash after dissolving them in kitty litter.

Hospice officials say they have a commitment to safety, and it’s safer to get the drugs out of homes immediately. They cannot legally transport the drugs to dispose of them elsewhere because of federal law, and hospice officials say it would be a huge risk for them to do that, anyway.

A state Department of Natural Resources employee said flushing drugs is bad for the environment, but she recognizes hospices are trying to meet their commitment to safety.

The head of a state hospice organization in Madison said drug flushing and dumping is an environmental issue that hospices ignore.

One alternative is for hospices to not take responsibility for the drugs and instead educate families on how to safely dispose of them.

Jane Quinn, vice president of quality and compliance for HospiceCare, said hospices are required to have a drug disposal policy. Flushing is recommended by the Federal Drug Administration as the most efficient and immediate method.

“Anybody could get a hold of the medicines,” Quinn said. “The reason we have a disposal policy is our commitment to safety.”

Hospice staff encourage families to use other methods of disposal for non-narcotic drugs, but nurses will flush those, as well.

It would be a risk for hospice nurses to transport the controlled substance, she said.

Nancy Bracken, director of home health and hospice for Mercy Health System, said her nurses squish drugs in a baggy with water and kitty litter and put the baggy in the trash.

It’s “pasty, nasty mess” but effective, Bracken said.

Disposing of drugs is part of the hospice goal to make things as easy as possible for the family after a death, she said.

“The last thing you want is to leave a blizzard of pills for the families and say, ‘Good luck getting rid of these.’ That’s not what we’re about.”

Hospices across the country use the kitty litter-disposal method, Bracken said.

“I really don’t think that I would want my staff to be riding around with drugs in their cars,” she said.

Dan Chin, spokesman for HospiceCare, said his organization continues to look for ways to increase safety for the environment without endangering safety in homes.

“Our hands are pretty much tied in this,” he said, adding that it’s a huge problem for all health care institutions, not just hospices.

Mercy Hospital and Trauma Center has a policy that forbids flushing or putting drugs in the trash.

Joan Shadel, director of retail operations, said the hospital contracts with an outside firm that picks up expired medication and properly incinerates it.

The head of the state association for all hospices and palliative care said hospices could change their policies and don’t have a legal requirement to get rid of medications.

“There’s no reason, in my opinion, to be dumping them down the toilet,” said Melanie Ramey, executive director of The Hospice Organization and Palliative Experts of Wisconsin.

Old habits die hard, she said.

Part of the problem is confusion caused by the federal government about what is supposed to be done.

“There’s the EPA, the FDA and the DEA, so they all chime in on these things, and then nobody knows what they’re supposed to do,” Ramey said. “One says ‘Flush them.’ One says ‘No, don’t flush, take them and squish them up in kitty litter and put it in your trash.’”

Her belief?

“It’s none of the hospices’ business,” she said.

She understands that families often ask nurses what to do with the medicine. She agrees they need to be removed quickly because some criminals target homes if families thank hospice in obituaries.

Nurses could instead educate families how to best get rid of drugs, which should be easier now that 24-hour drops-offs are becoming increasingly common.

“It is an environmental issue, that’s all there is to it,” Ramey said. “It can’t continue like it’s been. It doesn’t make sense.”

Barb Bickford of the state Department of Natural Resources said hospices are well-intentioned in trying to prevent drug diversion and accidental poisoning.

“When someone dies, (the families) are not thinking very clearly,” Bickford said. “If they (hospice) could provide good, solid education for their clients, it would be a wonderful service.”

Federal law regulating controlled substances is changing, and that could lead to policy changes.

Bickford would like to see more unused cancer and chronic illness drugs returned for reuse to the state’s chronic disease registry.

“The easiest way is to flush them and get them out of there right now,” she acknowledged.

“That’s too bad,” she said. “We don’t want that.”

What to do with unused drugs

Secure boxes soon will be available for 24-hour drug drop-off at three locations in Janesville: the Janesville Police Department, Mercy Clinic East and Mercy Health Mall.

Major sponsors include the Rock County Health Department, Mercy Health System and the Janesville Police Department.

Janesville police will collect the drugs from the sites. A volunteer pharmacist will separate the narcotics from the other drugs for incineration at separate locations.

Narcotics will be taken to a St. Louis-area incinerator.

The Department of Natural Resources first recommendation for the proper disposal of drugs is to use drop boxes if available. If not, attend the nearest drug collection event.

Other advice includes:

-- Reduce pharmaceutical waste whenever possible. Take all your antibiotics as prescribed by your doctor. Buy only as much as you can use before the expiration date. Ask your doctor to prescribe only enough of a new medication to see if it will work for you. Do the same for your pet's medications.

-- Reconsider use of antibacterial products. Washing with plain soap and water has proven just as effective.

-- Donate whatever leftover drugs you can, especially those used for cancer and chronic diseases. Certain drugs can be returned to drug repositories for reuse.

Details about donating drugs is available by going online to dnr.wi.gov and searching for “donating medical items” or going to dhs.wisconsin.gov and searching for “drug repository.”

-- Never flush your pharmaceuticals and personal care products down the toilet. If no other options are available, the DNR recommends removing labels that identify the drugs and yourself and dissolving the drugs in water or grinding them and mixing them with coffee grounds or kitty litter before putting them in the trash.

-- Never burn pharmaceuticals or personal care products in a burn barrel. Hospitals used to burn hospital waste, including plastics and mercury, but that caused air pollution issues, said Barb Bickford of the DNR.

Last updated: 5:05 pm Thursday, December 13, 2012

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