Drug disposal

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This is a drug disposal receptacle in the lobby of a hospital. Drug disposal receptacle.jpg
This is a drug disposal receptacle in the lobby of a hospital.

Drug disposal is the discarding of drugs. Individuals commonly dispose of unused drugs that remain after the end of medical treatment. [1] Health care organizations dispose of drugs on a larger scale for a range of reasons, including having leftover drugs after treating patients and discarding of expired drugs. Failure to properly dispose of drugs creates opportunities for others (of whom the drug is unintended) to take them inappropriately. [1] Inappropriate disposal of drugs can also cause drug pollution. [1] [2]

Contents

People dispose of drugs in various ways; even organizations with expertise on drugs may give inconsistent information to consumers about drug disposal. [3] Proper waste management system including distribution, control, and disposal not only helps the Healthcare Centres but also promote environmental health. [4]

Sources of drugs

Medication waste includes both hazardous and non-hazardous waste, controlled substances, and expired pharmaceuticals. [5]

Medication waste can come from multiple levels in the drug's lifespan. First, it can come from production factories from where they were created. This includes unwanted pharmaceutical ingredients and materials that can no longer be used in the drug manufacturing process. [6] Second, medication waste can be generated from healthcare facilities including hospitals, clinics, and pharmacies. Medication waste from this source can be from over prescribing of drugs from healthcare providers, hospital labs, expired drugs, opened drug containers and partially used medications. [5] Furthermore, these wastes can include materials, such as syringes, vials, IV bags, and tubing that contain excess drugs or contaminated in the process of handling hazardous pharmaceuticals, such as chemotherapy drugs. [6] Some states have regulations that require healthcare facilities to destroy unused medications. [7] Lastly, pharmaceutical waste can come from excessive consumption of over-the-counter medications from patients. [8]

Sometimes normal use of a drug can result in waste. For example, when someone uses a dermal patch, after the patch is used, it will still retain significant potency, necessitating safe disposal. [9]

Reasons for disposal of drugs

Medical authorities advise that consumers not store any drug that they would not have a reason at present to possess. [1] Storing drugs creates a possibility that someone will use them inappropriately and suffer harm. [1] Accidental ingestion of medications prescribed for another individual is a leading source of poisonings in American households. According to Poison Control Centers in the United States, in 2007 approximately 23,783 of 255,732 cases involving inappropriate medication use were associated with inadvertent exposure. [10] 5,000 of these cases involved children under the age of 6 years old. [10] Due to the variations in the way children's bodies metabolize drugs, medication poisoning in children can be extremely fatal. [11]

Methods for disposal

Disposal for individuals and communities

The most obvious way for individuals to dispose of drugs is through the household waste management service. [1] Experts advise checking other options first because simply discarding drugs with other trash creates the possibility that someone could use them and be harmed. [1] Medical authorities recommend against disposing of drugs by passing them on to other consumers. [9]

The best source of local advice will be the community pharmacy. [1] Pharmacies already handle drugs and will recommend what sort of disposal method is most appropriate. [1] Many pharmacies will collect drugs and dispose of them as a community service. [1] Some regions have special government services that offer to take back and dispose of drugs. [1] Sometimes, either a pharmacy or government service will provide a way to mail drugs to a special drug disposal facility. [1] If there are no other options and one must put drugs into the trash, a recommended safer way to do so is by mixing the drug with unattractive trash. [1] Putting pills into the toilet can cause drug pollution, but this might be justified as a way to quickly dispose of dangerous drugs. [1]

There have been many attempts in the United States to encourage consumers to bring their leftover drugs to disposal centers. [12] Some examples of disposal programs include having a special event at a community center with prior advertisements for people to bring their drugs to the event, or otherwise educating individuals and concerned organizations about the correct way to dispose of drugs. [12] One study reviewing the efficacy of these programs found that their impact was too low to have the desired result of decreasing community access to leftover drugs. [12]

Disposal for organizations and industry

Disposal of large amounts of drugs can cause drug pollution and negatively impact the environment. [13] Organizations might choose to dispose of large amounts of drugs by returning them to the manufacturer, putting them in landfills, using Incineration, or dumping the drugs into sewers. [13]

Disposal of controversial drugs

Drugs associated with substance abuse and prohibited drugs receive special attention in their disposal. [14] The police might seize such drugs as contraband, and then have to destroy them. [14] In other cases, some legal drugs create risks for abuse and need more attention in disposal than drugs that are not attractive for abuse. [15] It is challenging for governments to discuss how to properly dispose of controversial drugs. [15]

One small regional study in the United States reported the outcomes of a public health program to take back unused opioids. [16] This study found that individuals who returned opioids tended to return more than half of what they were prescribed, which could be an indication that these people had twice as much medication as they wanted. [16] The study was too limited to form a general conclusion, but it provided information to guide further discussion and research on whether people would participate in opioid take-back programs, what sorts of drugs are more likely to be returned, and how much people would return. [16]

There is a list of medications in which the U.S. Food and Drug Administration recommends to be disposed of via flushing down the toilet if consumers are unable to take these drugs to a drug take-back program. These medications contain controlled substances that are dangerous to pets and other people in the home and should be disposed of immediately when no longer needed. Examples include Dilaudid (hydromorphone hydrochloride) tablets, fentanyl patches and morphine sulfate oral solution. [17] In 2016, a Harvard University study found unsafe levels of poly-fluoroalkyl and perfluoroalkyl substances (PFASs) (industrial chemicals associated with cancer, hormone malfunction, and several health problems) in the drinking water of 6 million Americans. [18] These products should immediately flush due to high potential for abuse and overdose. [19]

Worldwide drug disposal practices

European Union

In 2001, the European Parliament released a Directive regarding the disposal practices of medicinal products. [20] Directive 2001/83/EC stated that the outer packaging of medications needed to include special disposal precautions. [20] In 2004, the EU put out another directive that further clarified the 2001 directive and called for establishment of medication collection protocols and information regarding specific collection protocols for the state or country be placed on the packaging. [21]

United Kingdom

As outlined in National Health Service SI 2014/349: The National Health Service (Pharmaceutical and Local Pharmaceutical Services) Regulations 2013, local pharmacies are obligated to take back unused and unwanted medications generated in the home. [22] Per these same regulations, pharmacies are responsible for sorting the medications and returning them to the NHS. [22]

Canada

Canada has no specific nationwide drug take back or disposal policy, but most provinces have individual plans. [23] Most pharmacies in Canada can take back unused and expired medications any day of the year. [24]

Australia

According to the Return Unwanted Medicines (RUM) project in Australia, many of the medicines can be placed directly in the disposal bins except for opioids which must be stored separately. The pharmacist must be known as sorting material of medications for appropriate disposal. [25]

Asian Regions

Unused or Expired medications are stored in the households and disposed of in the trash or flushed into the toilets among the Asian countries such as Malaysia, Bangladesh, Thailand. [26] [27]

National Regulations in the United States

In the United States, used prescriptions are serious safety concerns because they can be accidentally ingested, overdosed or diverted for illegal use.

To address these concerns, the Drug Enforcement Administration (DEA) created the National Take Back Initiative. [28] Drug Take-Back Days occur twice annually in April and October. [29] The take-back events are part of a mission to create safe medication disposal sites, prevent drug diversion or transfer of the prescribed drug for illicit use, and provide education for the public. [29] In April 2021, the program reported the collection of 420 short tons (380,000 kg) of drugs at 5,060 sites around the country. [28] Additionally, The National Association of Drug Diversion Investigators (NADDI) sponsors a website to locate Rx Drug Drop Boxes for safe medication disposal outside of National Prescription Drug Take-Back Days.

Secure and Responsible Drug Disposal Act of 2010

Congress approved an amendment to the Controlled Substances Act in 2010. The law provides the DEA with the option to develop a permanent process for people to safely and conveniently dispose of their prescription drugs. President Barack Obama signed the Secure and Responsible Drug Disposal Act of 2010, and the DEA immediately began installing regulations for a more permanent solution. [30] The law prohibits the disposal of controlled substances unless a member of law enforcement has authorization from the DEA to directly receive and dispose of the controlled substance. This bars drug take-back programs from being able to receive and dispose of controlled medications for members of the public, which in turn can lead to the potential misuse of these drugs. Misuse of prescription medications has been a growing epidemic, with deaths from opioids quadrupling since 1999. [31] It was shown that in 2006, about 1/3 of new prescription drug abusers were 12-17-year-olds. [32] With these statistics, Congress decided to take an active role in trying to make drug take-back programs more readily available. Therefore, the "Secure and Responsible Drug Disposal Act of 2010" was created to allow the Attorney General permission in creating new policies to provide citizens "convenient and safe" disposal of their unwanted medications to authorized people or facilities. [32] Congress created this act with a goal of preventing drug diversion and environmental harm/pollution by these drugs. [32]

Other Take Back Programs

In addition to the drug disposal of 2012, other national agencies have also promoted the use of the drug take-back programs. In 2011, White House announced the first national Prescription Abuse Prevention Plan. The Prescription Abuse Prevention Plan expanded support to the prescription drug disposal programs and decreased the supply of unused prescription drugs. [33] The U.S. Environmental Protection Agency (EPA) also encouraged the use of prescription drug disposal programs with guidelines for household disposal of medication and recommendations on the incineration of the household pharmaceutical product. [34] The American Pharmacist Association and Pharmaceutical Research and Manufacturers of America also partnered with the U.S. Fish and Wildlife Service to raise awareness for consumers to properly dispose of medication. The campaign encouraged consumers to not flush unused medications or pour them down the sink. The campaign also recognized pharmacists' role to inform consumers of the different disposal techniques and which medications are appropriate for flushing. [35]

Examples of State Regulations

Alameda County Safe Drug Disposal Ordinance

Alameda County was the first county in the United States to make the manufacturer pay for safe disposal of pharmaceutical waste. This ordinance required companies that manufacture drugs sold and distributed in Alameda County must operate and pay for a "Product Stewardship Program." [36] Examples of these programs include a drug kiosk or mail-back program and volunteer collectors, such as law enforcement and pharmacies. [37] Due to this program 8 other counties in California adopted similar programs, including San Mateo, Santa Barbara, Santa Clara, Marin, Los Angeles, Santa Cruz, Sonoma, Contra Costa, San Luis Obispo, and Tehama Counties. [38]

California State Board of Pharmacy

In California, entities including pharmacies in retail and hospital settings may host drug take-back programs as long as they follow requirements under Article 9.1 of Division 17 of Title 16 of the California Code of Regulations. [39] These pharmacies are required to register with the Drug Enforcement Administration (DEA) and notify the Board of Pharmacy and DEA within 30 days of starting or stopping a program. [39] These pharmacies must have collection receptacles located in authorized locations and have liners that are certified to meet American Society for Testing Materials standards. [39] The pharmacies must also follow protocols like accepting prescription drugs to be sent back to an authorized DEA destruction site and no employee can be part of the program if they have a history with controlled substance-related felonies. [39] The pharmacy may not sort, count, or review the unwanted prescription medications once collected and they are required to report tampering of any receptacles to the Board of Pharmacy within 14 days. [39] It is important to note that these pharmaceutical take-back programs only take prescription medications, not drug samples or medical waste. [39]

California Senate Bill 212

On September 30, 2018, California passed SB 212: Solid waste: pharmaceutical and sharps waste stewardship. [40] Similar to the Alameda County Ordinance, this is a statewide drug and needle program funded by manufacturers or distributors. The bill requires that these entities create their own stewardship program or be part of a stewardship program, which will be approved by CalRecycle. [40] The bill mandates a minimum of 5 collection sites per county or if the county is larger it requires 1 per 50,000 people. [40] They also require retail pharmacies to serve as an "authorized collector." Authorized collectors serve their counties in one location or 15% of store locations in the county, depending which is greater. [40] The bill will begin January 2019, with approvals by CalRecycle completed and implementation of the programs started January 2021. [40]

See also

Related Research Articles

<span class="mw-page-title-main">Controlled Substances Act</span> United States drug-regulating law

The Controlled Substances Act (CSA) is the statute establishing federal U.S. drug policy under which the manufacture, importation, possession, use, and distribution of certain substances is regulated. It was passed by the 91st United States Congress as Title II of the Comprehensive Drug Abuse Prevention and Control Act of 1970 and signed into law by President Richard Nixon. The Act also served as the national implementing legislation for the Single Convention on Narcotic Drugs.

<span class="mw-page-title-main">Over-the-counter drug</span> Medication available without a prescription

Over-the-counter (OTC) drugs are medicines sold directly to a consumer without a requirement for a prescription from a healthcare professional, as opposed to prescription drugs, which may be supplied only to consumers possessing a valid prescription. In many countries, OTC drugs are selected by a regulatory agency to ensure that they contain ingredients that are safe and effective when used without a physician's care. OTC drugs are usually regulated according to their active pharmaceutical ingredient (API) and strengths of final products.

<span class="mw-page-title-main">Pharmacy</span> Clinical health science

Pharmacy is the science and practice of discovering, producing, preparing, dispensing, reviewing and monitoring medications, aiming to ensure the safe, effective, and affordable use of medicines. It is a miscellaneous science as it links health sciences with pharmaceutical sciences and natural sciences. The professional practice is becoming more clinically oriented as most of the drugs are now manufactured by pharmaceutical industries. Based on the setting, pharmacy practice is either classified as community or institutional pharmacy. Providing direct patient care in the community of institutional pharmacies is considered clinical pharmacy.

<span class="mw-page-title-main">Prescription drug</span> Medication legally requiring a medical prescription before it can be dispensed

A prescription drug is a pharmaceutical drug that is permitted to be dispensed only to those with a medical prescription. In contrast, over-the-counter drugs can be obtained without a prescription. The reason for this difference in substance control is the potential scope of misuse, from drug abuse to practicing medicine without a license and without sufficient education. Different jurisdictions have different definitions of what constitutes a prescription drug.

Walgreen Company is an American company that operates the second-largest pharmacy store chain in the United States, behind CVS Health. It specializes in filling prescriptions, health and wellness products, health information, and photo services. It was founded in Chicago in 1901, and is headquartered in the Chicago suburb of Deerfield, Illinois. On December 31, 2014, Walgreens and Switzerland-based Alliance Boots merged to form a new holding company, Walgreens Boots Alliance. Walgreens became a subsidiary of the new company, which retained its Deerfield headquarters and trades on the Nasdaq under the symbol WBA.

Drug diversion is a medical and legal concept involving the transfer of any legally prescribed controlled substance from the individual for whom it was prescribed to another person for any illicit use. The definition varies slightly among different jurisdictions, but the transfer of a controlled substance alone usually does not constitute a diversion, since certain controlled substances that are prescribed to a child are intended to be administered by an adult, as directed by a medical professional. The term comes from the "diverting" of the drugs from their original licit medical purpose. In some jurisdictions, drug diversion programs are available to first time offenders of diversion drug laws, which "divert" offenders from the criminal justice system to a program of education and rehabilitation.

An online pharmacy, internet pharmacy, or mail-order pharmacy is a pharmacy that operates over the Internet and sends orders to customers through mail, shipping companies, or online pharmacy web portal.

<span class="mw-page-title-main">Pharmacy (shop)</span> Shop that provides pharmaceutical drugs

A pharmacy is a premises which provides pharmaceutical drugs, among other products. At the pharmacy, a pharmacist oversees the fulfillment of medical prescriptions and is available to counsel patients about prescription and over-the-counter drugs or about health problems and wellness issues. A typical pharmacy would be in the commercial area of a community.

Electronic prescription is the computer-based electronic generation, transmission, and filling of a medical prescription, taking the place of paper and faxed prescriptions. E-prescribing allows a physician, physician assistant, pharmacist, or nurse practitioner to use digital prescription software to electronically transmit a new prescription or renewal authorization to a community or mail-order pharmacy. It outlines the ability to send error-free, accurate, and understandable prescriptions electronically from the healthcare provider to the pharmacy. E-prescribing is meant to reduce the risks associated with traditional prescription script writing. It is also one of the major reasons for the push for electronic medical records. By sharing medical prescription information, e-prescribing seeks to connect the patient's team of healthcare providers to facilitate knowledgeable decision making.

<span class="mw-page-title-main">Opioid overdose</span> Toxicity due to excessive consumption of opioids

An opioid overdose is toxicity due to excessive consumption of opioids, such as morphine, codeine, heroin, fentanyl, tramadol, and methadone. This preventable pathology can be fatal if it leads to respiratory depression, a lethal condition that can cause hypoxia from slow and shallow breathing. Other symptoms include small pupils and unconsciousness; however, its onset can depend on the method of ingestion, the dosage and individual risk factors. Although there were over 110,000 deaths in 2017 due to opioids, individuals who survived also faced adverse complications, including permanent brain damage.

<span class="mw-page-title-main">Environmental impact of pharmaceuticals and personal care products</span> Effects of drugs on the environment

The environmental effect of pharmaceuticals and personal care products (PPCPs) is being investigated since at least the 1990s. PPCPs include substances used by individuals for personal health or cosmetic reasons and the products used by agribusiness to boost growth or health of livestock. More than twenty million tons of PPCPs are produced every year. The European Union has declared pharmaceutical residues with the potential of contamination of water and soil to be "priority substances".[3]

Electronic Prescriptions for Controlled Substances (EPCS) was originally a proposal for the DEA to revise its regulations to provide practitioners with the option of writing electronic prescriptions for controlled substances. These regulations would also permit pharmacies to receive, dispense, and archive these electronic prescriptions. These proposed regulations would be an addition to, not a replacement of, the existing rule.

<span class="mw-page-title-main">Environmental persistent pharmaceutical pollutant</span> Environmental term

The term environmental persistent pharmaceutical pollutants (EPPP) was first suggested in the nomination in 2010 of pharmaceuticals and environment as an emerging issue in a Strategic Approach to International Chemicals Management (SAICM) by the International Society of Doctors for the Environment (ISDE). The occurring problems from EPPPs are in parallel explained under environmental impact of pharmaceuticals and personal care products (PPCP). The European Union summarizes pharmaceutical residues with the potential of contamination of water and soil together with other micropollutants under "priority substances".

The National Take Back Initiative is a voluntary program in the United States, encouraging the public to return excess or expired drugs. The take back events occur twice annually, in the spring and in the fall. The program is coordinated by the Drug Enforcement Administration (DEA).

<span class="mw-page-title-main">Opioid epidemic in the United States</span> Ongoing overuse of opioid medication in the US

There is an ongoing opioid epidemic in the United States, originating out of both medical prescriptions and illegal sources. It has been called "one of the most devastating public health catastrophes of our time". The opioid epidemic unfolded in three waves. The first wave of the epidemic in the United States began in the late 1990s, according to the Centers for Disease Control and Prevention (CDC), when opioids were increasingly prescribed for pain management, resulting in a rise in overall opioid use throughout subsequent years. The second wave was from an expansion in the heroin market to supply already addicted people. The third wave starting in 2013 was marked by a steep 1,040% increase in the synthetic opioid-involved death rate as synthetic opioids flooded the US market.

An unused drug or leftover drug is the medicine which remains after the consumer has quit using it. Individual patients may have leftover medicines at the end of their treatment. Health care organizations may keep larger amounts of drugs as part of providing care to a community, and may have unused drugs for a range of reasons. The unused drugs should be destroyed utterly to eliminate the toxic effects of undisposed drugs on flora and fauna. The improper disposal of unused drugs could be the reason for the contamination of Surface, Ground and Drinking Water. Discharge of unused antibiotics and disinfectants in the sewage system may ruin the aquatic life or contamination of drinking water.

Drug recycling, also referred to as medication redispensing or medication re-use, is the idea that health care organizations or patients with unused drugs can transfer them in a safe and appropriate way to another patient in need. The purpose of such a program is reducing medication waste, thereby saving healthcare costs, enlarging medications’ availability and alleviating the environmental burden of medication.

<span class="mw-page-title-main">Opioid epidemic</span> Deaths due to abuse of opioid drugs

The opioid epidemic, also referred to as the opioid crisis, is the rapid increase in the overuse, misuse/abuse, and overdose deaths attributed either in part or in whole to the class of drugs called opiates/opioids since the 1990s. It includes the significant medical, social, psychological, demographic and economic consequences of the medical, non-medical, and recreational abuse of these medications.

<span class="mw-page-title-main">Prescription drug addiction</span> Medical condition

Prescription drug addiction is the chronic, repeated use of a prescription drug in ways other than prescribed for, including using someone else’s prescription. A prescription drug is a pharmaceutical drug that may not be dispensed without a legal medical prescription. Drugs in this category are supervised due to their potential for misuse and substance use disorder. The classes of medications most commonly abused are opioids, central nervous system (CNS) depressants and central nervous stimulants. In particular, prescription opioid is most commonly abused in the form of prescription analgesics.

Harm reduction consists of a series of strategies aimed at reducing the negative impacts of drug use on users. It has been described as an alternative to the U.S.'s moral model and disease model of drug use and addiction. While the moral model treats drug use as a morally wrong action and the disease model treats it as a biological or genetic disease needing medical intervention, harm reduction takes a public health approach with a basis in pragmatism. Harm reduction provides an alternative to complete abstinence as a method for preventing and mitigating the negative consequences of drug use and addiction.

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