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Medication Disposal

With the push to manage waste pharmaceuticals in a more environmentally friendly manner, and Environmental Protection Agency (EPA) enforcement taking a step up recently, some medical facilities report tenfold cost increases for managing pharmaceutical waste. Prevention options are helping some facilities reduce these expenses.

Unwanted medication should not be disposed into the sewer system. Wastewater treatment plants can't remove drug compounds from the water. Evidence shows a connection between pharmaceuticals in wastewater and impacts on aquatic life. Concerns include hormone disruption, antibiotic resistance and other effects. Hormones from drugs cause male fish to develop female traits and change behaviors in both sexes. Some drugs are also considered acutely hazardous.

Epinephrine is one such acutely hazardous waste. It's deemed dangerous enough to be specifically listed by the EPA on their P-list. As a small healthcare facility, carefully track your current and historical epinephrine use and control its waste to avoid becoming a "Large Quantity Generator" (LQG) subject to additional EPA requirements. See pages 8-20 and 8-21 of your Quality America OSHA Safety Program Manual or pages 5-32 and 5-33 of the Dental OSHA Safety Program Manual to find out more about LQGs.

One way to reduce waste from expired epinephrine is to rotate short-dated medications to areas of high use. A particular facility used only a fraction of the epinephrine intracardiac syringes it purchased. The facility was able substitute a packaged 100 microgram per milliliter (100 mcg/ml) syringe with an 18-gauge needle affixed to the outside of the box. This allows for stock rotation and reduced hazardous waste by 13 pounds per year, a savings of $900!

Crash boxes, kits and carts are among locations with the greatest potential for products to expire and become waste. Rather than letting products expire in these areas, plan to bring items that have high use elsewhere back into circulation two to three months prior to expiration for redistribution.

Samples left by pharmaceutical representatives are often short dated or sometimes have expired. Practices can quickly accumulate expensive sample waste. For example 35 pounds of pharmaceutical samples cost one medical center $520 in disposal and sorting fees.

Make sure all samples dropped off are properly logged, and have pharmaceutical representatives agree to take back expired product. Use the "Sample Expired Medication Acceptance Agreement" located in the OSHA Watch Newsletter Resources section of Quality America's Online Resource Center for this purpose.

To find out more about disposing of drug products, check out these Quality America OSHAlert Blog Posts:

Disposing of Epinephrine
Discard Formaldehyde, Lidocaine with Epinephrine, Aluminum Chloride

Source: Minnesota Technical Assistance Program

Posted by Quality America on July 30, 2007 | Comments (4)


Is one allowed to flush pharmaceuticals into the sewage system if it is a private septic tank and does not go into a public sewage plant?

Posted by: Sue Hahn at July 31, 2007 10:04 PM

1. Who can I contact to dispose of my outdated medications? In the past we have been placing them in the regulated waste containers.

2. When all of a medication is not used and is wasted (narcotic) with a witness, where can it be wasted so as not to enter the sewer system? We use the sink?!

Thanks for the help.

Posted by: Doris Hopkins, RN at August 1, 2007 07:23 AM

Flushing pharmaceuticals into a private septic system is ill advised. The chemicals in pharmaceuticals will damage the septic system as well as pollute the environment.

The basic parts of a septic system include the septic inlet, layers in the tank (gas, scum, liquid effluent, and sludge) and an outlet to the drainage field. Waste enters through the inlet and separates into layers in the tank. Septic systems digest the suspended solids and biodegradable organic material, but are not designed to remove synthetic pollutants such as pharmaceuticals as they are resistant to biological degradation.

What you're left with is a septic tank full of dangerous chemicals that kill the bacteria which allow your septic system to function properly.

Chemicals that are in solution and don't settle out into the septic tank will release into the drain field. Here they can leach into nearby groundwater, lakes and streams.

I'm not sure where you are located so I can't say whether flushing pharmaceuticals into a septic system in your area is illegal, however the condition can spell the quick and costly destruction of a septic system. Therefore I'd recommend you pursue other options for disposing of your pharmaceutical waste.

Posted by: Sarah Alholm at August 1, 2007 11:30 AM

1. Check with your county as some have programs to dispose of outdated medications. You may also consider a reverse distribution of pharmaceuticals, which primarily involves the return of unused, outdated pharmaceuticals to the manufacturer for credit.

2. Best management practices encourage avoiding the drain disposal of any waste pharmaceuticals, with special emphasis on those that are hazardous. However, accomplishing this goal can be challenging and costly.

Controlled substances must be destroyed so that they are beyond reclamation and two health care professionals must document the destruction. Since most healthcare facilities do not have ready access to incinerators in which to burn the drugs, the next most efficient way to accomplish this is through drain disposal.

Certain states, such as California and Washington, have already prohibited the sewering of virtually any drugs. Work with your local wastewater treatment plant to determine what wastes are appropriate for discharge to the sewer system. Most POTWs (Publicly Owned Treatment Works) do not have a problem with the sewering of solutions in IV bags that only contain saline, lactate, nutrients, vitamins, potassium and other electrolytes.

If sewering of narcotics is prohibited by your local POTWs work to select a vendor whose is authorized to pick up hazardous waste and is also a DEA registrant. This can be found on page 56 here:


Influential healthcare groups are working with DEA to eliminate drain disposal, understanding the environmental impacts of managing waste pharmaceuticals.

Source: Managing Pharmaceutical Waste: A 10-Step Blueprint for Health Care Facilities In the United States, Hospitals for a Healthy Environment, April 15, 2006

Posted by: Sarah Alholm at August 13, 2007 09:59 AM

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