Last Saturday, several sites in the Spokane-Coeur d’Alene area, including Fairchild Air Force Base, participated in the National Prescription Take Back Day. That’s the day when you can throw all of your old, unused prescription drugs in a bag and bring them to participating sites for disposal. Municipal water officials say it’s a better solution than flushing them down the toilet.
Many cities in the U.S. have found unusually high levels of the compounds found in prescription drugs in public water supplies. Andrew Maher is a compliance inspector with the hazardous waste program for the Washington Department of Ecology.
“Pharmaceutical waste is very prevalent, certainly at hospitals or long term care facilities that we visit. It’s a wide range," Maher said. "It’s not just the medications and the pills that everyone thinks of. There’s things like epinephrine, nitroglycerin, chemotherapy wastes, inhalers, ointments, creams and even vitamin and mineral preparations that you wouldn’t necessarily think of as a pharmaceutical.”
“And then do they all have their own specific ways of disposing of them?” Nadvornick said.
“Yeah, the disposal depends on the overall toxicity and danger of the waste itself," Maher said. "Epinephrine is what we call a P-listed waste if it’s not used, which is our highest category of waste. It’s a very dangerous material to have around people that don’t need it or shouldn’t be having it. And that goes along with a lot of those other things, controlled substances, nicotine, Warfarin. You really don’t want those getting into the hands of the folks that don’t need them or shouldn’t have them. So there’s a couple of different options.”
Those options are spelled in out in a thick binder of state rules, which tells you about the layers of regulation around pharmaceutical waste. Maher says the Environmental Protection Agency is rewriting federal rules regarding the disposal of pharmaceutical waste and he doesn’t think that process will go away even given the uncertainty around EPA. Meanwhile, the state has written an interim pharmaceutical waste policy.
“This is an attempt to get folks in our state ready for some of the changes that are coming from the EPA in the next couple of years. It gives some options on how to manage some of these things. For example, controlled substances are now able to be rendered unusable at a facility, collected and then disposed of without having to go down the drain,” Maher said.
“What’s the harm in flushing my extra pills down the toilet?” Nadvornick asked.
“Most pharmaceuticals or drugs are designed, in some way shape or another, to harm something, whether it’s a disease or a virus, biological, whatever it is," Maher said. "Drugs tend to do damage to natural systems. Drugs being in high levels in our water and in our soil, those can result from drugs not being properly disposed of. They can end up in the sewer, which eventually lead to the rivers and these are chemicals that don’t occur naturally in our rivers.”
“And does the Spokane River, some of the waterways in this area, have that issue with excess pharmaceuticals there?” Nadvornick asked.
“In our area, our wastewater treatment folks, both at the county and the city have been proactive on helping hospitals and long-term care facilities not discharge things down the sewer,” Maher said.
“Let’s pick a few things on this list: nitroglycerin, Warfarin, nicotine. What is the general accepted way to get rid of those things?” Nadvornick asked.
“The best way to get rid of those is at the hospital facilities," Maher said. "They have the option of, if the medication is still viable, they can send it through a reverse distributor back to their supplier. And that is a good option. It allows that medication to be used by somebody else if there’s a need for it. It doesn’t count as a waste from the facility because it’s still a viable product. So they don’t have to count toward their generator status.
"And sometimes things like epinephrine, we have epinephrine pens where the pen has expired, is no longer viable, and those need to be shipped off site. And, depending on the size of the facility, the best option would be to either use either a vendor or take advantage of the interim waste policy, which allows you to collect and dispose of them without counting them against your generator status,” he said.
“So help me understand generator status. What does that mean?” Nadvornick asked.
“That’s the term that we use to classify facilities and it’s based upon how much dangerous waste they generate in any given month," Maher said. "Generators who produce between zero and 220 pounds a month are called ‘small quantity generators’ in Washington. Any generator that produces between 220 and 2,200 pounds is a ‘medium quantity generator’ and then anyone over 2,200 pounds per month is a ‘large quantity generator.’"
“What’s the significance of being a small generator or a medium or a large?” Nadvornick asked.
“Our ‘small quantity generators’ have the least stringent regulations. Their regulations are basically to make sure that they have designated all of their waste," Maher said. "And then they need to make sure it’s handled properly at their facility. Having all of the containers closed and having things labeled so that folks know what’s in them. And then making sure it goes to a correct disposal location. If it’s a pharmaceutical and they’re just a dangerous waste here in our state, they can go to incinerators in our state.
"But then ‘medium quantity’ and ‘large quantity’ generators have more stringent regulation and have a specific time they can accumulate waste before it has to be sent off site,” he said.
“So you made reference to incinerators. Are there specific incinerators for burning this kind of stuff?” Nadvornick asked.
“If it’s a state-only waste, it can go to a municipal incinerator. Our waste-to-energy plant is a municipal incinerator," Maher said. "If it’s a federal dangerous waste pharmaceutical, then it would need to go a federally-designated incinerator. There’s three or four around the country. The closest one to us, I believe, is in Utah.”
Andrew Maher says the Drug Enforcement Administration and Food and Drug Administration periodically hold ‘take back’ events, such as those held last Saturday. If you can’t make it one of those, he says you can dispose of those drugs yourself by taking some special steps.
“Mixing it with coffee grounds or kitty litter or some of those other things and then disposing of it in your municipal waste," Maher said. "You want to try to make it so it’s irretrievable, so you don’t have people trying to take it out of the garbage can and use it. You don’t really want to crush it, but you can mix in the pills with something that someone’s not really going to want to dig through to find your old medication.”
The Food and Drug Administration has information about how to dispose of unused medicines on its website at fda.gov.