Warner Pacific College
May 15, 2014
Response Paper Workshop Three
As a nation we are progressively facing an ethical issue, the proper disposal of prescription drugs that have not been used or have expired. This has become an urgent public health issue in the U.S. as the rate of prescription drug abuse rises, along with accidental poisoning, and the prevalence of chemicals found in the drinking water has gained nationwide attention. Most recent example of fluoride in the water to prevent childhood tooth decay was voted down in Portland, Oregon to keep chemicals out of the water. Consumers want to know how to keep their water pure but at the same time they want to know how to keep their loved ones and community at large safe from medication diversion. “Disposal of unused prescription drugs, and controlled substances in particular, is a complicated issue. Unused drug take-back programs are emerging across the country as one strategy for reducing drug abuse, accidental poisoning, and flushing drugs into the water supply. Current laws and regulations regarding controlled substances, however, limit these programs from accepting all drugs without strict oversight from law enforcement” (Avalere 2008).
The Drug Enforcement Agency (DEA) has regulations that state who can handle controlled substances, and more challenging how to dispose of unused or expired drugs. The law and regulations specifically does not allow pharmacies, providers, and hospitals from collecting controlled substances from patients. Meaning if a patient had been already dispensed a controlled substance and on the rare occasion, a provider may want to change treatment, the provider is unable to take possession of the unused medications prior to the patient picking up a new prescription. In these situations, general rule of thumb is that the patient may be asked to dispose of the medication in the provider’s presence. In compliance with U.S. Food and Drug Administration (FDA) guidelines and the Controlled Substances Act (CSA) opiate disposal down the drain sewer (flushing) is an acceptable destruction option. That same destruction method would also apply to fentanyl patches. Unused patches are to be removed from their pouches, folded so that the adhesive side of the patch adheres to itself, and flushed down the toilet.
Under the Resource Conservation and Recovery Act (RCRA), the EPA regulates the production, storage, transport, treatment, and disposal of pharmaceutical wastes that are defined as hazardous. Some common examples of prescription medications that are hazardous when disposing of them include nitroglycerin, warfarin, and some chemotherapy agents. It is estimated that approximately that five percent of pharmaceuticals are listed as hazardous. Local, state, and federal protocols vary and control disposal practices. Law enforcement officers, under supervision of the DEA, are able to accept controlled substances at take-back events. Due to budgets these take-back events are held inconsistently across the nation less than twice per year. The DEA has outlined proper disposal methods on their website but, many patients hold onto unused/expired prescriptions “just in case” or due to lack of education on how to dispose of them properly.
As can be imagined this ownership can pose several risks related to diversion, accidental overdose, and ingesting of expired substances. The existence of these unused or expired prescriptions are directly tied to the growing rates of prescription drug abuse among Americans and teenagers in general. Teenagers often succumb to Superman complex; invincibility, and/or mistakenly believe that it is safer to use prescription drugs than street drugs. “Nearly 60 percent of people ages 12 and older obtain prescription painkillers for free through friends or family” (Avalere 2008). The growing rate of prescription drug abuse is propelling demand for a much needed thorough and functional drug disposal program. Thanks in part to the White House Office of National Drug Control Policy (ONDCP) National Anti-Drug Media Campaign more parents are aware of this issue.
“To date, scientists have identified numerous pharmaceutical compounds at discernable concentrations in our nation’s rivers, lakes, and streams” (EPA, Aug. 2008). The EPA has been researching how the drugs are entering waterways and what dynamics contribute to the situation since 2007. The research on unused or expired prescription medications does not include what has been excreted through human waste or void. The EPA has also been working diligently with local, state, and federal agencies to better understand the consequences of surfacing chemicals or contaminants detected in our water (drinking, waste, surface, and ground). As well as continues to actively evaluate routes and levels of exposure, and potential effects on public health and aquatic life. At this point in time, there is little data suggesting the public and aquatic health is at risk due to these pharmaceutical chemicals. The data does suggest there is more risk in diversion, abuse, and poisoning. Local, state, and federal government really need to take on the responsibility for achieving the goal of a controlled substances disposal system.
Avalere (2008). Safe disposal of unused controlled substances: current challenges and opportunities for reform. Retrieved from: http://www.ncdoi.com/osfm/safekids/Documents/OMD/SafeDisposalOfUnusedControlledSubstancesReport.pdf
American society of consultant pharmacists (2014). Pharmaceutical waste practice resource center. Retrieved from: https://www.ascp.com/articles/pharmaceutical-waste-practice-resource-center
Environmental protection agency (2007-2009). Health care industry unused pharmaceuticals detailed 2007-2009 data collection and outreach. Retrieved from: http://water.epa.gov/scitech/wastetech/guide/unusedpharms_index.cfm
Environmental protection agency (Aug 2008). Unused pharmaceuticals in the health care industry: interim report. Retrieved from: http://water.epa.gov/scitech/wastetech/guide/unusedpharms_index.cfm
U.S. Department of justice drug enforcement administration office of diversion control (Dec. 21, 2012). Rules – 2012. Retrieved from: http://www.deadiversion.usdoj.gov/fed_regs/rules/2012/fr1221_8.htm