[Pharmwaste] OH MY - For Medication Disposal, New Advice Is Trash Beats Take-Back

Lotzer Donna M DLotzer at uwhealth.org
Fri May 18 11:44:38 EDT 2012

18 May 2012   

Returning extra medicine to the pharmacy for disposal might not be worth
the extra time, money or greenhouse gas emissions, according to a
University of Michigan study that is the first to look at the net
effects of so-called take-back programs. The new evidence suggests that
discarding unused drugs in the trash is a better option to limit the
risk of poisoning and at the same time curb pollution of both water and

To arrive at this conclusion, the researchers compared the total
emissions created by take-back, trash and toilet disposal methods. This
included emissions of pharmaceutical active ingredients as well as
releases of other water and air pollutants. "National policy seems to be
changing to support take-back programs, and we don't know if that's
justified," said Sherri Cook, a doctoral student in the U-M Department
of Civil and Environmental Engineering. Cook is first author of a paper
on the findings published in Environmental Science & Technology. 

U.S. households accumulate an estimated 200 million pounds of unused
pharmaceuticals every year, the researchers say. In most cases today,
the FDA recommends throwing them away, but only if you don't have access
to a take-back program. Cities, states and even some stores have
initiated them. From collection sites, the returned drugs are
transferred to another facility where they're incinerated as hazardous
Health officials caution that unused pills should be out of the house as
soon as possible to prevent poisoning and drug abuse by other family
members. But that need must be balanced with pollution control, both for
human health and environmental reasons. Flushing unused pills down the
toilet is no longer advised, as the active ingredients in drugs have
been found in drinking water and aquatic environments. 

The new study found: 

*	If half of people threw away unused medications and half took
them back to the drug store, the amount of active pharmaceutical
ingredients in the environment would be reduced by 93 percent compared
with today. 
*	If everyone trashed their extra drugs, those amounts would be
reduced by 88 percent. 
*	That 5 percent improvement in pharmaceutical emission reduction
due to take-back programs would come at a significant cost, possibly
more than a billion dollars annually, along with a 300 percent increase
in other emissions such as greenhouse gases and smog-forming substances.

"Nobody has ever added up all the emissions associated with disposing of
medication," said Steve Skerlos, a professor in the departments of
Mechanical Engineering and Civil and Environmental Engineering and a
co-author of the study. "When you look at the available evidence to
support take-back, it just doesn't add up." The researchers focused on a
50 percent take-back compliance rate based on actual practice in Sweden,
which has had a national take-back program for 40 years. The compliance
rate there is just 43 percent. Drugs that aren't returned tend to stay
in the medicine cabinet, defeating the goal of getting unused
medications out of the home quickly, the researchers say. 

The U-M researchers considered a wide range of factors, including how
often people would return medication, how far they live from take-back
sites, how rainfall might affect landfill leachate leaking into
groundwater, and what percentage of residents could be expected to
comply. The results surprised the team. "We didn't expect that
landfilling would be the best option, because when you incinerate
something, it's gone, and when it's in a landfill, it can remain for
some time," said Nancy Love, a professor in the Department of Civil and
Environmental Engineering and a co-author of the study. "However, once
we considered all the environmental emissions for the three options, the
results made sense." 

The researchers encourage policymakers to focus on getting more people
to get rid of medicines by trash, rather than take-back. "Trashing
unused medications reduces the consumer's inconvenience relative to
take-back, and if there is a clear message perhaps we could increase the
percentage of people putting them in the trash," Cook said. Currently,
about 60 percent of people already use trash disposal, while 40 percent
of people still flush unused medication down the toilet. When discarding
pills in the trash, the FDA recommends mixing them with an unpalatable
substance such as coffee grounds in a plastic bag. This helps to deter
would-be abusers from picking them out of the garbage. 

The paper is titled, "Life Cycle Comparison of Environmental Emissions
from Three Disposal Options for Unused Pharmaceuticals." 
University of Michigan <http://www.umich.edu/> 

Donna Lotzer, Senior Clinical Pharmacist
Poison Education Coordinator
University of WI Hospital & Clinics 
Poison Prevention & Education Center
600 Highland Avenue, MC # 9475
Madison, WI 53792
dlotzer at uwhealth.org
Phone: 608-265-8160

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