[Pharmwaste] FW: OH MY - For Medication Disposal, New Advice Is Trash BeatsTake-Back

DeBiasi, Deborah (DEQ) Deborah.DeBiasi at deq.virginia.gov
Fri May 18 14:28:00 EDT 2012

Perspective on the pharmaceutical issue would seem to be the key here.  From a pollution prevention standpoint, trash disposal probably does use less energy than incineration.  From an environmental perspective, it's better than sewer disposal in that it delays entry into the surface and ground waters, but not nearly as good as incineration for removal.  Maine did a study in 2010 and found pharmaceuticals in the leachate from their landfills (http://eponline.com/articles/2010/02/10/maine-dep-finds-pharmaceuticals-in-landfill-leachate.aspx), so we know that many drugs are present potentially years after disposal.  Typically, landfill leachate is piped or trucked to a wastewater treatment plant, which cannot remove all of the pharmaceuticals either, so they get discharged in the effluent to the receiving stream.  Incineration destroys the pharmaceuticals and results in a waste product that is less of a concern environmentally, and of negligent concern to health and law enforcement.

Another issue is safety at landfills.  Pharmaceuticals are not always disguised by additional packaging when they are tossed by the home owner, or may simply become visible with all of the manipulations of waste collection trucks and landfill equipment.  They can become recognizable and available to "scroungers", both human and wildlife, creating health concerns and potentially criminal issues.  Our landfill inspectors have seen people raking through the garbage looking for drugs and alcohol, which creates a safety issue for all involved.

This study was interesting, and useful for looking at the carbon footprint of the disposal methods.  However, I feel that incineration is still the best option we have for drug destruction.

Deborah L. DeBiasi, Virginia DEQ
Office of Water Permit and Compliance Assistance Programs
Email:   Deborah.DeBiasi at deq.virginia.gov
PH:         804-698-4028

From: pharmwaste-bounces at lists.dep.state.fl.us [mailto:pharmwaste-bounces at lists.dep.state.fl.us] On Behalf Of Volkman, Jennifer (MPCA)
Sent: Friday, May 18, 2012 1:55 PM
To: pharmwaste at lists.dep.state.fl.us
Subject: RE: [Pharmwaste] FW: OH MY - For Medication Disposal, New Advice Is Trash BeatsTake-Back

Discussion is good.
I don't know if it has been peer-reviewed and whether they took into account everything we've all looked at. If collection is at a pharmacy that someone is going to already to pick up refills or other items, I don't see how the emissions factor in there. Most law enforcement collection points are located in population centers that people travel to as well. I could see that some people might just make one direct trip, but most people run a string of errands and naturally plan out a route that wouldn't seem to add significantly to emissions.

Growing up outside a small town, there were times where you went to town for a carton of milk if you really needed it, but generally we'd go to the store, post office, gas station, bakery, pharmacy and, hopefully, the Dairy Queen. Still do, even though I'm in a larger town.

If law enforcement and pharmacies are already properly managing their waste or confiscated drugs, the amounts collected by take back just add to the outbound shipment already going for incineration.

But I do always appreciate a study that looks at the carbon footprint, so I'm looking forward to reading the details.

From: pharmwaste-bounces at lists.dep.state.fl.us [pharmwaste-bounces at lists.dep.state.fl.us] on behalf of Fredrick L. Miller [millerfl at tricity.wsu.edu]
Sent: Friday, May 18, 2012 12:48 PM
To: pharmwaste at lists.dep.state.fl.us
Subject: RE: [Pharmwaste] FW: OH MY - For Medication Disposal, New Advice Is Trash BeatsTake-Back
Sorry for using the wrong address, Laurie.  I'll try to keep it straight in the future.

I realize my position isn't plain vanilla and may draw a little push-back.  I take sole responsibility for it and ask that any who have strong feelings about the matter please feel free to contact me via the list or in private.  I don't take negative or opposing feedback personally or lightly.  I've been known to learn from it when people find holes in my logic or knowledge.  After all, if all we consumed was our own product how would we learn and grow?


From: pharmwaste-bounces at lists.dep.state.fl.us [mailto:pharmwaste-bounces at lists.dep.state.fl.us] On Behalf Of Tenace, Laurie
Sent: Friday, May 18, 2012 10:06 AM
To: pharmwaste at lists.dep.state.fl.us
Subject: [Pharmwaste] FW: OH MY - For Medication Disposal, New Advice Is Trash BeatsTake-Back

Please note that Fred Miller's email did not originate with me - Laurie

Please take a few minutes to share your comments on the service you received from the department by clicking on this link DEP Customer Survey<http://survey.dep.state.fl.us/?refemail=Laurie.Tenace@dep.state.fl.us>.
From: Fredrick L. Miller [mailto:millerfl at tricity.wsu.edu]<mailto:[mailto:millerfl at tricity.wsu.edu]>
Sent: Friday, May 18, 2012 12:29 PM
To: pharmwaste-bounces at lists.dep.state.fl.us<mailto:pharmwaste-bounces at lists.dep.state.fl.us>
Subject: RE: OH MY - For Medication Disposal, New Advice Is Trash Beats Take-Back

As an environmental management practitioner I have no problem with landfilling pharmaceuticals in cells constructed to modern standards.  By the time they make their way through the biological and chemical processes going on in the landfill itself and the leachate collection/treatment system it's at least as well degraded as in many of the thermal treatment options (waste to energy and other non-RCRA permitted burners).  The UM study is a good start at examining the costs, both fiscal and environmental, of take-back programs but its limited scope precludes full examination of the problem.  I must say their work is a great start to launching a rational discussion of the problem rather than simply continuing down the knee-jerk path to take-back.  Let's not let the bureaucrats promulgate regulations the normal way but rather use our brains and voices to influence the outcome this time 'round.


Fred Miller

From: pharmwaste-bounces at lists.dep.state.fl.us<mailto:pharmwaste-bounces at lists.dep.state.fl.us> [mailto:pharmwaste-bounces at lists.dep.state.fl.us] On Behalf Of Lotzer Donna M
Sent: Friday, May 18, 2012 8:45 AM
To: Lotzer Donna M
Subject: [Pharmwaste] OH MY - For Medication Disposal, New Advice Is Trash Beats Take-Back

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 air.

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 waste.

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<mailto:dlotzer at uwhealth.org>
Phone: 608-265-8160
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