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

Ed Gottlieb egottlieb at cityofithaca.org
Mon May 21 07:14:11 EDT 2012

Ditto Amy & others.
I'd like to elaborate on the question of did this study consider the
risks associated with people or animals rifling through the trash.
There are many documented cases of accidental poisonings from
medications put in the trash.  I've never hear of any occurring from a
take back program.  Does anyone on this list serve know the average cost
for one poisoning case?  The annual costs I've seen published are
staggeringly large, and climbing each year, seeming to track the
increase in the numbers of prescriptions being written.
I'd be willing to bet that if our local collection program prevented
one such poisoning (not an unreasonable conjecture considering the total
number of poisonings occurring in this country) the savings would more
than pay the costs of our program since its inception, two and a half
years ago.  Maybe it wouldn't offset the additional carbon footprint,
but we need to keep all the costs and benefits in mind when considering
options, not just a single factor.  And, just how do we measure, and
factor in, the impact on a family who loses a child in this way?

Ed Gottlieb
Chair, Coalition for Safe Medication Disposal
Industrial Pretreatment Coordinator
Ithaca Area Wastewater Treatment Facility
525 3rd Street
Ithaca, NY 14850
(607) 273-8381
fax: (607) 273-8433

>>> <Amy.Roering at co.hennepin.mn.us> 5/18/2012 2:18 PM >>>
Agreed -- discussion is good.

The conclusion are not that surprising when a person factors in
transportation (similar conclusions have been drawn about batteries,
etc.).  But I
haven't read the study.

As Jennifer stated, I wondered if the researchers considered that
consumers may combine trips (for example, drop off their old meds when
they visit
the retail pharmacy to make a purchase).  And if they considered the
risks associated with people or animals rifling through the trash.

I'm not a scientist, but it seems like the jury is still out on the
fate of pharmaceuticals when they're placed in a landfill & the

There's also an interesting statement in the NPR story:
"But Barbara Carreno, a DEA spokeswoman, says collection programs bring
in people who otherwise might never have disposed of their old drugs.
brought medicines to our [April] take-back that had been sitting in
drawers, I kid you not, for 40 years,' she says."

From:"Volkman, Jennifer (MPCA)" <jennifer.volkman at state.mn.us>
To:"pharmwaste at lists.dep.state.fl.us"
<pharmwaste at lists.dep.state.fl.us>
Date:05/18/2012 12:55 PM
Subject:RE: [Pharmwaste] FW: OH MY - For Medication Disposal, New
Advice IsTrash BeatsTake-Back
Sent by:pharmwaste-bounces at lists.dep.state.fl.us

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
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
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
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
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
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,
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 –

Please take a few minutes to share your comments on the service you
received from the department by clicking on this link DEP Customer
      From: Fredrick L. Miller [mailto:millerfl at tricity.wsu.edu]
      Sent: Friday, May 18, 2012 12:29 PM
      To: 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
      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
      examination of the problem.  I must say their work is a great
start to launching a rational discussion of the problem rather than
      continuing down the knee-jerk path to take-back.  Let’s not let
the bureaucrats promulgate regulations the normal way but rather use our
      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] 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
      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

      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
      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
      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
      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,
      more than a billion dollars annually, along with a 300 percent
increase in other emissions such as greenhouse gases and smog-forming

      "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,
      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
      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
      of people putting them in the trash," Cook said. Currently, about
60 percent of people already use trash disposal, while 40 percent of
      still flush unused medication down the toilet. When discarding
pills in the trash, the FDA recommends mixing them with an unpalatable
      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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