[Pharmwaste] Chemo Drugs and HELP?

Volkman, Jennifer (MPCA) jennifer.volkman at state.mn.us
Tue May 22 15:31:42 EDT 2012

I stand somewhat corrected. I received a note from a person who takes a lot of pharm calls, as I do.

"I have taken too many calls from grieving families wanting to be sure their loved one’s meds aren’t flushed by hospice to think this is simply not an issue for sick people, chemo patients or otherwise. The more we educate people about this the more questions they’ll have and the less complacent they will be.

I think DEA might appreciate knowing about chemo drugs. Just because they aren’t controlled doesn’t mean they don’t get them at collection events. Should we assume cops are using the safe handling procedures that we would require of any person handling potentially hazardous waste? Isn’t this OUR piece of the puzzle?"

I had thought about the fact that we should educate law enforcement on what to do. In our workshops, we just tell them not to accept the materials and to direct people back to the facility they received it from. We should have a back up plan for them and a bit more detail on exactly how they should manage what they do receive.

On Education in general: I was talking to my boss the other day about how much time I spend on this waste stream. Apparently my manager even received a compliment on my work from local DEA. His thought was where is DEA, why aren't they helping more with the education. Where is the healthcare industry, what are they doing? They all know what PHARMA supported SMARxT did to education efforts in MN (ignored collection). I get so wrapped up in the policy and procedures to figure out collection and disposal options that I haven't had time to think about how to better engage healthcare. We have some contact with the pharmacists association and some pharmacies, but really none with the healthcare industry. I figure they'd need to be more involved in the prevention/reduction area, but I don't know that MN has really gone beyond pharmacies and we haven't done enough work with them yet.

Bottom line, the boss was pointing to product stewardship and that the manufacturers and health care providers need to step up. I think different states have different levels of success already with involving the health care industry (not just pharmacies).

So, who's missing again, in this whole battle...who is silent until someone drafts up producer responsibility legislation...who advertises and sells but doesn't engage in discussions with the Product Stewardship Institute or other organizations in their efforts to develop a collection and prevention system...

From: pharmwaste-bounces at lists.dep.state.fl.us [pharmwaste-bounces at lists.dep.state.fl.us] on behalf of Volkman, Jennifer (MPCA) [jennifer.volkman at state.mn.us]
Sent: Tuesday, May 22, 2012 1:22 PM
To: pharmwaste at lists.dep.state.fl.us
Subject: RE: [Pharmwaste] Chemo Drugs?

You are very right that a patient is in no way going to think about what to do with the unused chemo. Unless they are one of us...and then maybe not. We should focus on how to educate oncologists and cancer treatment centers to accept it back and let patients know they do that.

I have no real good perspective on how toxic this is. I did have a HH program send a note saying that law enforcement found some during a screen. (We advise programs to do a visual screen as they are moving contents from the collection container to a disposal container to catch thermometers) The HHW Program's contractor retrieved the chemo and lab packed it for disposal. I suppose this could be a management option for some law enforcement based programs out there if they are really well connected with their HHW programs.

Mainly, it points to the fact that manufacturers and health care facilities should be more involved in collection and related policy.
From: Matthew C. Mireles [mirelesmc at earthlink.net]
Sent: Tuesday, May 22, 2012 1:06 PM
To: Volkman, Jennifer (MPCA); pharmwaste at lists.dep.state.fl.us
Subject: RE: [Pharmwaste] Chemo Drugs?

Jennifer, I totally agree that oncologists and dispensing pharmacies for chemo drugs are best equipped to handle disposal but they probably won't bother to take back unused amounts once the drugs are dispensed.  FYI, a lot chemotherapeutic drugs are prescribed for continuous infusion outside healthcare facilities.  Patients actually go home with a portable pump loaded with the drug.

I was involved with a neighbor who was a cancer patient.  He passed away on night.  I discovered this the next morning and called the authorities.  I knew he had an infusion pump.  With permission, I removed his pump with the meds and returned it to his oncologist at the hospital without incident.  But this may be a unique situation.

Cancer patients may not have the choice to refuse the medical treatment, or they may not care too much about proper disposal at that point when they are very sick and desperate to get well.

Matthew Mireles

-----Original Message-----
From: "Volkman, Jennifer (MPCA)"
Sent: May 21, 2012 2:07 PM
To: "pharmwaste at lists.dep.state.fl.us"
Subject: RE: [Pharmwaste] Chemo Drugs?

If I was in a position to offer guidance to these patients, I would tell them not to take that stuff home unless the oncologist or clinic agreed to take back any unused chemo medication. I say no, all of our guidance says, no, don’t accept it. I think most places will take it back. The first clinic that called me to find out how to take back pharms wanted to specifically take back chemo meds, which I thought was great. But I know of one person on the list serve that had a doctor call who was upset that collection sites didn’t take chemo. Any doctor who thinks it make sense to expose people to this toxic formulation by putting it in collection bins needs to spend about 30 seconds thinking about potential exposure and liability, and you can help them with that.

From: pharmwaste-bounces at lists.dep.state.fl.us [mailto:pharmwaste-bounces at lists.dep.state.fl.us] On Behalf Of Matthew C. Mireles
Sent: Monday, May 21, 2012 1:49 PM
To: ANGELA Deckers; pharmwaste at lists.dep.state.fl.us
Subject: Re: [Pharmwaste] Chemo Drugs?


Because chemo drugs are considered toxic, we advise people to return any remaining chemo drug (with packaging, infusion pump, etc.) back to the oncologist or the location where the drug was dispensed.  We looked at this issue several years ago with respect to toxic chemical exposure to volunteers who would be handled returned drugs.  It's not just an environmental concern but also an occupational exposure concern.

Matthew Mireles

-----Original Message-----
From: ANGELA Deckers
Sent: May 21, 2012 11:41 AM
To: pharmwaste at lists.dep.state.fl.us<mailto:pharmwaste at lists.dep.state.fl.us>
Subject: [Pharmwaste] Chemo Drugs?

Just a clarification from collection programs out there:

Do you accept chemo drugs in your drop-off programs at police stations? If so, are there special requirements for how residents should handle these and subsequently, how police personnel should handle them?

Please respond to me directly at adeckers at cityofboise.org<mailto:adeckers at cityofboise.org>

Thanks for your time.

Angela Deckers
Hazardous Materials Coordinator
Boise Public Works
adeckers at cityofboise.org<mailto:adeckers at cityofboise.org>
208.433.5650 fax
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