[Pharmwaste] Can LTC facilities and prisons use the HH waste exclusion?

[Bickford, Barbara J - DNR (Barb)]

Recently someone on the listserve suggested that the Federal Register (specifically, 12/2/08 FR p 7352) would allow prisons and long term care facilities to manage their residents' wastes as household wastes.  We think the quote from the Federal Register quote was taken out of context.   Here is an excerpt from 12/2/08 FR p 73525
http://www.epa.gov/fedrgstr/EPA-WASTE/2008/December/Day-02/f28161.pdf
c. Long-Term Care Facilities Nursing homes, assisted living centers, and other long-term care facilities also may be subject to the RCRA hazardous waste generator regulations. However, many long-term care facilities may be unaware of the applicability of the RCRA hazardous waste regulations to their hazardous pharmaceutical waste. Most long-term care facilities generate two types of hazardous pharmaceutical waste. First, the facility itself may generate hazardous wastes as a result of its central management of pharmaceuticals in its pharmacy or pharmacy-like area. These hazardous pharmaceutical wastes would be subject to the RCRA hazardous waste generator regulations since the pharmaceuticals are under the control of the facility, and, thus, the resulting wastes are generated by that facility (see 40 CFR part 262). The long-term care facilities, like other generators, are responsible for determining whether the wastes it generates are hazardous wastes subject to regulation under RCRA subtitle C. If so, the facility must then manage the wastes accordingly. Long-term care facilities face many of the same issues that health care facilities and pharmacies do in managing hazardous pharmaceutical waste, as discussed above. Secondly, patients and residents in long-term care facilities may generate hazardous wastes. Those pharmaceuticals that are under the control of the patient or resident of the long-term care facility, when discarded, would be subject to RCRA's household hazardous waste exclusion (40 CFR 261.4(b)(1)). Hazardous pharmaceutical wastes generated by the resident are excluded from regulation because they are considered to be derived from a household.

Our interpretation of the last three sentences is this:  If the patient or resident can manage their own hazardous waste medications (e.g., nicotine patches or Coumadin), they can dispose of them in the garbage or take them to a household medication collection program. If the facility is managing medications for them (because the resident is unable, due to incarceration or physical/cognitive inability), then the facility is the generator.  For details, see http://dnr.wi.gov/topic/HealthWaste/facility.html or http://dnr.wi.gov/files/pdf/pubs/wa/wa1214.pdf
Wisconsin DNR commented to DEA that it would be confusing to LTC facilities if DEA's determination of who can use collection boxes is based on who owns the waste medications and if EPA and the states based theirs on who controls or manages the waste medications.  We hope EPA and DEA can resolve this before the DEA finalizes its rules.
Barb Bickford
Wisconsin Department of Natural Resources
608-267-3548
barbara.bickford at wisconsin.gov






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