[Pharmwaste] FW: inconsistent message

[Bunnell, Ross]

Deb:

You said that "as far as I know, it is still legal to flush the pharmaceuticals that FDA advises."

I'm not sure which portion of Ohio EPA you are with (e.g., waste, water, pollution prevention), but some state water programs (such as ours here in Connecticut) have direct jurisdiction over discharges to city sewer, including discharges from hospitals.  Alternatively, the local sewer authority should have jurisdiction over discharges to city sewer, and may prohibit discharges of drugs without a permit or authorization to discharge such drugs.  As a result, it may not, in fact, be "legal" to flush schedule IV drugs - or other drugs - depending on what your state's laws are for discharges to city sewer.

-- Ross Bunnell
Senior Sanitary Engineer
Waste Engineering & Enforcement Division
Bureau of Materials Management and Compliance Assurance
Connecticut Department of Energy and Environmental Protection
79 Elm Street, Hartford, CT 06105-5127
P: 860.424.3274|F: 860.424-4059 |E: ross.bunnell at ct.gov<mailto:ross.bunnell at ct.gov>

[cid:image003.png at 01CFFF30.99F7A310]

www.ct.gov/deep<http://www.ct.gov/deep>

Conserving, improving and protecting our natural resources and environment;
Ensuring a clean, affordable, reliable, and sustainable energy supply.



From: pharmwaste-bounces at lists.dep.state.fl.us [mailto:pharmwaste-bounces at lists.dep.state.fl.us] On Behalf Of Hauser, Deborah
Sent: Thursday, November 13, 2014 7:56 AM
To: pharmwaste at lists.dep.state.fl.us
Subject: [Pharmwaste] inconsistent message

Good morning,

I've gotten the occasional question from hospital workers here in Ohio about policies to rinse Schedule IV drugs down the drain.  As I generally work with the residential side of things, I'm not as well-versed on hospital practices.  However, it seems to me there is a serious disconnect between the message from the environmental folks (like my agency, Ohio EPA) and the FDA.  The FDA's most recent guidance still suggests flushing a lengthy list of pharms (see below).   Has anyone had any experience with hospitals making it a policy to NOT flush pharmaceuticals?  As far as I know, it is still legal to flush the pharmaceuticals that FDA advises.  But I guess I'd like to see some sort of solution that involves incinerating ALL pharms, even the ones that have historically been flushed.  Do any of you have any suggestions I could pass on to Ohio hospitals?


Thanks,
Deb


Medicine

Active Ingredient

Abstral (PDF - 1M)<http://www.fda.gov/downloads/Drugs/DrugSafety/UCM239930.pdf>, tablets (sublingual)

Fentanyl

Actiq (PDF - 251KB)<http://www.fda.gov/downloads/Drugs/DrugSafety/UCM085817.pdf>, oral transmucosal lozenge *

Fentanyl Citrate

Avinza (PDF - 51KB)<http://www.fda.gov/downloads/Drugs/DrugSafety/UCM311346.pdf>, capsules (extended release)

Morphine Sulfate

Buprenorphine Hydrochloride, tablets (sublingual) *

Buprenorphine Hydrochloride

Buprenorphine Hydrochloride; Naloxone Hydrochloride, tablets (sublingual) *

Buprenorphine Hydrochloride; Naloxone Hydrochloride

Butrans (PDF - 388KB)<http://www.fda.gov/downloads/Drugs/DrugSafety/UCM219146.pdf>, transdermal patch system

Buprenorphine

Daytrana (PDF - 281KB)<http://www.fda.gov/downloads/Drugs/DrugSafety/UCM088581.pdf>, transdermal patch system

Methylphenidate

Demerol, tablets *

Meperidine Hydrochloride

Demerol, oral solution *

Meperidine Hydrochloride

Diastat/Diastat AcuDial<http://www.accessdata.fda.gov/scripts/cder/drugsatfda/index.cfm?fuseaction=Search.Overview&DrugName=DIASTAT>, rectal gel [for disposal
instructions: click on link, then go to "Label information"
and view current label]

Diazepam

Dilaudid, tablets *

Hydromorphone Hydrochloride

Dilaudid, oral liquid *

Hydromorphone Hydrochloride

Dolophine Hydrochloride (PDF - 48KB)<http://www.fda.gov/downloads/Drugs/DrugSafety/UCM311370.pdf>, tablets *

Methadone Hydrochloride

Duragesic (PDF - 179KB)<http://www.fda.gov/downloads/Drugs/DrugSafety/UCM088584.pdf>, patch (extended release) *

Fentanyl

Embeda (PDF - 39KB)<http://www.fda.gov/downloads/Drugs/DrugSafety/UCM179172.pdf>, capsules (extended release)

Morphine Sulfate; Naltrexone Hydrochloride

Exalgo (PDF - 83KB)<http://www.fda.gov/downloads/Drugs/DrugSafety/UCM204267.pdf>, tablets (extended release)

Hydromorphone Hydrochloride

Fentora (PDF - 338KB)<http://www.fda.gov/downloads/Drugs/DrugSafety/UCM088597.pdf>, tablets (buccal)

Fentanyl Citrate

Kadian (PDF - 135KB)<http://www.fda.gov/downloads/Drugs/DrugSafety/UCM311373.pdf>, capsules (extended release)

Morphine Sulfate

Methadone Hydrochloride, oral solution *

Methadone Hydrochloride

Methadose, tablets *

Methadone Hydrochloride

Morphine Sulfate, tablets (immediate release) *

Morphine Sulfate

Morphine Sulfate (PDF - 282KB)<http://www.fda.gov/downloads/Drugs/DrugSafety/UCM199333.pdf>, oral solution *

Morphine Sulfate

MS Contin (PDF - 433KB)<http://www.fda.gov/downloads/Drugs/DrugSafety/UCM311374.pdf>, tablets (extended release) *

Morphine Sulfate

Nucynta ER (PDF - 38KB)<http://www.fda.gov/downloads/Drugs/DrugSafety/UCM270268.pdf>, tablets (extended release)

Tapentadol

Onsolis (PDF - 297KB)<http://www.fda.gov/downloads/Drugs/DrugSafety/UCM285397.pdf>, soluble film (buccal)

Fentanyl Citrate

Opana, tablets (immediate release)

Oxymorphone Hydrochloride

Opana ER (PDF - 56KB)<http://www.fda.gov/downloads/Drugs/DrugSafety/UCM283820.pdf>, tablets (extended release)

Oxymorphone Hydrochloride

Oxecta, tablets (immediate release)

Oxycodone Hydrochloride

Oxycodone Hydrochloride, capsules

Oxycodone Hydrochloride

Oxycodone Hydrochloride (PDF - 100KB)<http://www.fda.gov/downloads/Drugs/DrugSafety/UCM289880.pdf>, oral solution

Oxycodone Hydrochloride

Oxycontin (PDF - 417KB)<http://www.fda.gov/downloads/Drugs/DrugSafety/UCM208530.pdf>, tablets (extended release)

Oxycodone Hydrochloride

Percocet, tablets *

Acetaminophen; Oxycodone Hydrochloride

Percodan, tablets *

Aspirin; Oxycodone Hydrochloride

Suboxone<http://www.fda.gov/downloads/Drugs/DrugSafety/UCM225677.pdf> (PDF - 83KB<http://www.fda.gov/downloads/Drugs/DrugSafety/UCM225677.pdf>)<http://www.fda.gov/downloads/Drugs/DrugSafety/UCM225677.pdf>, film (sublingual)

Buprenorphine Hydrochloride; Naloxone Hydrochloride

Xyrem (PDF - 185KB)<http://www.fda.gov/downloads/Drugs/DrugSafety/UCM089830.pdf>, oral solution

Sodium Oxybate

Zubsolv (PDF - 354KB)<http://www.fda.gov/downloads/Drugs/DrugSafety/UCM362203.pdf>, tablets (sublingual)

Buprenorphine Hydrochloride; Naloxone Hydrochloride


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