[Pharmwaste] inconsistent message

[Lotzer Donna M]

Diazepam may be Schedule IV but if you look down this list they are the heavy hitters with a high high potential for abuse and are Schedule II in most cases. Do I agree with flushing them? No...our hospital has recently gone to Cactus Sink instead of flushing or putting stuff in the sharps containers (!!) which is an improvement, albeit expensive. As a pharmacist with 25 years answering poison phones the more inaccessible these products are the safer everyone is. Donna
Donna Lotzer, Senior Clinical Pharmacist
Poison Education Coordinator
University of WI Hospital & Clinics Poison Prevention Center
600 Highland Avenue, MC # 9475, Madison, WI 53792
dlotzer at uwhealth.org<mailto:dlotzer at uwhealth.org>     Phone: 608-265-8160
Please encourage others to save 800-222-1222 in both cell and home phones.
This number will connect callers anywhere in the U.S. to a poison center.
Calls are free, confidential and answered 24/7/365.
Please help me educate your community about poison prevention.
Call or email me for materials or program opportunities.

From: Hauser, Deborah [mailto:Deborah.Hauser at epa.ohio.gov]
Sent: Thursday, November 13, 2014 6:56 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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