[Pharmwaste] inconsistent message
Catherine Zimmer
zenllc at usfamily.net
Thu Nov 13 12:12:22 EST 2014
Hi Deb and all,
Unfortunately, FDA has a disconnect when it comes to pharmaceuticals in our
drinking water sources and exposure to wildlife living in that water. Their
feeling is the potential for abuse, is of higher risk, hence pouring them
down the drain is ok. Technically under EPA rules, any wastewater treatment
plant discharging to surface waters is prohibited from sending pollutants
that "pass through",e.g. pharmaceuticals and other chemicals. However
pharmaceuticals are not explicitly prohibited.
DEA in their new rules calls for "irretrievable" in their standard for
destruction of controlled substances. They do not go so far as to define
irretrievable, but suggest incineration and chemical digestion as examples.
Flushing CS to the sewer does not meet the irretrievable standard. Also in
the new rules, hospital pharmacies and long term care facility pharmacies
are permitted to collect and dispose of controlled substances. With the new
rules there is no legitimate reason for healthcare facilities to be sewering
drugs. Waste pharmaceuticals can be legitimately and securely collected, no
inventorying is required (if the drugs have been dispensed), and the waste
incinerated. Costs can be minimized by enacting waste reduction procedures.
Its not rocket science, just better management and attention to
environmental and public health impact.
P.S. DEA only permits the flushing of the FDA list by "ultimate users", that
is, patients.
Very truly yours,
Catherine Zimmer, MS, BSMT
Zimmer Environmental Improvement, LLC
St. Paul, MN
Ph: 651.645.7509
<mailto:zenllc at usfamily.net> zenllc at usfamily.net
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 7:00 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
<http://www.fda.gov/downloads/Drugs/DrugSafety/UCM239930.pdf> Abstral (PDF
- 1M), tablets (sublingual)
Fentanyl
<http://www.fda.gov/downloads/Drugs/DrugSafety/UCM085817.pdf> Actiq (PDF -
251KB), oral transmucosal lozenge *
Fentanyl Citrate
<http://www.fda.gov/downloads/Drugs/DrugSafety/UCM311346.pdf> Avinza (PDF -
51KB), capsules (extended release)
Morphine Sulfate
Buprenorphine Hydrochloride, tablets (sublingual) *
Buprenorphine Hydrochloride
Buprenorphine Hydrochloride; Naloxone Hydrochloride, tablets (sublingual) *
Buprenorphine Hydrochloride; Naloxone Hydrochloride
<http://www.fda.gov/downloads/Drugs/DrugSafety/UCM219146.pdf> Butrans (PDF
- 388KB), transdermal patch system
Buprenorphine
<http://www.fda.gov/downloads/Drugs/DrugSafety/UCM088581.pdf> Daytrana (PDF
- 281KB), 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
<http://www.fda.gov/downloads/Drugs/DrugSafety/UCM311370.pdf> Dolophine
Hydrochloride (PDF - 48KB), tablets *
Methadone Hydrochloride
<http://www.fda.gov/downloads/Drugs/DrugSafety/UCM088584.pdf> Duragesic
(PDF - 179KB), patch (extended release) *
Fentanyl
<http://www.fda.gov/downloads/Drugs/DrugSafety/UCM179172.pdf> Embeda (PDF -
39KB), capsules (extended release)
Morphine Sulfate; Naltrexone Hydrochloride
<http://www.fda.gov/downloads/Drugs/DrugSafety/UCM204267.pdf> Exalgo (PDF -
83KB), tablets (extended release)
Hydromorphone Hydrochloride
<http://www.fda.gov/downloads/Drugs/DrugSafety/UCM088597.pdf> Fentora (PDF
- 338KB), tablets (buccal)
Fentanyl Citrate
<http://www.fda.gov/downloads/Drugs/DrugSafety/UCM311373.pdf> Kadian (PDF -
135KB), capsules (extended release)
Morphine Sulfate
Methadone Hydrochloride, oral solution *
Methadone Hydrochloride
Methadose, tablets *
Methadone Hydrochloride
Morphine Sulfate, tablets (immediate release) *
Morphine Sulfate
<http://www.fda.gov/downloads/Drugs/DrugSafety/UCM199333.pdf> Morphine
Sulfate (PDF - 282KB), oral solution *
Morphine Sulfate
<http://www.fda.gov/downloads/Drugs/DrugSafety/UCM311374.pdf> MS Contin
(PDF - 433KB), tablets (extended release) *
Morphine Sulfate
<http://www.fda.gov/downloads/Drugs/DrugSafety/UCM270268.pdf> Nucynta ER
(PDF - 38KB), tablets (extended release)
Tapentadol
<http://www.fda.gov/downloads/Drugs/DrugSafety/UCM285397.pdf> Onsolis (PDF
- 297KB), soluble film (buccal)
Fentanyl Citrate
Opana, tablets (immediate release)
Oxymorphone Hydrochloride
<http://www.fda.gov/downloads/Drugs/DrugSafety/UCM283820.pdf> Opana ER (PDF
- 56KB), tablets (extended release)
Oxymorphone Hydrochloride
Oxecta, tablets (immediate release)
Oxycodone Hydrochloride
Oxycodone Hydrochloride, capsules
Oxycodone Hydrochloride
<http://www.fda.gov/downloads/Drugs/DrugSafety/UCM289880.pdf> Oxycodone
Hydrochloride (PDF - 100KB), oral solution
Oxycodone Hydrochloride
<http://www.fda.gov/downloads/Drugs/DrugSafety/UCM208530.pdf> Oxycontin
(PDF - 417KB), 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
<http://www.fda.gov/downloads/Drugs/DrugSafety/UCM089830.pdf> Xyrem (PDF -
185KB), oral solution
Sodium Oxybate
<http://www.fda.gov/downloads/Drugs/DrugSafety/UCM362203.pdf> Zubsolv (PDF
- 354KB), tablets (sublingual)
Buprenorphine Hydrochloride; Naloxone Hydrochloride
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