By David Swenson, RPh
Recent Earth Day celebrations offer a terrific opportunity to see what pharmacists can do to improve the water we all drink. Often overlooked during Earth Day discussions is one of the leading sources of potentially dangerous pollutants—hazardous drugs from hospitals and health care facilities.
Each year, 5700 hospitals and 45,000 long-term care homes will purchase more than 4 billion vials, bottles, ampoules, and bags containing prescription drugs, generating more than 84,000 tons of pharmaceutical waste every year in the United States.
Some containers have residual medication that has not been consumed, leaving many health care providers and pharmacists with the question—how do we safely dispose of these chemicals?
Pharmaceutical waste management is a serious and growing concern. Nearly two-thirds of the nation’s hospitals remain noncompliant as they face an array of requirements specific to each medication classification and varying regulations at the federal, state, and local levels. A recent survey showed that 75% of hospital respondents are aware of the Resource Conservation and Reclamation Act (RCRA) of 1976, but a vast majority is concerned about compliance with the regulations.
Handling Pharmaceuticals—Cradle to Grave
In most cases, the hospital pharmacist is responsible for managing all pharmaceuticals from receipt to disposal (cradle to grave). Surveys have shown that these pharmacists are often challenged by the complex regulations of the RCRA, lack of in-house expertise regarding disposal, and insufficient storage space to deal with pharmaceuticals and resulting waste. Adding to the complexity is ongoing confusion on national formulary waste characterization caused by the continual release of new drugs and reclassification of others.
When these problems are not addressed, it leads to profound environmental concerns, such as polluting waterways, and takes hospitals farther away from initiatives to “go green.” In the absence of compliance, many hospitals continue the same practices they’ve been using for years.
Pharmacist and other health care providers may flush the unused medication down the toilet, and the drugs eventually end up in the water supply. A nurse will throw medication into a garbage bag that is thrown into a landfill, where the drugs can leak into a stream, lake, or ocean, producing diluted concentrations in fish, frogs, and other aquatic wildlife.
Seem far-fetched? Recent studies estimate that at least 250 million pounds of pharmaceuticals and contaminated packaging will be tossed this year alone. At least 46 million Americans, according to an Associated Press (AP) study, have had a vast array of pharmaceuticals—including antibiotics, anticonvulsants, mood stabilizers, and hormones—in their drinking water supplies. The AP also found that drugs have been detected in the drinking water supplies of 24 major metropolitan areas—from southern California to northern New Jersey, from Detroit to Louisville.
While many of the traces of pharmaceuticals are in quantities of parts per billion or trillion, they are still prevalent in municipal water supplies, aquifers, and even water wells, and can do harm to animals. One study found wildlife reproduction failures and another 2002 study from the US Geological Survey found trace amounts of drugs in more than 80% of streams in the United States.
An Expensive Problem
While waste haulers have faced enforcement scrutiny for some time, hospitals and health care systems are now facing similar scrutiny from the US Environmental Protection Agency (EPA), which has been making frequent inspections and enforcing the RCRA. In just the last 5 years, the EPA has cited 244 hospitals for improperly handling pharmaceutical waste. The EPA took formal action against 30 of those facilities and imposed penalties on 23, ranging from $700 to $106,267.
Hospitals can be fined up to $37,500 per infraction, per day, for improper disposal of pharmaceutical waste. Recently, a government-owned hospital was fined $51,501 and ordered to spend $500,000 to develop a program for pharmaceutical waste. Another large cancer hospital was fined $372,254 for improper handling and storage of hazardous pharmaceutical waste.
Also problematic are disposal methods for high-risk categories, such as RCRA black waste. This high risk category requires special handling and disposal methods, which are expensive—costing as much as $2 to $4/lb. Since all waste reverts to the highest risk level (black waste) when mixed, sorting by category is critical for hospitals to reduce their disposal costs.
What Pharmacists Can Do
Hospitals and health care systems, seeing the urgency to address medical waste management or face regulatory consequences, are reevaluating their practices for acting in a safe, eco-friendly way. Many are asking for innovative solutions in the medical waste management field, such as automated waste identification and segregation technology. Recently entering this area with an innovative solution is CareFusion, with the Pyxis EcoStation system, an automated pharmaceutical waste technology to help hospitals reduce cost and facilitate environmental responsibility. The Pyxis EcoStation system, formerly EcoRex from Vestara, is a bar-code system that uses an automated bin containing different compartments for different types of drug waste. When drug containers are scanned, it triggers the lid of the appropriate compartment to open so residue ranging from IV bags to chemotherapy bottles can be grouped. The Pyxis EcoStation system provides a safer, efficient, and easy-to-use option for health care workers to sort drug waste at the point of use.
Finally, pharmacists have a way to dispose of pharmaceutical waste that makes sense and also creates an audit trail that they can present to regulators to demonstrate compliance. Innovations like the Pyxis EcoStation system will help pharmacists effectively deal with some of the complexities of the RCRA, a solution that 70% recently said that they would implement within 1 year. And in so doing, finally help deliver on the promise of “going green.”
David Swenson is vice president of Marketing and Product Management for PyxisDispensing Technologies at CareFusion in San Diego, CA. Swenson’s background includes more than 17 years of hospital pharmacy and hospital pharmacy management experience. He was one of the original staff members of Pyxis Corporation, joining the product team in the company’s infancy.