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Left-Over Household Pharmaceuticals: A Government Perspective. Dave Galvin Local Hazardous Waste Management Program in King County (Seattle, WA) June 19, 2008. A reflection of concern…. Pharmaceuticals. Wide range of biologically-active chemicals 5-10% designate as hazardous waste

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left over household pharmaceuticals a government perspective

Left-Over HouseholdPharmaceuticals:A Government Perspective

Dave Galvin

Local Hazardous Waste Management Program in King County (Seattle, WA)

June 19, 2008

pharmaceuticals
Pharmaceuticals
  • Wide range of biologically-active chemicals
  • 5-10% designate as hazardous waste
  • A different 5-10% are Controlled Substances -- challenging to

manage

pharmaceuticals cont d
Pharmaceuticals (cont’d)
  • Controlled Substances – regulated by the Federal Drug Enforcement Administration due to potential for abuse
    • Schedule I – illegal drugs (ex., heroin, LSD)
    • Schedule II – morphine, OxyContin, codeine, Demerol, Ritalin, amphetamines, fentanyl
    • Schedule III – Tylenol with codeine, Vicodin
    • Schedule IV – benzodiazepines, Valium, Darvon, phenobarbital
    • Schedule V – codeine cough syrups
drugs are showing up in the environment
Drugs are showing up in the environment
  • Ibuprofen, valium, prozac, antibiotics, steroids, hormones
  • Found in 80% of U.S. streams tested by USGS
  • Found in drinking water supplies in many U.S. cities
drugs in the environment cont d
Drugs in the environment(cont’d)
  • Antibiotics, hormones, SSRIs are receiving the most attention.
  • Boulder Creek, CO, study: 50:50 female:male ratio upstream, 90:10 downstream; ethynyl-estradiol measurably higher downstream.
  • Male fish are

producing eggs in

many places.

drugs in the environment cont d1
Drugs in the environment(cont’d)
  • Bioassays of SSRIs

are showing some

sub-lethal effects at

environmentally-

relevant levels.

  • 2006 Italian study found that a mixture of common drugs at very low (ng/L - environmentally-relevant) concentrations inhibited the growth of human embryonic cells

Clean water

50 ppb fluoxetine

drugs enter the environment through use and disposal
Drugs enter the environment through use and disposal
  • Probably most result from use, passing through us un-metabolized, then going through wastewater treatment systems
  • Unused/unwanted quantities could be

huge, as much as 50% of many

prescriptions (80% for

antibiotics)

  • Common/historical

recommendation was to

flush; “crush&flush” is still

widely practiced method

too many drugs go unused
Too Many Drugs Go Unused
  • PhRMA uses an estimate of 3% of all meds go unused
  • British survey showed:
    • 82% of antibiotics go unused
    • 50% of antidepressants “
    • 50% of beta-blockers “
    • 20% of pain meds “

[Ref: Bound & Voulvoulis, 2005]

  • Austria & Germany
    • 25-33% go unused

[Source: Kummerer, K., 2004]

unused accumulations cont d
Unused Accumulations (cont’d)
  • Compliance/adherence rates for some medications are under 20%
  • Patient compliance goes down as # of medications goes up: “polypharmacy”
  • Medicare Part D now requires 30-day supply billings, regardless of need and without ability to refund unused expenses (or to return unused product)
unused accumulations cont d1
Unused Accumulations (cont’d)
  • Hospice nurses, nursing homes and medical examiners are faced with large accumulations of medicines, including potent controlled substances, when patients die
  • “Catch 22” for handling the left-overs – no easy, safe, legal or environmentally acceptable answers
drug sales have skyrocketed
Drug sales have skyrocketed

U.S. sales have more than doubled in last 5 yrs

(Ref: National Drug Intelligence Center, 2005, via Ilene Ruhoy, 2006)

increased sales more exposure
Increased Sales= More Exposure
  • From 1993 to 2003 the US population increased 13%
    • prescriptions purchased increased 70%
    • prescriptions/capita increased 7.8 to 11.8.

[Source: Kaiser Family Foundation, October 2004]

slide16

Increased Sales (cont’d)

Prescription Opiates Sold in King County

Percent Change 1997-2003

Source- ARCOS/DEA Data for Zip Codes 980xx and 981xx, which approximates King County boundaries

http://www.deadiversion.usdoj.gov/arcos/retail_drug_summary/index.html

poisonings
Poisonings
  • Of all calls to U.S. poison control centers in 2004:
    • 2,438,644 total exposures reported
    • 1,389,156 (57%) were pharmaceutical exposures
    • 581,488 (42%) of the

pharm exposures were

to children under 6

years of age

diversion abuse
Diversion & Abuse
  • Between 1992 and 2003:
    • # of teens (12 to 17 yrs of age)

who abused controlled drugs

jumped 212%

    • One in five teens says he or

she has been offered prescription drugs to get high

    • # of all Americans who abuse controlled prescription drugs nearly doubled, from 7.8 million to 15.1 million (Ref: CASA, 2005)
diversion abuse cont d
Diversion & Abuse (cont’d)
  • Increasing popularity of prescription narcotics over Schedule I drugs (perceived to be “safer”)
  • Most teens get their prescription drugs from home or friends
  • OxyContin street value

now = $80 per pill

trash msw is not the option
Trash (MSW) is not the option
  • White House Office of Drug Control Policy says mix with coffee grounds and throw in the trash
  • Not secure: still available to children, pets, homeless, solid waste workers
  • Landfills (80% of U.S. solid waste) still produce liquid leachate, which often goes to municipal wastewater plants
unfunded mandate
Unfunded mandate
  • Problem wastes should

not be the responsibility

of local government and

local tax-/rate-payers

  • A product stewardship approach is needed
summary of concerns
Summary of Concerns
  • Lots of unused drugs in people’s homes
  • Poisoning and abuse concerns
  • Low compliance = high accumulations
  • Left-overs are routinely flushed
  • Drugs are showing up in the environment
  • No safe, legal, environmentally-acceptable options exist
  • Local governments should

not have to foot the bill

slide25

Dave Galvin

Local Hazardous Waste Management Program in King County, Seattle, WA

Dave.Galvin@kingcounty.gov