WellnessFrom suicidal shrimp to spiked tap water: where unused medications end up
It used to be common practice to flush old medications down the toilet, but reports of feminized fish and drugged runoff have raised concerns. Alternative drug disposal methods are not much better.
The issues caused by the improper release of pharmaceuticals sound like something out of a sci-fi story: feminized flounder found in New York City’s Jamaica Bay, low levels of pharmaceuticals detected in the drinking water supply of 41 million Americans, pharmaceutical waste runoff causing shrimp to commit suicide—the list goes on and on. Hopes&Fears spoke to Brian Smith of Citizens Campaign for the Environment and Josh Frank of New York’s Department of Sanitation Environmental Police Unit on how to handle medications you no longer need.
Americans are buying more pills than they can swallow. With demand for pharmaceuticals growing every year—the U.S. spent a record $374 billion on prescription drugs alone in 2014—access to proper pharmaceutical disposal is becoming more important than ever. An estimated 250 million pounds of pharmaceutical waste is generated by American hospitals and long-term care homes each year. Add this to approximately one-third of medications sold that go unused by consumers, plus the millions of pounds of pharmaceutical waste produced by pharmacies, prisons, mental health facilities, farms and veterinary clinics each year, and we have a major disposal problem on our hands. In large part, the surplus of pharmaceutical waste is ending up in the trash, down the toilet, and ultimately in our waterways.
Oxycodone and kitty litter
For many years, the widely accepted approach for disposing of pharmaceuticals was to "just flush ‘em." That advice changed with studies like the 1999 and 2000 U.S. Geological Surveys, which identified traces of pharmaceuticals in 80% of the streams and rivers sampled. Although recent legislation such as the EPA’s proposed rule to ban healthcare facilities from flushing pharmaceutical waste down the toilet or drain is a step in the right direction, people are still flushing unused pharmaceuticals purposefully or inadvertently through waste.
Although wastewater is treated before being released into the environment, most treatment plants and septic systems are neither equipped nor required to filter out pharmaceuticals. “While some efforts have been made to improve filtering technology, the fact remains that our treatment plants are currently not designed to remove pharmaceuticals," Brian Smith, Associate Executive Director of Citizens Campaign for the Environment, tells Hopes&Fears.
Nowadays, the most popular method of disposing pharmaceuticals, according to a 2015 survey by Western University of Health Sciences, is to put them in the trash. Even the EPA, DEA, and FDA suggest trash disposal, if no safe drop-off is available. Their advice is to mix unused pharmaceuticals with an unpalatable substance (e.g. cat litter), seal them in a plastic container, and throw them away. This new trend has resulted in an estimated 1,040 tons of active pharmaceuticals entering U.S. landfills each year.
For disposing of controlled substances like opioids, the FDA still recommends flushing to prevent them from landing in the wrong hands. As a result, the same drugs the FDA does not want getting into the wrong hands are now ending up, in small traces, in our drinking water. If you had a glass of tap water today, chances are you had it with a twist of Oxycodone and any number of other commonly found pharmaceutical compounds in America’s public water systems.
Although landfilling may prevent unused medications from getting into the wrong hands, the method is far from environmentally sound. “Flushing and landfilling are never the right disposal solutions for unused pharmaceutical drugs,” says Smith, “pharmaceutical drugs can be found in landfill leachate [water that comes in contact with trash], and ultimately pose a threat to water quality.”
According to A study, shrimp exposed to antidepressants from waste runoff are five times more likely to swim towards light...while they would normally stay in more protected areas, these drug-induced sea creatures are basically committing suicide by gravitating towards situations that end up resulting in their early demise
Where unused medications end up
Bring out your drugs
The best thing to do, Smith says, is to take unwanted drugs to a safe and secure take-back event. Thanks to the Secure and Responsible Drug Disposal Act of 2010, individuals who are unable to make it to the safe take-back events can now dispose of controlled substances at a safe drop-box at their local pharmacy, law enforcement agency, or other DEA registrants. “Allowing pharmacies to take back unused controlled drugs was a game-changer for safe disposal,” says Smith. The DEA has since hosted ten national Take-Back Days (two per year) at more than 5,000 collection sites across the United States.
For more information on the logistics of safe take-back events on a local level, Hopes&Fears turned to Josh Frank of New York’s Department of Sanitation Environmental Police Unit. “All the drugs we collect, whether controlled substances or not, are treated the exact same,” said Frank. “When people bring us medications, we put them in boxes, then bring them to a secure New York Department of Sanitation storage facility where they stay until they are ready to be taken to our Energy-from-Waste facility on Long Island.”
From there, according to the website of New York’s Energy-From-Waste facility, Covanta, the municipal waste is transferred to a combustion chamber and maintained at extremely high temperatures (e.g. above 1,200ºC). The heat from the combustion process boils water, which produces steam, which drives a turbine, which generates electricity to be distributed to the local grid. Metals are extracted for recycling from the ash produced during the combustion process, and the remaining ash is landfilled. As for the gases produced during the process, those are filtered, cleaned and emitted back into the atmosphere.
What the take-back programs have been successful in are recruiting people who might not normally dispose of old medications at all. “The oldest bottle of medicine we collected was from the 1950’s. It was in a glass jar with old labeling and everything,” said Frank.
While increased access to safe disposal sites may help keep pharmaceuticals off the streets, some take-back programs, especially those using incineration (as opposed to Energy-from-Waste disposal), have been found to have negative environmental effects. A 2012 study by researchers at the University of Michigan found that take-back programs tend to produce high greenhouse gas emissions as a result of the typical long-haul transportation to and from drop-off points and to incineration centers. The study even suggested that landfilling, when compared to flushing and incinerating, was the greenest method of pharmaceutical disposal.
A costly method
Although safe disposal has become more accessible in recent years, pharmacy participation in the collection program remains voluntary and unfunded. A Google search for “Take-Back Day and Manhattan” leads to the NYC Department of Sanitation website, which notes to “Check back in early 2016 for details." If you plan on going, be sure to bring a book; the NYC Department of Sanitation website alerts visitors that "Because the events are popular, be prepared for a line."
DEA registrants, such as retail pharmacies, that volunteer to participate must shoulder the burden of costs associated with safe disposal, including setting up a receptacle, the recurring costs of replacing receptacle liners, and shipping costs. This may be why, after searching five separate databases for medication drop-boxes in Manhattan, Hopes&Fears came up with only four locations—all mom and pop pharmacies in the city. One pharmacist Hopes&Fears spoke with, who wished to remain anonymous, cited cost as the main reason her independently owned pharmacy is no longer offering the service.
None of the major pharmacy branches Hopes&Fears spoke with in Manhattan, such as CVS and Duane Reade—including the Duane Reade pharmacy headquarters on Wall Street—have a pharmaceutical drop-box. The CVS website does offer a mail-back program envelope for $3.99, but envelopes are often not stocked in-store.
"Old habits are hard to break"
Considering the limited availability to safe drop-offs and less than ideal trash disposal methods, what can we do now to increase access? One idea is to put responsibility on the pharmaceutical companies to help handle the waste. “Several counties in California are moving forward with extended producer responsibility (EPR) laws, which will ensure that pharmaceutical companies take responsibility for their products throughout the product’s life cycle,” says Smith, “To comply with such legislation, pharmaceutical manufacturers and others in the product chain will design, manage, and fund take-back programs to securely collect unwanted medicines and ensure the collected materials are properly managed.”
On the other side of the county, Maine has had some success with providing mail-back envelopes to residents for free. While EPR laws for pharmaceutical companies are a big step in the right direction, not much can be done legislatively about human behavior. “CCE and others are doing a significant amount of public education on safe disposal and we find that, as people are educated on the issue and have access to safe disposal, they will often do the right thing," Smith says.
"That being said, old habits are hard to break. Changing public behavior will take time and more education is certainly needed.”
Editor: Gabriella Garcia