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Vol. 14 Issue 2, Spring/Summer 2009

Keeping Pharmaceuticals Out of the
Water: Activities Around New York State
The
Ribbon

By Carmi Orenstein, MPH, Editor

A year ago in our Spring 2008 issue we wrote about “Following the News on
Pharmaceuticals in Drinking Water.” Here we offer an update on some of the
efforts in New York State (NYS) to keep pharmaceuticals out of the water that
have taken place since then.

NYS bill passed, public information campaign initiated

A bill that requires the New York State Department of Environmental
Conservation (DEC) in cooperation with the Department of Health (DOH) to conduct
an extensive public information campaign on the proper storage and disposal of
prescription and over-the-counter (OTC) drugs was passed in late Fall 2008. The
bill also requires the DEC to develop a notice containing proper disposal
information to be displayed in every pharmacy and retail business with more than
3,000 square feet of retail space that is authorized to sell drugs. The new law
authorizes DEC to establish or enter into contracts for the establishment of
demonstration programs to determine the most effective methods of drug disposal.
Assemblyman Steven Englebright states on his website that his original proposal
(introduced on the Senate side by Senator James Alesi) “was more far-reaching
and would have established a drug collection system statewide to be conducted
and paid for by the pharmaceutical companies. However, this new law is a good
first step toward a comprehensive drug collection program, and I am hopeful we
can build on our progress during the next few years.”

The “Don’t Flush Your Drugs” campaign (www.dontflushyourdrugs.net) consists
of guidance for pharmacies and a poster for display. The poster is required to
be “conspicuously displayed” as of March 24, 2009. The website has additional
information including background on why we are now being instructed not to flush
pharmaceuticals (when previous guidance often suggested otherwise, since
flushing was considered the best way to keep drugs out of the hands of
children). It also addresses why most community household hazardous waste (HHW)
collection days do not accept medications. This latter issue is the reason that
policy emphasis is now also being placed on community “take-back” programs.
Explains the DEC, “to ensure that controlled substances (narcotics) are properly
disposed of, the collection must ... occur separately from the other HHW and a
law enforcement official must be present to take possession of those drugs.”

Local and regional pharmaceutical take-back programs growing in
numbers

Westchester County is providing an excellent example of utility, convenience,
and success for a community take-back program for pharmaceuticals. In the past
year and a half, Westchester County, partnering with the Westchester/Rockland
Society of Pharmacists, has collected 4,250 pounds of unused medications from
1,600 households at drive-through events at multiple locations around the
county. These events are linked with the county’s roving Household Recycling
Days. Deputy Commissioner Louis Vetrone states that the program is “really
taking off” and even further expanding this year. Vetrone and Environmental
Project Coordinator Peter Costa describe a very comprehensive outreach program
involving automated recorded calls, print ads and brochures, and email news
blasts. These events have had increasing participation, but they also plan to
add events at senior centers, in order to reach that crucial group for whom the
drive-through events may not be as appropriate. See
http://www.westchestergov.com/environment_householdrecyclingschedule.htm for the
schedule of their events countywide.

On Long Island, Suffolk County Legislator Lynne C. Nowick is spearheading
action on pharmaceutical take-backs. Her actions, together with Stony Brook
University, Stony Brook University Medical Center, and other partners, supported
the New York Sea Grant (NYSG) program in the planning of a community event this
past April in Setauket, where almost 500 pounds of unwanted medicines were
collected from 140 participants. Legislator Nowick has also worked with
hospitals to sponsor take-back programs, including a yearly event to take place
at St. Catherine of Siena Medical Center in Smithtown. Larissa Graham, the Long
Island Sound Study Coordinator for the NYSG, collected evaluation data from
their April event and found that 34 towns were represented, with some
participants traveling over 45 miles to attend the event. All participants that
filled out the evaluation survey said that they would attend another event, and
the majority wanted to see this type of event held once a year. Participants
also expressed that they would like to see legislation at the town or village
level to collect unwanted medicines. Ms. Graham is currently developing a report
designed to help other entities establish such collection programs in response
to calls she has received requesting such guidance. “We are more than happy to
lend advice to other agencies that are interested in organizing a similar
event,” she says. To obtain their report about how to hold a successful
pharmaceutical take-back program, please visit www.nyseagrant.org. In Nassau
County, a town-run collection by the North Hempstead Solid Waste Management
Authority in Port Washington was held in late June. (Contact Frances Reid at
516-526-2572 or [email-masked] for information on future events.)

Ray Krupski, Director of Pharmacy at Eastern Long Island Hospital, describes
a unique program in which anyone can drop off unused pharmaceuticals at their
pharmacy, seven days a week, from 10:00am to 3:00pm. Situated on the far eastern
end of Long Island (with community members often arriving by boat to the
facility), the leadership at the hospital felt it important to make this
contribution to protecting their ecosystem and they conceptualized this program
over a year ago. Because this is an ongoing collection and having law
enforcement at the collection is not feasible, the program does not accept
controlled substances. (It also does not accept chemotherapy drugs.) There are
plans, however, for a community collection in October that would include law
enforcement and therefore be able to include controlled substances. Mr. Krupski
also does outreach to seniors in the community to build awareness of the program
and to teach about the importance of proper disposal of expired medications. He
regularly receives calls from other pharmacies interested in setting up such a
program.

Pharmaceuticals collected at all of the above events are destroyed by
incineration. In many cases they are dealt with in the same manner as drugs
confiscated by law enforcement. In the case of Eastern Long Island Hospital, the
take-back program links with the hospital’s existing setup for the facility’s
expired medications with Guaranteed Returns (a pharmaceutical reverse
distribution vendor).

DEC engaging in cooperative activities

In May of 2008, DEC and DOH hosted a roundtable with stakeholders to discuss
management options for unwanted drugs. The proceedings for this meeting can be
downloaded at http://www.dec.ny.gov/chemical/45118.html (on the right sidebar of
the web page, “Related Links”). This meeting not only addressed management of
household/individual disposal of medications (such as the programs described
above address), but also the vast issues associated with institutional
pharmaceuticals management. One presentation focused on the state of practice in
long-term care facilities where “common practice ... is to flush,” (as is still
approved by the DOH for these facilities). “While alternative management systems
exist ... they are costly and lacking a mandate or a strong education program,
and unlikely to gain administrative support,” explained the presenter, Holly
Vaughn of the Fort Hudson Nursing Home. The following presenter, Nancy Leveille
of the NYS Health Facilities Association, said that, “there is potentially less
waste of pharmaceuticals in a hospital setting than a nursing home/long-term
care facility since hospitals have in-house pharmacies and tend to dispense
medication by the individual dose.” Apart from approved destruction methods for
controlled substances however, flushing is still common for other medications.
Important steps outlined at the meeting for hospitals and institutional
pharmaceutical waste management included more regulatory clarity and education
and the need to revise Medicare Part B to allow for crediting and reuse of
unused medication. The DEC also pointed out that even the most advanced
wastewater treatment used in NYS does not effectively remove pharmaceutical
contaminants and that the state should “continue to monitor and support research
to develop technologies to address this and other emerging contaminants.”

Concerns
with the use of triclosan addressed in new fact sheet

In 2007 we
interviewed Dr. Anthony Hay on his work addressing contaminants in sewage
sludges. He discussed triclosan, a compound that shows up increasingly in
sludges, ecologic samples, and human blood, urine and breastmilk. Triclosan is a
widely used biocide that is present in almost all antibacterial soaps, as well
as many other products. According to Dr. Hay, as well as a 2005 FDA advisory
panel and a 2000 report from the American Medical Association, there is no sound
scientific support for its use, and it may pose hazards (such as antibiotic
resistance and ecologic and health concerns). A new fact sheet outlining “The
Trouble with Triclosan” is available at
http://www.foodandwaterwatch
.org/water/chemical-contaminants/
what-is-lurking-in-your-soap.
It was produced by two organizations: Food & Water Watch and Beyond
Pesticides.

In a letter to the US Environmental Protection Agency dated May 27, 2008, the
DEC Commissioner Alexander Grannis stated, “The problem of pharmaceuticals and
personal care products in water systems is multifaceted with no single solution,
“ and that the Pharmaceuticals Working Group established by the DEC “has
initially focused on reducing the disposal of unused pharmaceuticals into the
waters of New York State.” Looking beyond state lines for partnerships, the DEC
is also participating in the New England Interstate Water Pollution Control
Commission’s work group on pharmaceuticals, and continuing its work with the US
Geological Survey, which has reported for over a decade on the presence of human
and veterinary drugs in waterways. Also on a national level, DEC is
participating in the Product Stewardship Institute’s pharmaceuticals initiative.
Commissioner Grannis’ letter to the EPA makes an appeal for “a more proactive
and precautionary approach toward limiting the levels of contaminants that enter
in sources of drinking water...” and outlines the deficiencies of federal
regulations currently in place.

With over 225 million prescriptions filled annually in NYS, no access to
take-back programs for most of the State’s residents, barriers to carrying out
best practices in institutions, and regulatory deficiencies, clearly this is
just the beginning of the action needed for the management of pharmaceutical
waste.

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Last Update 06.30.09

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