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Vol. 14 Issue 2, Spring/Summer = 2009=20

Keeping Pharmaceuticals = Out of the=20 Water: Activities Around New York State
The=20 Ribbon

By Carmi Orenstein, MPH, Editor

A year ago in our Spring 2008 issue we wrote about =E2=80=9CFollowing = the News on=20 Pharmaceuticals in Drinking Water.=E2=80=9D Here we offer an update on = some of the=20 efforts in New York State (NYS) to keep pharmaceuticals out of the water = that=20 have taken place since then.=20

NYS bill passed, public information campaign initiated=20

A bill that requires the New York State Department of Environmental=20 Conservation (DEC) in cooperation with the Department of Health (DOH) to = conduct=20 an extensive public information campaign on the proper storage and = disposal of=20 prescription and over-the-counter (OTC) drugs was passed in late Fall = 2008. The=20 bill also requires the DEC to develop a notice containing proper = disposal=20 information to be displayed in every pharmacy and retail business with = more than=20 3,000 square feet of retail space that is authorized to sell drugs. The = new law=20 authorizes DEC to establish or enter into contracts for the = establishment of=20 demonstration programs to determine the most effective methods of drug = disposal.=20 Assemblyman Steven Englebright states on his website that his original = proposal=20 (introduced on the Senate side by Senator James Alesi) =E2=80=9Cwas more = far-reaching=20 and would have established a drug collection system statewide to be = conducted=20 and paid for by the pharmaceutical companies. However, this new law is a = good=20 first step toward a comprehensive drug collection program, and I am = hopeful we=20 can build on our progress during the next few years.=E2=80=9D=20

The =E2=80=9CDon=E2=80=99t Flush Your Drugs=E2=80=9D campaign = (www.dontflushyourdrugs.net) consists=20 of guidance for pharmacies and a poster for display. The poster is = required to=20 be =E2=80=9Cconspicuously displayed=E2=80=9D as of March 24, 2009. The = website has additional=20 information including background on why we are now being instructed not = to flush=20 pharmaceuticals (when previous guidance often suggested otherwise, since = flushing was considered the best way to keep drugs out of the hands of=20 children). It also addresses why most community household hazardous = waste (HHW)=20 collection days do not accept medications. This latter issue is the = reason that=20 policy emphasis is now also being placed on community = =E2=80=9Ctake-back=E2=80=9D programs.=20 Explains the DEC, =E2=80=9Cto ensure that controlled substances = (narcotics) are properly=20 disposed of, the collection must ... occur separately from the other HHW = and a=20 law enforcement official must be present to take possession of those = drugs.=E2=80=9D=20

Local and regional pharmaceutical take-back programs growing in=20 numbers=20

Westchester County is providing an excellent example of utility, = convenience,=20 and success for a community take-back program for pharmaceuticals. In = the past=20 year and a half, Westchester County, partnering with the = Westchester/Rockland=20 Society of Pharmacists, has collected 4,250 pounds of unused medications = from=20 1,600 households at drive-through events at multiple locations around = the=20 county. These events are linked with the county=E2=80=99s roving = Household Recycling=20 Days. Deputy Commissioner Louis Vetrone states that the program is = =E2=80=9Creally=20 taking off=E2=80=9D and even further expanding this year. Vetrone and = Environmental=20 Project Coordinator Peter Costa describe a very comprehensive outreach = program=20 involving automated recorded calls, print ads and brochures, and email = news=20 blasts. These events have had increasing participation, but they also = plan to=20 add events at senior centers, in order to reach that crucial group for = whom the=20 drive-through events may not be as appropriate. See=20 http://www.westchestergov.com/environment_householdrecyclingschedule.htm = for the=20 schedule of their events countywide.=20

On Long Island, Suffolk County Legislator Lynne C. Nowick is = spearheading=20 action on pharmaceutical take-backs. Her actions, together with Stony = Brook=20 University, Stony Brook University Medical Center, and other partners, = supported=20 the New York Sea Grant (NYSG) program in the planning of a community = event this=20 past April in Setauket, where almost 500 pounds of unwanted medicines = were=20 collected from 140 participants. Legislator Nowick has also worked with=20 hospitals to sponsor take-back programs, including a yearly event to = take place=20 at St. Catherine of Siena Medical Center in Smithtown. Larissa Graham, = the Long=20 Island Sound Study Coordinator for the NYSG, collected evaluation data = from=20 their April event and found that 34 towns were represented, with some=20 participants traveling over 45 miles to attend the event. All = participants that=20 filled out the evaluation survey said that they would attend another = event, and=20 the majority wanted to see this type of event held once a year. = Participants=20 also expressed that they would like to see legislation at the town or = village=20 level to collect unwanted medicines. Ms. Graham is currently developing = a report=20 designed to help other entities establish such collection programs in = response=20 to calls she has received requesting such guidance. =E2=80=9CWe are more = than happy to=20 lend advice to other agencies that are interested in organizing a = similar=20 event,=E2=80=9D she says. To obtain their report about how to hold a = successful=20 pharmaceutical take-back program, please visit www.nyseagrant.org. In = Nassau=20 County, a town-run collection by the North Hempstead Solid Waste = Management=20 Authority in Port Washington was held in late June. (Contact Frances = Reid at=20 516-526-2572 or reidf@northhempstead.com for information on future = events.)=20

Ray Krupski, Director of Pharmacy at Eastern Long Island Hospital, = describes=20 a unique program in which anyone can drop off unused pharmaceuticals at = their=20 pharmacy, seven days a week, from 10:00am to 3:00pm. Situated on the far = eastern=20 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=20 over a year ago. Because this is an ongoing collection and having law=20 enforcement at the collection is not feasible, the program does not = accept=20 controlled substances. (It also does not accept chemotherapy drugs.) = There are=20 plans, however, for a community collection in October that would include = law=20 enforcement and therefore be able to include controlled substances. Mr. = Krupski=20 also does outreach to seniors in the community to build awareness of the = program=20 and to teach about the importance of proper disposal of expired = medications. He=20 regularly receives calls from other pharmacies interested in setting up = such a=20 program.=20

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=20 confiscated by law enforcement. In the case of Eastern Long Island = Hospital, the=20 take-back program links with the hospital=E2=80=99s existing setup for = the facility=E2=80=99s=20 expired medications with Guaranteed Returns (a pharmaceutical reverse=20 distribution vendor).=20

DEC engaging in cooperative activities=20

In May of 2008, DEC and DOH hosted a roundtable with stakeholders to = discuss=20 management options for unwanted drugs. The proceedings for this meeting = can be=20 downloaded at http://www.dec.ny.gov/chemical/45118.html (on the right = sidebar of=20 the web page, =E2=80=9CRelated Links=E2=80=9D). This meeting not only = addressed management of=20 household/individual disposal of medications (such as the programs = described=20 above address), but also the vast issues associated with institutional=20 pharmaceuticals management. One presentation focused on the state of = practice in=20 long-term care facilities where =E2=80=9Ccommon practice ... is to = flush,=E2=80=9D (as is still=20 approved by the DOH for these facilities). =E2=80=9CWhile alternative = management systems=20 exist ... they are costly and lacking a mandate or a strong education = program,=20 and unlikely to gain administrative support,=E2=80=9D explained the = presenter, Holly=20 Vaughn of the Fort Hudson Nursing Home. The following presenter, Nancy = Leveille=20 of the NYS Health Facilities Association, said that, =E2=80=9Cthere is = potentially less=20 waste of pharmaceuticals in a hospital setting than a nursing = home/long-term=20 care facility since hospitals have in-house pharmacies and tend to = dispense=20 medication by the individual dose.=E2=80=9D Apart from approved = destruction methods for=20 controlled substances however, flushing is still common for other = medications.=20 Important steps outlined at the meeting for hospitals and institutional=20 pharmaceutical waste management included more regulatory clarity and = education=20 and the need to revise Medicare Part B to allow for crediting and reuse = of=20 unused medication. The DEC also pointed out that even the most advanced=20 wastewater treatment used in NYS does not effectively remove = pharmaceutical=20 contaminants and that the state should =E2=80=9Ccontinue to monitor and = support research=20 to develop technologies to address this and other emerging = contaminants.=E2=80=9D

Concerns=20 with the use of triclosan addressed in new fact sheet

In 2007 = we=20 interviewed Dr. Anthony Hay on his work addressing contaminants in = sewage=20 sludges. He discussed triclosan, a compound that shows up increasingly = in=20 sludges, ecologic samples, and human blood, urine and breastmilk. = Triclosan is a=20 widely used biocide that is present in almost all antibacterial soaps, = as well=20 as many other products. According to Dr. Hay, as well as a 2005 FDA = advisory=20 panel and a 2000 report from the American Medical Association, there is = no sound=20 scientific support for its use, and it may pose hazards (such as = antibiotic=20 resistance and ecologic and health concerns). A new fact sheet outlining = =E2=80=9CThe=20 Trouble with Triclosan=E2=80=9D is available at=20 http://www.foodandwaterwatch
.org/water/chemical-contaminants/
what= -is-lurking-in-your-soap.=20 It was produced by two organizations: Food & Water Watch and Beyond=20 Pesticides.=20

In a letter to the US Environmental Protection Agency dated May 27, = 2008, the=20 DEC Commissioner Alexander Grannis stated, =E2=80=9CThe problem of = pharmaceuticals and=20 personal care products in water systems is multifaceted with no single = solution,=20 =E2=80=9C and that the Pharmaceuticals Working Group established by the = DEC =E2=80=9Chas=20 initially focused on reducing the disposal of unused pharmaceuticals = into the=20 waters of New York State.=E2=80=9D Looking beyond state lines for = partnerships, the DEC=20 is also participating in the New England Interstate Water Pollution = Control=20 Commission=E2=80=99s work group on pharmaceuticals, and continuing its = work with the US=20 Geological Survey, which has reported for over a decade on the presence = of human=20 and veterinary drugs in waterways. Also on a national level, DEC is=20 participating in the Product Stewardship Institute=E2=80=99s = pharmaceuticals initiative.=20 Commissioner Grannis=E2=80=99 letter to the EPA makes an appeal for = =E2=80=9Ca more proactive=20 and precautionary approach toward limiting the levels of contaminants = that enter=20 in sources of drinking water...=E2=80=9D and outlines the deficiencies = of federal=20 regulations currently in place.=20

With over 225 million prescriptions filled annually in NYS, no access = to=20 take-back programs for most of the State=E2=80=99s residents, barriers = to carrying out=20 best practices in institutions, and regulatory deficiencies, clearly = this is=20 just the beginning of the action needed for the management of = pharmaceutical=20 waste.

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Last Update 06.30.09

=C2=A9 2009 Cornell University

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Keeping Pharmaceuticals = Out of the=20 Water: Activities Around New York StateThe=20 Ribbon

Keeping Pharmaceuticals = Out of the=20 Water: Activities Around New York State
The=20 Ribbon