Hospital-flushed drugs stir concern

U.S. hospitals and long-term care facilities annually flush millions of pounds of unused pharmaceuticals down the drain, pumping contaminants into America’s drinking water, according to an ongoing investigation.

These discarded medications are expired, spoiled, over-prescribed or unneeded. Some are simply unused because patients refuse to take them, can’t tolerate them or die with nearly full 90-day supplies of multiple prescriptions on their nightstands.

Few of the country’s 5,700 hospitals and 45,000 long-term care homes keep data on the pharmaceutical waste they generate. But based on a small sample, that could project to an annual national estimate of at least 250 million pounds of pharmaceuticals and contaminated packaging.

One thing is clear: The massive amount of pharmaceuticals being flushed by the health-services industry is aggravating an emerging problem: the commonplace presence of minute concentrations of pharmaceuticals in the nation’s drinking water supplies, affecting at least 46 million Americans.

Researchers are finding evidence that even extremely diluted concentrations of pharmaceutical residues harm fish, frogs and other aquatic species in the wild. Also, they say, human cells fail to grow normally in the laboratory when exposed to trace concentrations of certain drugs.

And while most pharmaceutical waste is unmetabolized medicine that is flushed into sewers and waterways through human excretion, institutional drug disposal of drugs is adding another substantial dimension to the problem.

“Obviously, we’re flushing them —- which is not ideal,” acknowledged Mary Ludlow at White Oak Pharmacy, a Spartanburg, S.C., firm that serves 15 nursing homes and assisted-living residences in the Carolinas.

Such facilities, along with hospitals and hospices, pose distinct challenges because they handle large quantities of powerful and toxic drugs —- often more powerful and more toxic than the medications people use at home. And hospital waste is particularly laden with both germs and antibiotics.

The Environmental Protection Agency is considering whether to impose the first national standard for how much drug waste can be released into waterways by the medical services industry, but EPA’s top water administrator, Ben Grumbles, said a decision won’t be made until next year, at the earliest.

So far, regulators have done little more than politely ask the medical care industry to stop pouring drugs into the wastewater system. “Treating the toilet as a trash can isn’t a good option,” Grumbles said.

Landfills are one alternative. At least they don’t empty directly, and immediately, into waterways like some sewage.

Marjorie Powell, a lawyer for the Pharmaceutical Research and Manufacturers of America, said landfills are “more environmentally friendly,” and EPA spokeswoman Roxanne Smith said landfilling hazardous pharmaceutical waste “poses little threat to the public.”

But Grumbles said landfills, while safer, are not a permanent solution. That’s because pharmaceuticals eventually can reach waterways from landfills through leaks or intentional releases of treated seepage known as leachate.

Environmental professionals outside government are reaching a consensus that incinerators are the best disposal method.

The push for incineration hides an irony. Several decades ago, drug waste was routinely chucked into the trash and burned in hospital or city incinerators.

Then came a national campaign against air pollution. Most hospitals shut down their burners, and city incinerator managers became pickier about what they’d accept. With options restricted, hospitals began shipping more drug waste to landfills —- and dumping more into toilets and sinks.

For now, many health facilities, especially small ones, are put off by the cost of proper handling.

Drugs deemed hazardous by the EPA —- about 5 percent of the market —- might cost up to $2 a pound to incinerate in a certified hazardous waste incinerator, said Alan Davidner, president of Vestara of Irvine, Calif., which sells systems to manage drug waste. A pound might cost 35 cents to burn in a regular trash incinerator.

Tom Clark, an executive at the American Society of Consultant Pharmacists, wondered: “When you can flush it down the toilet for free, why would you want to pay —- unless there’s some significant penalties?

SAFER SOLUTIONS

Some states are taking steps to make the medical industry discard pharmaceutical waste more safely. Among them:

> Minnesota encourages incineration of an expanded list of drugs.

> Washington state lists almost all pharmaceuticals as dangerous waste to give its regulators more power to force safer disposal.

> North Carolina makes nursing home pharmacies take back unused controlled drugs and sends inspectors to verify their destruction in incinerators.

> Louisiana lets nursing homes donate millions of dollars worth of unused drugs each year to charity.