Hospitals’ drug problem

Considerable attention has focused, in recent years, on why trace residues of prescription medicines contaminate most lakes, streams and estuaries. Excretion by consumers is one obvious source. But disposal of pharmaceutical wastes is another. And who has the most drugs to dump? Hospitals.

Figuring out how to responsibly discard drugs plagues hospitals and clinics throughout the country, according to Firouzan Massoomi. But not as many facilities worry about the problem as they should, he charges, because most don’t know that adhering to standard practice violates federal law or threatens to seriously pollute the environment.

It’s something that he, as the coordinator of pharmacy operations at Nebraska Methodist Hospital in Omaha, learned the hard way.

The Environmental Protection Agency randomly selected his hospital for an inspection, five years ago. The agency wanted to survey how well healthcare centers were adhering to hazardous-waste regulations called for under the Resource, Conservation and Recovery Act of 1976 — better known as RCRA (and pronounced rick’ ra). This law requires that any chemicals listed under the Act must be segregated from conventional wastes, itemized and then incinerated in an EPA-approved facility.

In talking with the EPA officials conducting the survey, Massoomi learned they had turned up RCRA violations at all 37 of the hospitals they had visited. If this hadn’t been a test visit but a bona fide inspection, these violations would have racked up some $9 million in fines, he reports. “The number one hospital violation was the failure to properly identify what materials were hazardous waste according to RCRA’s list.”

The irony: That list hadn’t been updated in nearly 30 years. So any drugs that have entered the market since 1976 are exempt. Regardless of their toxicity, these newer drugs can legally be discarded as conventional trash or even poured down the drain — and often are, he says.

Since the EPA visit to Methodist Hospital, Massoomi has been instructing the staff at this facility on federally mandated drug-wastes management. He’s also been surveying practices at sister facilities across the nation. And what he’s learned has been eye-opening.

Not only do healthcare facilities represent the “single largest identifiable source of pharmaceutical waste,” Massoomi says, but their wastes “are typically far more toxic” than those from homes or the urine of patients treated at home. The reason: Hospitals tend to dispense drugs at higher doses. Then again, their patients are typically the sickest of the sick. Bottom line: “Healthcare facilities handle the concentrated and most hazardous forms of these medications.” And all too often, Massoomi reports, these drugs are “legally poured down the drain or disposed of directly to landfills.”

The volumes of wastes are staggering. “A typical hospital handles over 700,000 containers of . . . hazardous pharmaceutical waste annually,” Massoomi notes. Some reflect doses of medicine, such as filled syringes or containers of pills, that are opened in anticipation of an emergency that doesn’t materialize or that is ultimately managed without them. A patient’s condition may simply change, requiring different medications — or none at all. And whenever patients are moved to higher or lower care parts of a hospital — such as from an operating room to intensive care or a normal bed — old meds are thrown out and new batches administered, Massoomi says.

He points to the Drug Free Water Act, a bill introduced into the House in January, as a promising step toward addressing hospitals’ drug problem. It would require that EPA survey all healthcare facilities to quantify drug wastes volumes and practices — and to identify innovative practices at the best facilities that could be copied by sister institutions.

But there still remains the problem that new drugs are still exempt from RCRA. Massoomi would prefer regulators impose a broad new mandate: “No pharmaceutical waste in the sewer or landfills. Period.”

In the mean time, he recommends that states and the Obama administration target funds to educating hospitals, clinics, physicians and nursing staff on their current (if less-than-ideal) responsibilities in managing discarded pharmaceuticals under existing law.

See related story: Maine way to get rid of drugs