Update on pharmaceutical waste disposal regulations: Strategies for success

Abstract

Trace pharmaceuticals have been identified and measured in our water supply as early as 1999, when a US Geological Survey study of over 1,000 sites found that 7% of public water supply samples and 14% of domestic water supply samples contained pharmaceuticals or hormones.1 In 2018, a study found traces of oxycodone in seafood, specifically in Seattle-area mussels.2 Compared to the rest of the world, the United States is one of the top countries in the number of pharmaceuticals found in drinking water.3 Municipalities do not currently regulate water for pharmaceutical levels.4 Furthermore, common filtration systems may not be adequately equipped to remove pharmaceuticals due to their unique chemical properties. While low levels of pharmaceuticals in water supplies currently pose an unlikely risk to human health, the long-term risks of continued long-term exposure, effects of pharmaceutical mixtures, and the potential for antibiotic resistance and drug tolerance are unknown. Health systems generate a significant portion of the pharmaceutical waste that is “sewered” into waste water, especially controlled substances (through efforts to render them irretrievable). The Environmental Protection Agency (EPA) recently published a new final rule on pharmaceutical waste disposal in an effort to simplify regulations and discourage sewering of all pharmaceuticals. Health systems must take responsibility to dispose of pharmaceutical waste in an environmentally friendly manner to avoid the continued contamination of water sources. The objective of this article is to highlight and identify the most significant changes in the EPA regulations that are relevant to health-system pharmacy and recommend practical ways to implement a successful program for pharmaceutical waste management.