New Safe Medication Disposal Rules

Is your facility in compliance with new EPA rules regarding disposal of pharmaceuticals?

In August 2019, new regulations from the United States Environmental Protection Agency (EPA) went into effect regarding the safe disposal of hazardous waste pharmaceuticals at nursing homes and other long-term care facilities. In an effort to curb accidental poisonings or misuse and abuse of certain high-risk medications, staff are no longer allowed to flush these items away — a practice referred to as “sewering.”

The new rule notes that this policy change “will make our drinking and surface water safer and healthier by reducing the amount of hazardous waste pharmaceuticals entering our waterways by 1,644 to 2,300 tons on an annual basis by prohibiting all facilities subject to the rule from sewering them. This action will help address the issue highlighted by a growing body of publicly available studies documenting the presence of pharmaceuticals in drinking and surface waters as well as their negative impacts to aquatic and riparian ecosystems,” the EPA explains.

Though the EPA has had a “long-standing policy of strongly discouraging the flushing of pharmaceuticals down the drain in any situation,” the agency reports, the passage of the new regulation puts enforcement teeth behind those recommendations.

In addition to eliminating sewering, the rule also streamlines standards to “protect human health and the environment while bringing efficiencies and cost-saving to the sector.” It also amends the P075 hazardous waste listing for nicotine so that over-the-counter nicotine replacement therapies such as patches, lozenges and gums no longer have to be classified as hazardous waste when discarded.

Assisted Living Facilities Exempted

While the rule has broad reach, assisted living facilities were exempted in part because residents in such facilities are often in charge of their own medication management. Because residents often purchase medications from a number of pharmacies and store these medications in their own units, enforcing regulations are exponentially more difficult and financially onerous for facility operators.

Therefore, in terms of this rule, the EPA defines long-term care facility the same way the Centers for Medicare & Medicaid Services and the Drug Enforcement Agency do and exempts independent living communities, group homes, assisted living facilities, and the assisted living components of CCRCs from the new regulations. Nevertheless, for these facilities, the EPA recommends creating a voluntary waste disposal program to prevent water contamination or misuse or abuse of discarded pharmaceutical wastes.

More information about the applicability of the rule, including state-by-state information, is available here.

Get into Compliance

If your facility is affected by these rule changes, have you gotten into compliance yet? If not, you could be hit with fines. The following tips and strategies should help you better manage pharmaceutical waste. It’s important that you make these changes to protect public and environmental health.

1. Train your staff. The frontline for properly disposing of medications are the people who work with these items every day. Put a policy into place and then train all staff who have any contact with medications on how to comply with that policy.
2. Make disposal convenient. Once you’ve established how you will collect discarded medications and keep them safe from theft or accidental ingestion, you need to make these disposal locations convenient for staff. A busy nurse may be more inclined to simply flush a medication down the toilet if he has to walk down the hall or to another floor to dispose of it properly. And make sure to empty these containers regularly — some medications can be returned to the prescribing pharmacy for reuse while some need to go back to the manufacturer or to a pharmaceutical waste management company to be destroyed safely.
3. Manage controlled substances. If you have narcotics or opioid-based medications on site, you must comply with all DEA regulations. Red Bags, a medical waste disposal services company, says that “controlled substances in their original container which need to be disposed of should remain in the original container with the volume recorded.” You’ll also need to fill out the proper disposal form, which can be obtained from the DEA. Marinating a clear chain of possession for the full volume of medications can keep you on the right side of the law regarding these potentially very dangerous drugs.
4. Keep tabs on pharmaceutical samples. When pharma reps visit, they often leave behind samples. If your facility gets such visits, you probably have a cabinet or closet where these samples tend to accumulate. Be sure you regularly check the expiration dates of all medications in the cabinet and safely dispose of anything that’s past its expiration date.
5. Safely manage vaccines and sharps. Vaccine manufacturers often take back unused doses, so inquire with your supplier about how best to manage these important pharmaceuticals. And of course, any sharps used to deliver vaccines or other injections should always be disposed of appropriately in a sharps container.
6. Use take-back programs or hire a waste disposal contractor. An experienced medical waste management company can ensure that your facility is in compliance with all applicable disposal rules.

Elaine Howley

Elaine K. Howley is a freelance journalist for various publications. An award-winning writer specializing in health, fitness, sports and history, her work has appeared in numerous print and online publications, including U.S. News, AARP.org, espnW, SWIMMER magazine and Atlas Obscura. She’s also a world-record holding marathon swimmer with a passion for animals and beer. Contact her via her website: elainekhowley.com.