COLORADO DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT Uniting Public Health Conference October 2, 2009

A SECURE, CONVENIENT AND ENVIRONMENTALLY SOUND OPTION FOR THE DISPOSAL OF UNUSED AND UNWANTED HOUSEHOLD MEDICATIONS

With the Environment… “How an aging population and our growing addiction to pharmaceuticals may be poisoning our rivers” NRDC – Fall 2006 “Fish sex change investigated - CU group establishes treatment plant effluent as culprit” Boulder Daily Camera – Dec “Pharmaceuticals found in drinking water, affecting wildlife and maybe humans” AP – March 2008 “Man-made chemicals found in drinking water at low levels” USGS – December 2008

WHAT ARE THESE CONTAMINANTS? Broad range of compounds including Pesticides Flame Retardants Teflon® and Gortex®-Related Materials Surfactants Nanomaterials Prions Personal Care Products Pharmaceuticals

The ability to detect is advancing faster than the understanding of potential effects However, we do know that many contaminants: Exhibit toxic characteristics May cause microbial antibiotic resistance Act as endocrine disruptors Sexual anomalies in fish have been observed Degrade into metabolites with potential effects Can persist in the environment With varying degrees of mobility

Where to Go for More Information USEPA PPCP’s in Water Home Page USGS Emerging Contaminants in the Environment Consortium for Research and Education on Emerging Contaminants (CREEC)

They are everywhere in modern society They are designed to have a biological effect They may be resistant to some forms of degradation to retain their activity over time Significant portions pass through the user unchanged or as biologically active metabolites They may be resistant to degradation or removal through conventional water and wastewater treatment techniques Stoner, et al NYSDEC

With Drug Abuse… “In 2008 three times as many people in Colorado died from prescription drug abuse (562) than from drunk-driving related crashes” CDPHE, Health Statistics “Nationally1 in 5 teens (19%) report abusing prescription drugs that were not prescribed to them” Partnership for a Drug Free America – “With kids availability and ease of use are two key factors when kids are using drugs” Boston Globe – January 2006

Challenges Majority of pharmaceuticals and their metabolites found in the environment are excreted by humans and animals Most pharmaceuticals do not have water quality standards and are not routinely monitored Environmental assessments of new drugs may not reveal chronic effects of low concentrations Alternative products or dosage reduction may not be viable options in treatment of health conditions

What Can We Do Now? Reduce those that enter the environment through disposal to landfills and drains Pick the “low-hanging fruit” and engage the public Immediate pollution reduction Education and awareness “Chemical Footprint” Purchasing decisions Support of further actions: Product stewardship Product packaging Prescription dosages

Available Medication Take-Back Strategies Take-Back Events Pharmacy Store/Health Agency Collection Points Police Station-Based Collection Points Mail-In Programs

King County, WA Survey Results What Locations are Convenient? If Convenient, Would You Use It? PH:ARM Team Washington State

Important Considerations Controlled Substances Act DEA must approve collection of controlled substances Controlled substances must be “in control” of law enforcement at all times through disposal Disposal Methods Controlled substances Limited to incineration with police evidence (contraband) Uncontrolled substances Hazardous waste incinerator affords greatest environmental protection

Project Design Components Convenience Security Controlled Substances Act Compliance Environmental Protection Contractor Qualifications Partnerships Promotion Costs Funding Outcomes

Chosen Collection Method for Pilot Project Pharmacy Store and Local Health Agency Medication Collection Bins Convenient Secure Cost-Effective No controlled substances accepted No need to sort medications No law enforcement or pharmacist interaction Measureable Success Pounds of medication collected User and host surveys

Secure collection boxes installed in: King Soopers/City Market 5 Front Range locations 2 Summit County locations* Tri-County Health Department Commerce City Englewood Denver Health Services Denver General Hospital *tentative

Collection boxes constructed with: Signage indicating “non-controlled medications” Attached list of prohibited controlled substances Heavy-gauge steel Floor or wall bolts One-way repository Double-lock mechanism Lighted view port

Collection Bin unlocked by location representative and contractor at same time Bag pulled from box without examination Contents immediately shredded in transport truck Disposal Hazardous waste incinerator

What About Controlled Substances? Most difficult aspect of medication take-back event or project planning Drug Enforcement Administration is considering public comments on disposal options In the interim, guidance must be available directing public to: Seek out local collection events that accept them, or Properly dispose of them in the trash if no alternative can be found

USFWS, APA, PhRMA

Contractor Qualifications Employee screening program Registered hazardous waste transporter Commercial drivers licensing with hazardous materials endorsements Colorado hazardous waste transfer facility Staffed call center to accept after-hours service requests

And the Contractor is……. Curbside Inc. Meets all project requirements Extensive household hazardous waste experience Similar project experience Garden Grove, CA Laguna Woods, CA Buena Park, CA Costa Mesa, CA Orange, CA

Project Partners King Soopers Tri-County Health Department Pollution Prevention Advisory Board (PPAB) Peer Assistance Services Pharmaceutical Research and Manufacturers of America (PhRMA) Colorado Pharmacists Society Various cities, counties and utilities

Promotion Avoid “over selling” a small-scale pilot project Press Release Web Page Talking Points Posters Fact Sheets Partner Web Links Partner Contact List Coordinated Location Host Advertising

Costs Collection Boxes ~ $1,700 per site for two year period Collection and Transport ~ $2,000 per site for two year period Disposal ~ $4,100 per site for two year period Total Two-Year Cost Per Site ~ $7,800

Funding USEPA – Region 8 Funding leases for 10 collection boxes CDPHE Internal Funds $15,000 Supplemental Environmental Project (SEP) Dollars Pollution Prevention Advisory Board $12,000 pollution prevention grant Denver Water Contribution for Denver Locations Funding for collection, transport and disposal costs

Outcomes Frequency of collection Pounds of medications collected Customer survey results Host location survey results

What Results Might We Expect? Similar Pilot Project – State of Washington Two-year duration (October 2006 – October 2008) Gradual expansion to 25 locations Minimal advertising and promotion More than 15,000 pounds collected of non-controlled substances collected Estimated that state-wide program, if manufacturer funded, would add $0.01 to $0.02 to cost of each medication PH:ARM Team Washington State

Future Direction State-wide program? Pilot will provide data for evaluation Legislation may be necessary to secure funding sources

Washington – Pending Manufacturers must develop approved programs for collection, transport and disposal Manufacturers responsible for program costs Maine - Pending Mail-in program Manufacturers responsible for program costs California – 2007 Requires development and implementation of model programs – Report to legislature Dec. 2010

Long-term care facilities are flushing pharmaceutical wastes to sewer And Shredding pharmaceutical waste which goes to a landfill

Nursing Homes 20-bed nursing home Up to 20 gallons per month of waste medications ~ 220 nursing homes in Colorado Estimated 4,400 gallons per month Flushed, trashed or improperly disposed

Waste from nursing homes (estimate 4,400 gallons per month) + Over 500 assisted living facilities + Elder home health care + others = Total rough estimate ~16,000 gallons of waste medication per month in Colorado

Household Pharmaceutical Wastes Implement Medication Take-Back Pilot Project Monitor programs and legislation in other states Provide advice to local take-back event planners Long-Term Care and Medical Facility Wastes Identify opportunities for solid waste program integration, training and guidance Monitor activities in other states Develop partnerships Gather data Pursue funding

Contacts Greg Fabisiak Project Manager Kathryn Stewart Generators Assistance Program