June 2008, Vol. 20, No.6

Taking Back the Drugs

Taking Back the Drugs

Water quality professionals know that old, unused, and unwanted medications should not be disposed of down the toilet. The tough part is getting that message out to customers and then providing an alternative disposal method that is as easy as a flush.

Drug take-back programs are prompted by utilities’ desires to keep excess pharmaceuticals out of the wastewater stream, said Brandon Koltz, vice president of Symbiont (West Allis, Wis.), an engineering and consulting firm. “Anything you can keep out of the wastewater stream is going to be beneficial,” he said. “Obviously, anything that you keep out, you don’t have to deal with later.”

“It’s an emerging concern for presences of substances … it’s an awareness and trying to stay ahead of the curve,” Koltz said. “This is the same thing as we saw 15 years ago with household hazardous waste.”

In addition to protecting water quality, these programs also reduce avoidable poisonings from expired or misused drugs, as well as prevent the intentional misuse of prescriptions, especially by teenagers, according to Janet Gillaspie, executive director of the Oregon Association of Clean Water Agencies (ORACWA; Portland). ORACWA assembled a stakeholder group to make recommendations on how to approach this issue in Oregon.

Controlled Substances
Each take-back program is organized a little differently, Koltz said. There can be single-day events, continuous drop-off locations, or even mail-in programs to return the drugs to the manufacturer. Regardless of the design, one issue continually present challenges: controlled substances.

Sorting out these challenges requires help from law enforcement.

The Controlled Substances Act (Title 21 USC) requires that drugs deemed controlled substances, such as narcotic painkillers, only be turned over to law enforcement officers, Koltz said. Additionally, “you have to have people as part of the collection programs, such as doctors or nurses or pharmacists, who are able to recognize and categorize the substances that you are collecting,” he said.

The largest challenge that people face is dealing with U.S. Drug Enforcement Agency regulators, Gillaspie said. “You don’t want to craft a program that is illegal, and the Controlled Substance Act is a very serious law,” she said.

Put another way, “in order to legally collect unwanted controlled substances, it is an absolute necessity that law enforcement officials be on-site, participate in the collection, take physical control and custody of all controlled substances, and be responsible for their destruction as required by state and federal law,” according to the publication Operating Unwanted Medication Collections — A Legal & Safe Approach, published by the Northeast Recycling Council Inc. (Brattleboro, Vt.).

In some cases, organizers of take-back programs have decided not to collect controlled substances in order to simplify their programs. For example, in 2004, Alachua County, Fla., took advantage of a grant from the Florida Department of the Environment to enact a continuous 5-month drop-off program.

Utility customers were asked to bring their unwanted or expired drugs to 12 locations throughout the county, according to Kurt Seaburg, hazardous waste coordinator for the Alachua County Environmental Protection Department. Each location, such as the county’s hazardous waste disposal facility or a local pharmacy, was equipped with a 19-L (5-gal) steel-lined pail topped with a receiving funnel. The pails contained a weak hydrochloric acid solution that dissolved and neutralized the drugs, Seaburg said.

“Customers at these locations had to pour their medications into the funnel,” Seaburg said. The customers were also responsible for disposing of the medication containers.

The program received the most deposits at the county’s household hazardous waste center, Seaburg said. To measure the quantity collected, the pails and acid solutions were weighed before they went to the locations and then again after they were collected. During the pilot project, a total of 138 kg (305 lb) of drugs was collected. The collected waste was shipped to a hazardous waste disposal facility for incineration, Seaburg said.

In Oregon’s case, the stakeholder group convened by ORACWA looked at the possibility of combining drug collection programs with household hazardous waste programs and decided that it was not a good fit for Oregon. Both the Oregon law enforcement community and the household hazardous waste programs were not comfortable with the additional burdens a drug take-back program would pose, Gillaspie said.

The Oregon stakeholder group is continuing to put pressure on the U.S. Drug Enforcement Agency to make regulations that would enable convenient take-back programs, Gillaspie added.

Even if the laws were changed to make handling controlled substances easier, the question remains who should pay for these programs. In most cases, the agencies working together to organize the event — commonly the wastewater utility, police or sheriff’s office, and local medical organizations — share the costs. Or, as in Alachua County’s case, a grant helps to defer the expenses. Alachua’s 5-month program costs about $16,000. Once the grant expired, the county cut the program back to just four drop-off locations.

But ORACWA’s stakeholder group believes another funding source exists. The group has recommended that Oregon’s drug take-back program be financed by the drug manufacturers that serve Oregon, Gillaspie said.

So far, the group has not has much success in getting the pharmaceutical industry to foot the bill for a program, Gillaspie said. ORACWA has sent letters to the three respective trade associations representing name-brand, generic, and over-the-counter medications. The group also is planning to compose legislation for the 2009 Oregon Legislature that would ask manufacturers to put a program in place voluntarily. If manufacturers do not voluntarily institute a program, ORACWA will ask that manufacturers be forced to establish a program, Gillaspie said.

In its official report on the matter, the group does not give specific recommendations on what form the program should take. Instead, the group suggests that the drug manufacturers bring their business expertise to bear on how best to accomplish this goal.

Gillaspie added that whatever form the program takes, it needs to be “effective, serve all of Oregon — both rural and urban residents — and be as convenient as a flush.”

The two most likely models, she said, are bin deposits at pharmacies and a mail-back program.

“Just think if we had a percentage of the drug and over-the-counter advertising budget for these companies that serve America,” Gillaspie said. “Think about what percentage of the budget we would need to put an effective take-back program in place.” She added that the companies could also use the take-back program materials as advertising pieces.

Setting up the collection site or mail-in system is only half of the equation. An effective take-back program also requires a strong education component.

In fact, Seaburg said one of the biggest challenges to Alachua’s program was getting the word out that the collection was happening. Program advertising and education was the second most expensive component of that program, second only to personnel costs.

Koltz said the need exists to educate users and medical care facilities, specifically those specializing in elder care, in the proper disposal of medications.
Some measures are as simple as providing flyers to pharmacies to accompany prescriptions on the proper disposal methods for unused medication, Koltz explained.

The U.S. Environmental Protection Agency (EPA), in its premiere Nov. 11 Greenscene video podcast, included a segment on the proper disposal of unwanted drugs. George Gray, associate administrator of EPA’s Research and Development Office, told viewers to seek out their local drug take-back programs.

Gray added that if a take-back program isn’t available, the Office of National Drug Control Policy advises residents to throw pills away in the trash and ideally mix them with something unpleasant, such as kitty litter or coffee grounds. That mixing is intended to prevent people from looking for controlled substances in others’ trash. (But throwing unwanted drugs in the trash may just delay the issue in some parts of the country. Gillaspie said that because of Oregon’s rainy climate, putting unwanted drugs in the landfill leads to them leaching into the water system.)

The educational movement extends beyond residents, too.

“The pharmaceutical industry itself is also being proactive in this area and working with its more direct customers, hospitals, pharmacies, and nursing homes, to take back expired and unused products [except controlled substances],” Koltz said.

There are also resources for agencies interested in creating a take-back program of their own. The Illinois–Indiana Sea Grant and EPA’s Great Lakes National Program Office have created a guide to help communities initiate unwanted drug collection programs. The guide, Disposal of Unwanted Medicine: A Resource for Action in Your Community, includes background information on unwanted drugs, detailed instructions for holding a collection event, model materials, and a synopsis of take-back legislation.

Moving Forward
Just as European countries were first to act on microconstituents, those countries also are ahead on unused drug take-back programs. “The European programs are probably 10 years more mature than ours,” Koltz said. But, whereas the U.S. programs are voluntary, the European programs are often mandated.

For example, since the 1980s, Italy has had one day each year where everyone is supposed to return their unused products, and pharmacies are supposed to clear the shelves of anything expired, Koltz said.

On the international front, ORACWA also has found a model to follow. “Our group was really inspired by the [mail-based] medicines return program that is in place in British Columbia now,” Gillaspie said. “Every pharmacy in the province participates. They collect unwanted pharmaceuticals. The program is totally organized and paid for by the pharmaceutical industry.”

While the U.S. and Canadian regulations on drug take-back are different, the British Columbia program demonstrates an effective, convenient, and cost-effective solution, Gillaspie said. “They’ve never had any diversion problems in the many years they’ve been running it,” she noted. “And interestingly, the City of Vancouver just passed a local ordinance that went into effect on the first of the year saying that you can no longer put unwanted medicines out in your household trash.”

Regardless of the legal and financial challenges to preventing these drugs from entering the wastewater stream and becoming microconstituents, prevention is the best method of handling the issue.

“Pollution prevention is always preferred over treatment,” Gillaspie said.

Steve Spicer, WE&T


More Drug Take-Back Information

The No Drugs Down the Drain Program

No Drugs Down the Drain is a public outreach program to alert California residents living in specific regions about the problems associated with flushing unused, unwanted, and expired medications down the toilet or drain, and to provide them with other safe and proper disposal choices.

Program sponsors include the City and County of Los Angeles, Sanitation Districts of Los Angeles County, Orange County Sanitation District, and the City of San Diego. The California Pharmacists Association (Sacramento) is a partner to the program.

Disposal of Unwanted Medicines: A Resource for Action in Your Community

The Illinois–Indiana Sea Grant and U.S. Environmental Protection Agency Great Lakes National Program Office have created this guide to help communities initiate unwanted drug collection programs. The guide includes background information on unwanted drugs, detailed instructions for holding a collection event, model materials, and a synopsis of take-back legislation.

Oregon Association of Clean Water Agencies

The Oregon Association of Clean Water Agencies (Portland) is composed of 75 wastewater treatment and stormwater management agencies and associate members providing water quality services to Oregon’s urban areas. The organization convened an extensive stakeholder group to determine the best means to implement an unwanted drug take-back program for Oregon. The group’s full report can be downloaded from the site.








USGS Report Links Land Use, Water Quality
Study of shallow groundwater in U.S. Southwest leads to further investigation of deeper aquifers

A recent U.S. Geological Survey (USGS) National Water Quality Assessment (NAWQA) report quantifies how land-use practices in the southwestern United States may influence recently recharged shallow groundwater quality.

In regions that are experiencing tremendous population growth, information about the condition of potential groundwater supplies can help prevent future problems for communities and water utilities, according to Sue Thiros, USGS hydrologist and coordinator of the regional water quality study.

“In groundwater, especially these basin-fill aquifers in the Southwest, there is a long residence time [for compounds] as [water] moves to the deeper system,” Thiros said. “If these things get down there … they’re going to stay for a long time or be costly to remove.”

The study found nitrates, pesticides, and some volatile organic compounds (VOCs) in portions of the Southwest’s shallow groundwater.

Regional Approach
NAWQA, which began monitoring 51 U.S. river basins and aquifers in 1991, targets 86 pesticides, 55 types of VOCs, select nutrients, and trace elements.

The program looks at water quality on a national scale by comparing data to national standards in order to inform water resource management and protection decisions.

“What was missing was the regional perspective,” Thiros said.

By extrapolating out similarities in the NAWQA southwestern basin data, an assessment can help determine the future water quality of this fast-developing region.

According to the 2005 U.S. Census, population in the western United States is expected to grow 46% between 2000 and 2030. Nevada and Arizona top the list of projected high-growth states.

In general, more-developed basins have more contaminants associated with the land surface, Thiros said. When agricultural lands are converted to commercial and residential communities, water quality concerns greatly increase.

“In some areas, hydrology is greatly changed, and there is a high draw on groundwater,” Thiros said.

NAWQA samples in geographically defined areas called study units, which cover about 10,000 km2 (3900 mi2) or more and are classified by similar features.

For this study, USGS analyzed data collected from 273 agricultural and 181 urban wells between 1993 to 2004 in seven study units in Arizona, California, Nevada, New Mexico, south-central Colorado, and Utah.

Three of the study units, or basins, were both agricultural and urban, and four were one or the other, according to USGS hydrologist Angela Paul.

The number of wells sampled varied among the basins, ranging from nine to 110, with median well depths ranging from 6 to 39 m (20 to 129 ft) below land surface.

Paul’s team performed two types of statistical analyses on the data — univariate and multivariate regression. In the former, the team examined simple 1:1 correlations between land use and water quality, such as fertilizer use with nitrate concentrations.

In the multivariate logistic-regression, the team looked at multiple factors — such as 2:1 and 4:1 correlations.

“The relevant factor is not the same for each contaminant,” Paul said. Multivariate analysis “teased out” how several factors affect a contaminant’s presence, she said.

According to the report, many areas in the U.S. Southwest rely exclusively on groundwater for potable supplies. Even in areas that have surface water supplies, there is often a need to supplement this with groundwater.

“The concern is that if the shallow groundwater is hydrologically connected to the deeper groundwater systems, that could be an avenue to enrichment of deeper supplies,” Paul said.

The report indicates that numerous land-use factors, such as infiltration of both agricultural and urban irrigation water, reclaimed-wastewater irrigation, pesticides and fertilizers, artificial recharge, mining activities, sewer leakage, and chemical spills, affect groundwater.

While the Southwest basins analyzed have similar land-use and aquifer characteristics, each is unique, and further study is needed to examine whether shallow and deeper groundwater systems are linked,
Paul cautioned. “In some areas, they are [linked]; in some, they are not,” she said.

Paul reiterated that there are several pertinent factors, human and natural, that act in concert to influence the shallow groundwater quality.

Nitrate concentrations were highest in shallow groundwater beneath agricultural lands, exceeding the U.S. Environmental Protection Agency (EPA) drinking water standard of 10 mg/L (as nitrogen) in 25% of the study units’ agricultural wells.

Natural factors, such as evapotranspiration and water–rock reactions, influence groundwater quality. The report cited numerous prior studies that determined substantial subsoil nitrate reserves are present in desert environments; such reserves pose a threat to groundwater through leaching of nitrate through the vadose zone.

Irrigation practices and fertilizer use also increase nitrates, according to the report.

In agricultural and urban areas throughout the United States, about 15% of shallow groundwater samples exceeded the drinking water standard for nitrates, the report cited as a baseline.

Nitrate concentrations were lower in the study’s urban areas, exceeding EPA standards in 10% of the study units’ urban wells. 

Differences in nitrate concentration between agricultural and urban areas “likely are influenced by groundwater redox [oxidation-reduction] conditions,” the report said.

Fertilizer use, sprinkler irrigation, redox, the percentage of sand within the 500-m buffer areas around the wells, and infiltration are all pertinent factors, Paul said.

These findings can help states, federal agencies, and others anticipate conditions in unmonitored areas and implement nitrogen-reduction strategies in priority areas.

Chemicals most heavily applied in the study units are fertilizers, herbicides, and insecticides, according to the report. Triazine herbicides were most prominent in both agricultural and urban areas of the study, Paul said.

While concentrations of organic compounds rarely exceeded drinking water standards — with detection concentrations less than 1 µg/L — the most frequently detected pesticides in shallow groundwater beneath the agricultural regions were simazine (28%), atrazine (16%), and diuron (13%).

Simazine is used on certain crops, including corn, citrus, and vineyards, Paul said. Atrazine is a restricted herbicide that must be applied by a licensed professional, she noted. It controls broadleaf and grassy weeds, while diuron is a general herbicide that inhibits photosynthesis.

Atrazine (24%), prometon (25%, used in landscaping), and simazine (17%) were most commonly detected in urban areas.

The report noted that carbamate pesticides — amide and metolachlor — were detected infrequently.

Paul’s team concluded that factors influencing pesticide detection in shallow groundwater were dissolved oxygen, general soil permeability characteristics, temperature, and depth-to-screened interval.

The report cited prior studies estimating that approximately 15% of untreated groundwater in the contiguous United States contains VOCs.

For this study, trihalomethanes (THMs), solvents, and the fuel oxygenate methyl tert-butyl-ether (MTBE) were detected in the urban wells.

However, samples did not exceed the EPA’s standard for total THMs — 80 µg/L. Also, chloroform, a water-disinfection byproduct, was found at 29%.

Tetrachloroethene (PCE) and trichloroethene (TCE), industrial solvents, were found at 10%. A low percentage (less than 4%) of the urban wells exceeded drinking water standards (5 µg/L) — for TCE, two wells in the Nevada Basin Region, and for PCE, five wells in the Nevada and one in the Great Salt Lake basin, said Paul.

Two samples collected in Nevada exceeded the TCE standard and the drinking water advisory for MTBE (20 to 40 µg/L). A PCE concentration in one sample from urban Utah and five samples from urban areas within Nevada exceeded the 5 µg/L standard.

Both chloroform and PCE were found in well-oxygenated groundwater, while MTBE was detected in less-oxygenated water.

Soil fumigants, which are environmentally persistent, were detected almost entirely within an agricultural area in the Central Valley of California. The principal compound was dibromochloropropane, a nematocide used on a host of crops.

Multivariate logistic-regression showed that dissolved oxygen, pH, and the percentage of industrial land use played roles in the detection frequency of several VOCs in the samples. Also affecting the detection frequencies of VOCs were groundwater redox conditions.

Further Research Ahead
A series of studies will follow the report, Thiros said. One goal is to develop a geographical information system data set or other tool that will help resource managers in planning.

“Hopefully, we’ll be able to tell people what factors are most important in affecting water quality in these basins so locals can better spend their money and know what factors there are, in terms of development,” Thiros said.

According to Paul, further study of land-use and aquifer characteristics “will lead to a better idea of how to proceed.”

“The substantial contribution of this work is looking at these different land-use practices in concert with each other,” Paul said. “We’re moving down the right path looking at the environment as a whole.”

USGS is continuing research to determine which factors affect the quality of the Southwest’s deeper basin-fill aquifers. For more information, see water.usgs.gov/nawqa/studies/praq/swpa.

Question of the Month

Which cogeneration technology does your plant use or plan to use?
        a) Internal combustion engines.
        b) Microturbines.
        c) Gas turbines.
        d) Fuel cells.
        e) Stirling engines.
        f) None.

Click here to respond. We’ll share your responses in a future issue.— Andrea Fox (Bistany), WE&T