The EPA is considering whether to impose the first national standard for how much drug waste may be released into waterways by the medical services industry, but Ben Grumbles, the EPA's top water administrator, says a decision won't be made until next year, at the earliest.
So far, regulators have done little more than politely ask the medical care industry to stop pouring drugs into the wastewater system. "Treating the toilet as a trash can isn't a good option," says Grumbles.
Some think it's time to do more than ask. "It's strange that we have rules about the oil from your car; you're not allowed to simply flush it down the sewer," says US Rep. Tim Murphy, R-Pa. "So why do we let these drugs, without any kind of regulation, continue to be flushed away in the water supply?"
Landfills are one alternative. At least they don't empty directly, and immediately, into waterways like some sewage.
Marjorie E. Powell, a lawyer for the Pharmaceutical Research and Manufacturers of America, says landfills are "more environmentally friendly," while EPA spokeswoman Roxanne Smith contends that landfilling of hazardous pharmaceutical waste "poses little threat to the public."
Still, Grumbles acknowledges that landfills, while safer, are not a permanent solution. That's because pharmaceuticals can eventually reach waterways from landfills through leaks or intentional releases of treated seepage known as leachate.
An agency staffer wrote in a memo last year: "EPA recognizes that residuals in the leachate could contaminate groundwater supplies and ultimately reach water treatment plants, but disposal into the trash is currently considered a BMP" -- or best management practice.
Already, researchers have detected trace concentrations of drugs -- including the pain reliever ibuprofen and seizure medicine carbamazepine -- in seepage or groundwater near landfills.
Environmental professionals outside government are reaching a consensus that incinerators are the best disposal method.
"That's the best practice for today because we don't really know what the hell to do with the stuff," says industrial engineer Laura Brannen, an executive at Waste Management Healthcare Solutions, of Houston. She says burning destroys more drug waste than all other methods, though some contaminants may escape in smoke and ash.
On a recent day at Abbott Northwestern Hospital in Minneapolis, Mary Kuch was getting ready to squirt leftovers from a syringe of hydromorphone, a powerful morphine derivative, into a sink. When she started out in nursing 18 years ago, "I took it for granted, because I was a young nurse, and that's what other nurses did," she says. "But I did find it strange."
These days, only four gallons -- drugs with high potential for abuse -- go down the hospital's drains each year. Nearly all leftover medicine and contaminated packaging are instead tossed into black bins and rolled to a hospital storage room crammed with scores of 55-gallon drums.
There, waste-company employee Bryant Sears -- dressed in a Teflon suit, rubber gloves and goggles -- conducts a sorting operation. Pills, blister packs and liquid medicines collected in vials, along with syringes and IV bags, are separated out according to differing disposal standards and methods. Occasionally, he glances at a wall-sized placard with details on which drug goes where -- hazardous waste in one barrel, nonhazardous in another. A roll of "hazardous waste" stickers hangs from a pole on the wall.
Sears points to some epinephrine, a heart drug, saying, "Now that it's past its expiration date, it's waste."
These leftovers and discards ultimately will be incinerated.
EPA's Smith says even municipal burners unapproved for hazardous waste "will destroy all but a minute fraction" of organic compounds -- the kind found in pharmaceuticals.
But Stephen DiZio, a manager with the California Department of Toxic Substances Control, says not so fast. "I don't think we're encouraging incineration of anything. The public outcry would be so great."
The push for incineration hides an irony. Several decades ago, drug waste was routinely chucked into the trash and burned in hospital or city incinerators.
Then came a national campaign against air pollution. Most hospitals shut down their burners, and city incinerator managers became pickier about what they'd accept. With options restricted, hospitals began shipping more drug waste to landfills -- and dumping more into toilets and sinks.