AMA seeks advice on safe drug disposal

An increasing amount of attention is being paid to this emerging issue.

By Victoria Stagg Elliott — Posted July 3, 2006

Print  |   Email  |   Respond  |   Reprints  |   Like Facebook  |   Share Twitter  |   Tweet Linkedin

Like most physicians, when J. James Rohack, MD, changes a patient's medication, he tells the patient to discard the old pills -- but doesn't say exactly where or how.

"Right now, it's up to the patient," said the AMA Trustee and cardiologist from Temple, Texas.

But recognition is growing that improperly discarded pharmaceuticals might not be good for the environment, and physicians and patients need more specific direction on what should be done with medications that are no longer needed.

"Very few patients really realize what they should do with their leftover drugs," said Alfred Cox, MD, a family physician and delegate from South Bend, Ind. "Throwing them in the garbage or flushing them down the toilet is not the right answer."

Concern is particularly high with regard to the impact of discarded pharmaceuticals on the water supply. To address this issue, the American Medical Association wants the Environmental Protection Agency to bring together federal agencies, medical societies, pharmaceutical firms, pharmacists and public health organizations to develop guidelines that would reduce the chance of contaminating drinking water with drugs or personal care products, according to a policy based on three resolutions that was approved at the AMA Annual Meeting last month.

"We want to have a way to dispose of [drugs] safely so that we don't wind up polluting the water," Dr. Rohack said.

This action is being taken after investigations by the U.S. Geological Survey detected small amounts of acetaminophen, estrogen and several antibiotics in organic wastewater. The effect, if any, that these levels might have on people is unclear.

Evidence suggests, though, that it's not good for flora and fauna. Several studies, for instance, have documented altered brain chemicals in fish due to exposure to fluoxetine and changes in gender expression related to estrogen ingestion.

"There's a concern about what is in the water and the water supply," said Raymond A. Dieter Jr., MD, a thoracic surgeon from Glen Ellyn, Ill., who spoke on behalf of the International College of Surgeons during meeting deliberations.

The USGS, the Environmental Protection Agency and the World Health Organization are studying the issue, and at least three states have programs to collect unused pharmaceuticals and discard them as hazardous waste.

Experts say the attention is the result of several factors. A growing proportion of the population is taking medication, and current water treatment technology has been unable to deal with it. In some areas of the country, it's illegal to dispose of pharmaceuticals in the trash because of the fear they could fall into the wrong hands. The Tylenol murders 25 years ago also ended the practice of pharmacies accepting returns of medications.

"If you had unused medications, you used to be able to sometimes go back to your pharmacy and get a rebate," Dr. Rohack said. "Ever since Tylenol, once it leaves that pharmacy, they can't deal with it."

But although the challenge is being recognized, it's unclear exactly how physicians should handle it.

"The problem's there, but what do we do about it?" said Sandra Adamson Fryhofer, MD, an internist and delegate from Atlanta "We need to know what to do in our offices, what to tell our patients to do with their unused pharmaceuticals, and this way we can help keep our nation safe."

Appropriate disposal seems like the most obvious answer. Still, AMA representatives pointed out that other options could be considered. "Should we have a mechanism where we recycle old medications?" Dr. Rohack said.

Several charities collect unused drugs to give to those who cannot afford them, and about 20 states are considering laws that would allow redistribution of unused drugs in specific places, such as in correctional facilities or long-term-care homes.

At the AMA meeting, some doctors also brought up an even more difficult issue -- that of pharmaceuticals that are ingested but, because of how they are metabolized, still make it into the water supply. The requested guidelines are not expected to address this.

"It's not only things that we throw into the water supply through the sewage system directly unused, but also those things that we use properly but come through us unchanged," said Gail Baldwin, MD, a family physician and delegate from Duluth, Minn.

The American Medical Association previously has worked to ensure that needles used outside the health care setting are disposed of properly.

Back to top

External links

2006 Annual Meeting of the American Medical Association's House of Delegates (link)

Emerging Contaminants In the Environment, Toxic Substances Hydrology Program, U.S. Geological Survey (link)

Pharmaceuticals and Personal Care Products as Environmental Pollutants, U.S. Environmental Protection Agency (link)

Back to top



Read story

Confronting bias against obese patients

Medical educators are starting to raise awareness about how weight-related stigma can impair patient-physician communication and the treatment of obesity. Read story

Read story


American Medical News is ceasing publication after 55 years of serving physicians by keeping them informed of their rapidly changing profession. Read story

Read story

Policing medical practice employees after work

Doctors can try to regulate staff actions outside the office, but they must watch what they try to stamp out and how they do it. Read story

Read story

Diabetes prevention: Set on a course for lifestyle change

The YMCA's evidence-based program is helping prediabetic patients eat right, get active and lose weight. Read story

Read story

Medicaid's muddled preventive care picture

The health system reform law promises no-cost coverage of a lengthy list of screenings and other prevention services, but some beneficiaries still might miss out. Read story

Read story

How to get tax breaks for your medical practice

Federal, state and local governments offer doctors incentives because practices are recognized as economic engines. But physicians must know how and where to find them. Read story

Read story

Advance pay ACOs: A down payment on Medicare's future

Accountable care organizations that pay doctors up-front bring practice improvements, but it's unclear yet if program actuaries will see a return on investment. Read story

Read story

Physician liability: Your team, your legal risk

When health care team members drop the ball, it's often doctors who end up in court. How can physicians improve such care and avoid risks? Read story

  • Stay informed
  • Twitter
  • Facebook
  • RSS
  • LinkedIn