Drug Topics - December 12, 2008 - (Page H1)

® Health-System Edition H6 C. dif cile deaths increasing H5 Off-label cancer Rx: New information Controlled substance disposal a growing problem for hospitals FRED GEBHART, Contributing Editor ederal drug policy is pushing hospitals and other healthcare facilities into a corner. Unused medications are increasingly recognized as hazardous waste that should be incinerated. But the Drug Enforcement Administration’s rules on controlled substance disposal are forcing many hospitals to ﬂush unused medications. The alternative is waste disposal under the surveillance of law enforcement personnel or someone registered with DEA. Witnessed disposal is expensive. “That’s a huge ﬁnancial hit that can’t be passed on to our patients,” Steven Waderich, hazardous waste disposal manager at Abbott Northwestern Hospital in Minneapolis, said. “It’s the right thing to do environmentally, but it is not reimbursed by anyone.” How big a hit? Waderich said Abbott spent about $38,000 on hazardous waste disposal in 2004. He expects to spend more than $500,000 this year. Controlled substance incineration costs about $38 per pound, Waderich added. Abbott will generate more than 1,000 pounds of unused controlled substances this year, accounting for 75 percent of his entire hazardous waste disposal budget. “We have to manage controlled substances as DEA materials as well as hazardous materials under Minnesota law,” Waderich said. Waderich could be spending more. Abbott’s Pyxis medication control system reports nurses squirt about four gallons of unused medications into hospital sinks every year. The typical scenario is a physician order for 6 ml of a product that is stocked in 10-ml vials. The remaining 4 ml is waste. For busy nurses, washing the excess down the nearest sink is the most time-effective solution. Two nurses witness each disposal and document the event. Nearby North Memorial Medical Center in Robbinsdale, F Shirley Reitz of Group Health Cooperative in Seattle says her organization still disposes of some meds in the sink. Network SEE INDEX PAGE 8 Regulatory & Legal For more info on this topic, see www.drugtopics.com Minn., pours 50 gallons of controlled substance waste down the drain every year. The alternative is to spend $25,000 on controlled substance disposal, according to regulated-waste coordinator Jerry Fink. Most hospitals put part or all of their controlled substance waste into the sewer, Shirley Reitz, associate director of pharmacy clinical services for Group Health Cooperative in Seattle, said. “When we waste part of a vial, we shoot it down the sink with witnesses,” she said. “If you don’t put controlled substances down the drain, you have to bring in hazardous waste management.” But not everywhere. Abbott Northwestern has managed to keep most of its controlled substance waste out of the sewer. San Francisco General Hospital doesn’t pour any controlled substances down the sink, Sharon Kotabe, pharmacy director for the city Department of Public Health, said. Instead, the hospital uses secure containers with absorbent materials to soak up liquid waste. SF General’s nurses follow the DEA’s familiar witnessed-disposal procedures, but squirt into a bin instead of a sink. The containers are collected on a regular basis for incineration. The San Francisco system, or something similar, could become standard across the country. “Every state is looking to ban ﬂushing meds,” said Gene Memoli, RPh, president elect of the Connecticut Society of Consultant Pharmacists and a member of the Drug Topics Editorial Advisory Board. “Pharmaceutical disposal is on everybody’s mind. If there isn’t a regulation in your state yet, there will be.” D E C . 15, 2008 COURTESY GROUP HEALTH COOPERATIVE IN SEATTLE W W W.D R U GTO P I C S .C O M DRUG TOPICS H1 http://www.drugtopics.com http://WWW.DRUGTOPICS.COM

Table of Contents Feed for the Digital Edition of Drug Topics - December 12, 2008

Drug Topics - December 12, 2008 Contents Up Front Up Front In Depth Letters Health-System Edition Cover Story: Controlled Substance Disposal a Growing Problem for Hospitals Pharmacists Hope for Speedy Approvals Deaths from C. Difficile Increasing PharmMD Teams with HealthSpring RX Care Commentary Ohio Hospital Automates Pharmacy The Business Outlook for 2009 OTC The Pharmacist's Duty to Warn: Implications for Pharmacy Practice New Products Viewpoint

Drug Topics - December 12, 2008

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