Home‑Generated Sharps and Pharmaceutical Waste
By Designating a Lead Agency, the State Could Increase Proper Disposal

Introduction

Background

Every year Californians use hundreds of millions of sharps—such as syringes, lancets, and other devices used to penetrate the skin for the delivery of medications—and obtain hundreds of millions of prescriptions, according to estimates by the California Department of Resources Recycling and Recovery (CalRecycle) and by the Henry J. Kaiser Family Foundation, a nonprofit organization. When consumers improperly dispose of these sharps and pharmaceuticals, the discarded items can potentially pose health, safety, and environmental risks.

If residents improperly dispose of home‑generated sharps waste, that waste can represent a risk to public health. For example, if consumers dispose of sharps waste through the trash, workers who process that trash may be stuck by loose needles. A 2015 report by the University of California, Berkeley, for the Commission on Health and Safety and Workers’ Compensation indicated that the risk of contracting serious diseases, such as HIV, from such injuries is low. However, because of the fear of disease contraction, needle‑stick injuries can result in significant psychological stress, if not infection.

On the other hand, the risks associated with the improper disposal of pharmaceutical waste largely relate to environmental impact and inappropriate consumption. Pharmaceutical waste consists of both prescription and over‑the‑counter medications. In a 2011 study, the U.S. Geological Survey found that measurable amounts of pharmaceutical compounds were present in the State’s groundwater. These compounds can come from a number of different sources, including treated wastewater, landfills, septic systems, sewer lines, and animal waste. Pharmaceutical waste in waterways can cause behavioral changes in fish, according to a 2014 study published by the Royal Society, a scientific academy. A separate danger is that minors or opioid addicts may consume unused pharmaceuticals that consumers stockpile in homes or dispose of improperly.

Four state agencies are involved in overseeing or regulating the disposal of home‑generated sharps and pharmaceutical waste. The text box contains short descriptions of the agencies and their regulatory responsibilities related to these types of waste.

The Disposal and Treatment of Home‑Generated Sharps Waste

California law imposes a number of restrictions on the disposal of home‑generated sharps. The Medical Waste Management Act (medical waste act), enacted in 1995, regulates the disposal of medical waste in California from commercial sources, such as hospitals, clinics, and other medical waste generators. Although the medical waste act specifically excludes home‑generated waste from its requirements, it also states that collection sites must treat any home‑generated sharps waste they receive as medical waste. Further, since September 2008, state law has specifically prohibited California residents from disposing of sharps waste in the trash.

Both Public Health and CalRecycle encourage consumers to dispose of their sharps waste at collection sites or via approved mail‑back containers. State law limits collection of home‑generated sharps waste to the entities listed in the text box. As Figure 1 shows, approved collection sites can include pharmacies, hospitals, household hazardous waste sites, police stations, or sharps collection kiosks. State law requires that when residents return sharps waste to collection sites, they do so in approved sharps containers or other containers that local enforcement agencies may approve. In addition, consumers may purchase or otherwise obtain U.S. Postal Service‑approved mail‑back containers to dispose of sharps waste by mailing it to disposal facilities. Finally, local governments may provide a collection service through waste haulers. This service allows consumers to call their local trash haulers to request sharps collection at their residences.

Figure 1
Collection Sites Offer Options for Legal Disposal of Home‑Generated Sharps

The type of collection site at which consumers dispose of sharps waste will determine how the waste is processed. Because state law requires collection sites to dispose of sharps as medical waste, the sites must send sharps waste to approved medical waste treatment facilities for treatment and disposal. There are 18 medical waste treatment facilities that operate in California. These treatment facilities can sterilize sharps waste to protect against disease transmission, and then they may dispose of the waste in landfills. However, federal law imposes different requirements when consumers return sharps waste to household hazardous waste sites. Specifically, even though sharps waste may not be considered hazardous waste legally, federal law states that any mixture of solid waste and hazardous waste is a hazardous waste.

The Disposal and Treatment of Home‑Generated Pharmaceutical Waste

Although state law defines pharmaceutical waste, it does not identify or provide any specific regulatory framework for home‑generated pharmaceutical waste. As household waste, home‑generated pharmaceutical waste—in most circumstances— is exempt from state and federal hazardous waste laws and state medical waste laws. Thus, consumers may legally dispose of their pharmaceutical waste in their garbage. However, federal regulations do place certain restrictions on the collection of pharmaceutical waste that contains controlled substances. Specifically, federal law mandates that controlled substances can only be collected by law enforcement and certain collection sites that register with the Drug Enforcement Administration (DEA), such as hospitals and pharmacies.

Californians have several options for legally disposing of most pharmaceutical waste; however, not all of the methods are equally safe and appropriate. For example, California law does not clearly prohibit consumers from disposing of pharmaceutical waste by placing it in the trash or by flushing it down the toilet. However, localities may prohibit the flushing of home‑generated pharmaceutical waste, as does the City and County of San Francisco (San Francisco), citing concerns with water quality. For the same reason, state agencies discourage the practice. Figure 2 shows that the methods consumers use to dispose of pharmaceutical waste determine the state and federal agencies with oversight authority of that waste.

Figure 2
California’s Consumers Unknowingly Choose How Home‑Generated Pharmaceutical Waste Is Processed

In 2010 CalRecycle issued a report outlining its adopted model guidelines for home‑generated pharmaceutical collection programs. Its guidelines recommended that programs allow residents to return pharmaceutical waste to designated permanent collection sites, which can include pharmacies, health care collection sites, police stations, and public health agencies, among others. Also, consumers may use approved mail‑back containers to send pharmaceuticals to registered collectors of controlled substances.

CalRecycle’s model guidelines recommend that collection sites should treat home‑generated pharmaceutical waste as either medical or hazardous waste. Additionally, in 2012 the U.S. Environmental Protection Agency (EPA) recommended that collection sites destroy pharmaceutical waste using hazardous waste incinerators or, if these are not feasible, municipal waste incinerators. As we discuss in the Audit Results, local data suggest that most incineration of pharmaceutical waste occurs out of state, although California’s in‑state incinerators can and do destroy some amount of pharmaceutical waste. Figure 3 illustrates the different recommendations that federal and state agencies have issued for how to dispose of sharps and pharmaceutical waste other than controlled substances.

Figure 3
State and Federal Agencies Suggest Ways to Dispose of Home‑Generated Sharps and Pharmaceutical Waste

Scope and Methodology

The Joint Legislative Audit Committee (Audit Committee) directed the California State Auditor to conduct an audit of home‑generated sharps and pharmaceutical waste disposal in California. We list in Table 1 the Audit Committee’s 11 separate approved objectives and the methods we used to address them.

Assessment of Data Reliability

The U.S. Government Accountability Office (GAO), whose standards we are statutorily required to follow, requires us to assess the sufficiency and appropriateness of the computer‑processed information that we use to support our findings, conclusions, or recommendations. Table 2 describes the analyses we conducted using the data from the information systems we used, our methods for testing them, and the results of our assessments.

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