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California State Auditor Report Number : 2016-127

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



Our review concerning home‑generated sharps and pharmaceutical waste highlighted the following:

Results in Brief

When consumers improperly dispose of home‑generated sharps and pharmaceutical waste, the waste can pose an unnecessary risk to others and to the environment. Sharps waste—which consists of used needles, lancets, and other medical devices with sharp points or edges—can potentially result in disease transmission. On the other hand, pharmaceutical waste—which consists of prescription and over‑the‑counter medications—can harm water quality or be misused. Agencies that provide advice offer consumers different, and sometimes conflicting, guidance about how and where to dispose of these types of waste. For example, some agencies recommend that consumers use official collection programs to dispose of pharmaceutical waste, but others recommend placing it in the trash or flushing it down the toilet. Similarly, state agencies generally recommend that consumers dispose of home‑generated sharps waste in approved disposal containers, but some federal agencies recommend putting this waste in heavy plastic containers, making it illegal to transport in California if the local enforcement agency has not approved the container. These inconsistencies may confuse consumers, increasing the likelihood that they will dispose of home‑generated sharps and pharmaceutical waste in unsafe or environmentally harmful ways.

Conflicting guidance regarding the disposal of sharps and pharmaceutical waste is in part the result of the fact that the State has not assigned oversight of this issue to a specific state agency. Rather, a number of different agencies have related responsibilities depending on how the waste is collected and processed. Specifically, the California Department of Resources Recycling and Recovery (CalRecycle), the California Department of Public Health (Public Health), the California State Board of Pharmacy, and the Department of Toxic Substances Control all play roles related to the processing of this waste. By placing oversight responsibility with a single agency, the State could ensure the creation of a unified educational campaign promoting consistent and proper disposal methods. We believe CalRecycle may be best‑positioned to oversee household pharmaceutical and sharps waste because it already provides oversight for all state‑managed solid waste‑handling programs.

If the State assigned responsibility to a single agency, that agency could also help to ensure that all Californians have access to and awareness of collection sites and other means of sharps and pharmaceutical waste disposal. Although our analysis suggests that about 89 percent of consumers live within a 20‑minute drive of sites for proper disposal, these consumers may not be aware of this access because no state agency maintains an accurate and comprehensive list of such sites. Both Public Health and CalRecycle maintain lists of collection sites; however, these lists are difficult to access and contain numerous errors. Further, our analysis suggests that about four million Californians may not live within 20 minutes of collection sites. An oversight entity could ensure that the State implements options to help these consumers, which might include subsidizing the use of mail‑back containers to dispose of sharps and pharmaceutical waste.

California has more than sufficient capacity to process all of the State’s home‑generated sharps and pharmaceutical waste; however, laws and regulations discourage processing pharmaceutical waste within the State. In California, sharps are generally sterilized at one of the State’s 18 medical waste facilities and then deposited in landfills. Home‑generated sharps waste represents less than 1 percent of the available capacity of these facilities. If pharmaceutical waste includes controlled substances, the DEA requires collectors to ensure that such waste is rendered irretrievable, which usually means some form of incineration. Although three incinerators operate in the State that could dispose of pharmaceutical waste, government recommendations and legal requirements discourage these in‑state incinerators from accepting pharmaceutical waste. Consequently, collection programs dispose of pharmaceutical waste by hauling it to out‑of‑state incinerators. Both the out‑of‑state and in‑state incinerators have more than sufficient capacity to handle any future increases in the amount of the State’s home‑generated pharmaceutical waste.

California could improve its collection and disposal of home‑generated sharps and pharmaceutical waste by adopting programs and practices that other states and countries use. For example, the state of New York requires all pharmacies to display that state’s approved pharmaceutical disposal methods and requires all hospitals to accept household sharps for disposal. Canada uses extended producer responsibility programs (EPR programs) to assign the cost for disposal of pharmaceutical and sharps waste to the producers or manufacturers of the products, although in California these costs could ultimately be transferred to consumers through price increases. Several California counties have also begun implementing EPR programs but have encountered delays, mainly due to the resistance of the sharps and pharmaceutical industries.

In addition, at the Legislature’s request, in 2010 CalRecycle provided options for statewide pharmaceutical waste collection programs. Although we have concerns about three of the four options CalRecycle outlined, one of its proposed models generally aligns with our audit recommendations. Specifically, this option focuses on the Legislature’s assigning oversight responsibility to a single state agency, which could then adopt regulations that might increase consumers’ proper disposal of pharmaceutical waste.

Summary of Recommendations

To foster consumers’ proper disposal of sharps and pharmaceutical waste, the Legislature should provide CalRecycle statutory oversight responsibility for home‑generated sharps and pharmaceutical waste disposal and provide CalRecycle additional resources to the extent it can justify the need. This responsibility should include the following activities:

To increase in‑state options for processing California’s home‑generated pharmaceutical waste, the Legislature should consider expressly authorizing municipal solid waste incinerators to burn limited quantities of home‑generated pharmaceutical waste, but only after considering environmental impacts.

To ensure consistency throughout the State, the Legislature should adopt standard requirements for counties to follow when implementing EPR programs. These requirements should limit any additional costs the programs may impose on consumers.

Agency Comments

Although we only have recommendations directed to the Legislature, we provided a draft redacted copy of our report to CalRecycle for review and comment because we are recommending that it become the lead state agency over the disposal of sharps and pharmaceutical waste. In its response, CalRecycle took issue with certain information in our report and it also expressed significant reluctance in taking on this leadership role.

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