When patients die or their prescriptions change, possibly billions of dollars’ worth of unopened and unexpired drugs are thrown away–a waste of valuable medicine that creates an environmental hazard.
To help solve that problem, the American Legislative Exchange Council (ALEC), a nonpartisan group of state legislators and private business leaders, in December took the first step toward creating a more efficient and environmentally safe drug disposal and recycling system by passing a resolution at its annual States and Nation Policy Summit in Phoenix.
The Resolution on Federalism in Recycling Narcotics asks the national government to relax its laws governing narcotic drug disposal, allowing more state control.
In January, the resolution was adopted by ALEC’s national board of directors, making the legislation official ALEC policy, which state legislators may adopt in their own states. If adopted in statehouses, the resolution will also be sent to Congress, the president, and other key national leaders.
“Many states already have recycling and drug repositories where cancer patients can donate drugs, but federal regulations don’t allow states to recycle usable narcotic-level pharmaceutical drugs,” explained Christie Raniszewski Herrera, director of ALEC’s Health and Human Services (HHS) Task Force. “That is what we’re trying to change.”
Changing Policy
“[Changing federal policy] would allow states to work with the federal government in creating recycling and repository programs for narcotic-level drugs,” Herrera said.
Narcotics are regulated by federal laws and are classified by their clinical testing schedule. Under current national law, unused narcotics must be destroyed.
As drug prices have risen, recycling usable drugs has become a growing concern for nursing homes. According to the Centers for Medicare and Medicaid Services, nursing home patients use up to six different medications a month.
In March 2006, the American Health Care Association estimated 90,000 to 100,000 nursing home patients on Medicaid nationwide could have had their prescriptions recycled.
While state laws on pharmaceutical disposal vary, many states allow nursing homes the choice of flushing a medication down the toilet, so long as it is done with two witnesses, or returning it to the pharmacy. Other states expressly forbid medical professionals to flush unused medications, because of environmental concerns.
While some organizations have tried to return medications, the required documentation and administrative costs are sometimes too time-consuming for nursing home staff.
Seeking Alternative
“We are open to looking at alternative ways to dispose controlled medications safely and cost effectively,” said Steve Albrecht, an ALEC HHS Task Force member and regional director of government relations for Golden Ventures, an administrative services company that provides services to nursing homes and other health care companies, based in Fort Smith, Arkansas.
“Our goal is to devote as much time as possible to our patients,” Albrecht said.
Joining Forces
State legislators aren’t interested only in how much recycling narcotics would save on Medicaid costs, since many nursing homes’ residents are funded by federal programs. They are becoming increasingly concerned about the environmental effects of drugs getting into groundwater.
“The nursing home industry came to me several years ago about this issue,” said Wisconsin state Rep. Kitty Rhoades (R-Hudson), who heads the Recycling Narcotics Working Group on ALEC’s HHS Task Force. “It’s not only wasting usable pharmaceutical drugs–the drug residuals are turning up in our groundwater.”
Advocates of recycling and drug disposal have joined forces on the issue.
“This has brought together both the financial, conservative groups as well as the environmental ones,” Rhoades said. “It’s a major accomplishment to say we are all united on this issue.”
Seeking Leeway
The resolution does not detail how narcotic-level drug recycling programs should be implemented, Albrecht said, but allows state legislators to pass the resolution and ask the federal government for guidelines.
Creating recycling and better disposal systems for drugs would benefit many, Herrera said. It would be a voluntary program that would help the environment, save states and patients money, and cost little to run.
“The cost could be minimal. For example, in some states that have cancer drug recycling, it costs only about $70,000 [annually] for one staffer to oversee the program,” Herrera explained. “This would be for drugs that are unopened, not expired, and unadulterated in any way.
“The federal government is concerned about the potential abuse of narcotic-level drugs,” Herrera said. “These drugs would still be regulated by individual states. We’re just asking the federal government to allow the states more leeway.”
Marika Benko ([email protected]) writes from Berkeley, California.
