Emily Maloney Bickle and Jennifer Markley, two School of Nursing graduate students, assessed the Austin community in hopes of guiding future public education efforts regarding the proper disposal of unused pharmaceuticals. They discovered there is a great need for more public education about how to dispose of unused drugs and more medication take-back days.
A 2008 Associated Press investigation across the United States revealed the presence of various pharmaceuticals including antibiotics, mood stabilizers and sex hormones in drinking water. There are multiple vehicles by which pharmaceuticals can enter a city's drinking water system. Some drugs enter the system through runoff from livestock farms that give medicines to their animals. Others enter by being flushed directly into the system by their users or being indirectly introduced through the excretion of drug metabolites in urine.
Working with an ad hoc committee between the School of Nursing and the College of Pharmacy, we helped investigate what Austin residents know about proper disposal of unused pharmaceuticals by conducting a short survey in English and Spanish with Austin residents at five local Walgreens pharmacies. In addition, city of Austin staff conducted the same survey at the city's Household Hazardous Waste drop-off site.
After completing the survey, many people admitted they did not know the correct disposal methods and asked how they should dispose of their medications. Most Austin residents (44 percent) put their medications directly into the trash, and 12 percent flushed their medications down the toilet or sink.
Among 1,515 respondents, 38 percent reported having unused or expired medications in their homes. Only 2 percent of those surveyed reported mixing their unused medications with kitty litter or coffee grounds and then throwing them in the trash, which for non-controlled medications is the Food and Drug Administration (FDA)-recommended method for disposal. For a list of 27 controlled substances, the recommendation is to flush the medications into the water system. This helps prevent drug diversion, or the unauthorized re-use or abuse of those medicines.
Dr. Bill McIntyre of the College of Pharmacy said, "For decades, individuals, including my family, thought the safe way to dispose medications was to flush them. Assessing the public understanding of proper medication disposal is key to developing strategies to increase awareness of pharmacy-based take-back programs and proper disposal."
There are only two pharmacies in the Austin area that participate in medication take-back programs: Live Oak Pharmacy and South Lamar Plaza Drug Store. These pharmacies accept non-controlled substances -- in their original bottles -- for disposal. The city of Austin participated in a national medication take-back day on Sept. 25, which allowed residents to bring back all medications to designated drop off-points. Law enforcement officials were present so that controlled substances also could be dropped off.
McIntyre and Trish O'Day, who teaches public health nursing at the School of Nursing, talked last week with Austin City Council Member Laura Morrison, about the possibility of having an ongoing medication take-back program. The unused medications survey was a project in O'Day's class.
"Working together on this issue is a win-win for the university and the city," O'Day said. "City leadership has baseline data that will help shape policies related to disposal of unused medication, and nursing and pharmacy students can practice community assessment and advocacy skills. All undergraduate nursing students as well as pharmacy students receive content on current practices for disposal of medications, along with the resources to check for any future changes."
Results of the survey highlight the need for public education regarding the proper disposal methods of medications. This could be accomplished through public service announcements and education disseminated through primary health care providers and public health workers. Additionally, there is a significant need for more medication take-back programs, whether they are sponsored by pharmacies, cities or municipalities, law enforcement, drug companies or some other collaboration between these groups.
Regardless of how action is taken, it is evident that something must be done soon to protect the quality of our drinking water and ultimately the health of the public that consumes it.