Waste Prevention Information Exchange: Health Care Waste

Health Care Waste at Home

Add information to the Information Exchange.

This subtopic addresses the subjects of hypodermic needles, mercury fever thermometers, and PPCPs. PPCP is an acronym for Pharmaceuticals and Personal Care Products. PPCPs comprise a very broad, diverse collection of thousands of chemical substances, including prescription and over-the-counter therapeutic drugs, fragrances, cosmetics, sunscreen agents, diagnostic agents, nutraceuticals, biopharmaceuticals, and many others.¹ The information on this page was compiled with the help of U. S. Environmental Protection Agency (EPA), Region 9, the California Department of Health Services, and the California Department of Toxic Substances Control.

Attention all home sharps users and home care professionals! Beginning September 1, 2008, home-generated sharps can no longer be thrown in the trash or in recycling containers. Visit CIWMB's Sharps Waste web page for more disposal options and additional information.

Visit CIWMB's Pharmaceutical Drug Waste web page to learn about safe disposal methods.

Important!!! The procedures below ONLY apply to medical wastes FROM A PRIVATE HOME IN CALIFORNIA. If a health care facility or health care professional visiting a private home followed these procedures for sharps and pharmaceuticals, they might be in violation of the law. Health care facilities and in-home health care professionals are subject to the Medical Waste Management Act (MWMA). Health care facilities and health care professionals should contact their local health departments for information. Information is also available from the California Department of Health Services and (916) 449-5671.

Officially, there are no California medical regulations governing household medical waste. For questions regarding household medical waste and pharmaceuticals, contact the California Department of Health Services at (916) 449-5671.

For questions regarding mercury thermometers and other products that contain mercury, contact the Department of Toxic Substances Control (DTSC). Contact information for DTSC is listed on the WPIE Hazardous Substances page.

• Where California Households Can Dispose of Mercury Fever Thermometers
• Where California Households Can Dispose of Lotions, Cosmetics, and Similar PPCPs
• Why Not Send Unused Drugs, Lotions, and All Other Unwanted or Expired PPCPs Down the Drain?
• Other Resources

Where California Households Can Dispose of Mercury Fever Thermometers

Mercury fever thermometers must not be placed in the trash. Mercury fever thermometers from homes must be disposed as household hazardous waste. There are four places you can search for household hazardous waste facilities:

• Look in the city or county government section of your local white pages, under the environmental health or public works department, for a household hazardous waste listing,
• Call 1-800-CLEANUP (1-800-253-2687), a service of Earth 911,
• Visit the Earth 911 website, or
• See the Local [Waste] Enforcement Agency Directory on this website.

Mercury escapes landfills into the air. It is suspected that this is primarily due to chemical modification by bacteria which converts elemental mercury (the stuff in thermometers) to methyl mercury. (See the subtopic, Mercury, in the topic, Hazardous Substances.) Elemental mercury is hazardous. Methyl mercury is much more hazardous than elemental mercury. Mercury also readily evaporates. This not only poses a risk in landfills, it poses a risk at home.

Mercury is readily absorbed into the body when you touch it. If you are near enough to touch elemental mercury, for example after a mercury thermometer breaks, you are most likely also inhaling elemental mercury. (See the links to the Broken Mercury Thermometer Video in the subtopic Mercury, in the topic Hazardous Substances.)

Where California Households Can Dispose of Lotions, Cosmetics, and Similar PPCPs

Please do not put lotions, cosmetics, and similar products down the drain or down the toilet. Ultimately, there is no such thing as throwing something away. When we "throw away" something, we really just put it somewhere else for long-term storage. In the case of lotions and cosmetics, and in the case of sharps and pharmaceuticals that we do not take back as described above, the best "somewhere else" to throw these items is your household trash, which in most cases will eventually find its way to a landfill. Landfills are the best place at present to dispose of PPCPs for which people have no further use.

Why Not Send Unused Drugs, Lotions, and All Other Unwanted or Expired PPCPs Down the Drain?

PPCPs are an emerging issue. PPCPs include thousands of compounds, which together are beginning to attract the attention of the scientific community. If you throw your PPCPs down the drain, or flush them down the toilet, and if your home is connected to a municipal sewage system, some of the PPCPs would typically be discharged into lakes, rivers, or oceans, because most waste water treatment plants are not designed to remove or destroy PPCPs from wastewater.² PPCPs can also find their way onto land by the disposal of sewage biosolids, a product of sewage treatment plants.³ Domestic septic systems do not destroy PPCPs either.² Thus, it has been theorized that PPCPs could be carried with septic leachate as it finds its way to the groundwater, as other substances in septic leachate have been known to be carried.

A few studies have found instances of extremely minute quantities of PPCPs or their metabolites that made it past local water treatment into drinking water.⁵ However, because there is so little data, it cannot be inferred that PPCPs or their metabolites make it into other or most municipal drinking water, or that such minute concentrations would pose a risk to human health.

The risks posed to aquatic organisms (by continual life-long exposure) and to humans (by long-term consumption of minute quantities in drinking water) are essentially unknown.⁴ The major concerns to date have been the promotion of pathogen resistance to antibiotics and disruption of endocrine systems by natural and synthetic sex steroids.⁴ The consequences of all other drugs and many personal care products are largely unknown. There is no evidence that the PPCPs in our environment are causing any harm, and some researchers have concluded that there is none. However, no data exists for revealing the potential for long-term trends.⁴

Disposal into sewers is not the only way PPCPs enter the environment. The ordinary use or consumption of PPCPs by humans sends small amounts of PPCPs into sewage systems.⁴ Additionally, the same or similar compounds used to improve human health are used to improve the health or productivity of animals. Veterinary pharmaceuticals used in commercial animal feed operations may be released to the environment with animal wastes through overflow or leakage from storage structures or land application.² (See illustration by U. S. EPA, Origins and Fate of PPCPs in the Environment.)

Reports of PPCPs entering the environment have appeared in the press. Prozac has been found in drinking water in London.⁷ Exposures of wildlife to PPCPs may be occurring in Texas.⁸ Recent evidence indicates that a drug, diclofenac, is causing large-scale deaths of vultures in Pakistan. Diclofenac belongs to a family of drugs called nonsteroidal anti-inflammatory drugs (NSAIDs) and is used to relieve the pain, tenderness, inflammation, and stiffness caused by arthritis in humans. Diclofenac is sometimes also used to treat domestic livestock. Vultures belong to a family of birds called raptors, which includes eagles, hawks, and owls. In Pakistan, vultures of the species, Gyps, obtain a substantial part of their diet from domestic livestock carcasses. A January 28, 2004 article ⁵ in the scientific journal, Nature, points to diclofenac residues in domestic livestock carcasses as the cause of vulture population decline in Pakistan. Other evidence ⁶ suggests that extinction of three Gyps vulture species is imminent in India, Pakistan, and Nepal. This is not to suggest that diclofenac or other pharmaceuticals should not be used. But the case in Pakistan is one instance where the presumably unintended environmental release of a pharmaceutical has caused unforeseen environmental harm. Sporadic poisonings of scavenging birds by organophosphate pesticides and barbiturates used in livestock have also been documented.⁵

As with all items and substances we use, the ultimate responsibility lies with the consumer to conserve resources and reduce the need for disposal. When the need does arise to dispose medical waste or PPCPs at home, try to dispose them as suggested on this page.

Other Resources

Documents

• PPCPs
  • Cradle-to-Cradle Stewardship of Drugs for Minimizing Their Environmental Disposition While Promoting Human Health--A two-article series on the impacts of pharmaceuticals in the environment. Among the many conclusions and recommendations, the articles note "disposal of drugs to domestic sewage systems is probably the LEAST desirable way to dispose of any drug." [Emphasis in original]
    • Part I: Rationale and Avenues toward a Green Pharmacy (Adobe PDF, 7.52 MB).
    • Part II: Drug Disposal, while Promoting Human Health. (Adobe PDF, 268 KB).
  • ⁵ Diclofenac residues as the cause of vulture population decline in Pakistan--Published online in the journal, Nature, on January 28, 2004.
  • ³ Environmental Stewardship and Drugs as Pollutants--Christian G. Daughton, US EPA/ORD, the Lancet, October 5, 2002, Vol. 360, 1035-1036.
  • ⁸ Frogs, Fish and Pharmaceuticals, a Troubling Brew--A number of aquatic and amphibian species are being exposed to small amounts of everything from Prozac to perfume to birth control pills that make their way into U.S. rivers and streams... CNN, November 14, 2003.
  • Origins and Fate of PPCPs in the Environment--PPCPs enter the environment from a number of sources, as depicted in this illustration.
  • ² Pharmaceuticals, Hormones, and Other Organic Wastewater Contaminants in U.S. Streams, 1999-2000: A National Reconnaissance--By the U. S. Geological Survey. Published by Environment Science & Technology. Posted on the Web by ACS Publications. Web Release Date: March 15, 2002. Errata for this report have been posted by the U. S. Geological Survey.
  • ⁷ Prozac Found in Drinking Water--(London) Traces of the anti-depressant Prozac have been found in the drinking water supply, setting off alarm bells with environmentalists concerned about potentially toxic effects... Reuters, August 8, 2004.
  • Stormwater Runoff Science/Engineering Newsletter Devoted to Stormwater-Runoff Water Quality Issues--A series of newsletters from G. Fred Lee and Associates, EnviroQual. One issue that is particularly relevant to PPCPs is Volume 7 Number 3, March 12, 2004.
  • Tri-TAC Memo to POTW Pretreatment Coordinators and Managers, September 23, 2003, With Attachment--Tri-TAC is a statewide technical advisory organization that represents publicly owned treatment works (POTWs) that collect, treat and reclaim more than two billion gallons of wastewater each day and serve most of the sewered population of California. This memo primarily addresses the disposal to sewers of pharmaceuticals at hospitals, but also contains information relevant to household disposal. Item number 7 of the memo addresses this page that you are now reading. Please note that the use of the term, policy, in item number 7 is technically incorrect. The California Integrated Waste Management Board has not formally passed a policy about pharmaceutical waste.
    • Memo with the Attachment Included (Adobe PDF, 207 KB).
    • Microsoft Word Version of the Memo (47 KB) and of the Attachment (177 KB).
      • The attachment is a follow-up to another memo (Adobe PDF, 156 KB) from Department of Health Services.

• Sharps
  • Handle with Care, How To Throw Out Used Insulin Syringes and Lancets At Home (Adobe PDF, 479 KB)--This booklet from U. S. EPA is for young people with insulin-dependent diabetes and for parents.

Websites

• PPCPs
  • Because We're Worth It! The Campaign for Safe Cosmetics --Information about questionable chemicals in personal care products.
  • Cosmetics Database--A guide to safe and effective personal care products, provided by the Environmental Working Group.
  • EPA PPCP Research Areas--From U.S. EPA.
  • ⁶ Manifesto on Diclofenac and Vulture Conservation--From Birdlife International.
  • ¹ Pharmaceuticals and Personal Care Products (PPCPs) as Environmental Pollutants.--From U. S. EPA.
  • ⁴ PPCPs as Environmental Pollutants, Frequently Asked Questions--From U. S. EPA.
    • How do I properly dispose of unwanted pharmaceuticals?
  • PPCPs as Environmental Pollutants, Some Websites Relevant to PPCPs in the Environment--From U. S. EPA.
    • Disposal and New Ideas in PPCP Recycling and Pollution Prevention
  • ⁵ PPCPs in Point-of-Use Drinking Water--From U. S. EPA.
• Sharps
  • Coalition for Safe Community Needle Disposal--A collaboration of businesses, community groups, nonprofit organizations and government that promotes public awareness and solutions for safe disposal of needles, syringes, and other sharps in the community. Advisory council members include: American Association of Diabetes Educators, American Diabetes Association, American Medical Association, American Pharmaceutical Association, and National Alliance of State and Territorial AIDS Directors.

Health Care Waste Home