When hospitals pour drugs down the drain

(CNN)Patricia Deesy, a registered nurse, is worried about the drinking water in her home state of North Carolina.

"When I started out in nursing almost 30 years ago, policy at hospitals was to waste partial doses of narcotics in the sharps containers," Deesy said. "These containers would then be incinerated by a company that picked them up when they became full."
Yet this incineration caused air pollution, Deesy said, so over time, hospitals shifted to "dumping the containers into landfills."
"People would actually break into the containers and steal the wasted meds and syringes and use them," said Deesy, who lives near Charlotte. As a contract nurse, she has worked "for just about every hospital within two hours of my home."
    Today, the policy "in every facility that I am aware of" is to "waste" unused medicines down the sink or toilet.
    "If someone is ordered morphine 1 milligram every four hours and it comes supplied in 2-milligram vials, then I have to waste 1 milligram down the sink each time," she explained. "It's ridiculous." Imagine all the nurses on all the shifts in all the hospitals across the country doing the same, she said.
    "Every time I waste something, I think I'm destroying my water system," she said. "I've got kids and grandkids. I hate to see us polluting their water like that."

    'Conflicting rules'

    A 2017 study titled "Drugs down the drain: When nurses object" begins with an observation: "Many times during a typical workday, American hospital nurses routinely discard unused portions of narcotics and other controlled substances into municipal water supplies." The reason this practice is routine, the authors suggest, stems from inconsistencies in regulations and how they are interpreted by hospitals.
    "There are agencies at the federal, state, and local levels that have issued conflicting rules" about pharmaceutical disposal methods for hospitals, the authors wrote.
    The Environmental Protection Agency strongly discourages pouring or flushing pharmaceuticals down the drain in any setting, including at health care facilities, because they may enter and pass through water treatment systems and contaminate the water supply. As part of its rule for managing hazardous waste pharmaceuticals, the EPA has banned the "sewering" (or pouring down the drain or toilet) of hazardous waste pharmaceuticals at health care facilities.
    However, this rule, which was only finalized this month, applies only to drugs considered hazardous waste, such as toxic chemotherapy drugs. Most pharmaceuticals do not fall into this category.
    In contrast to the EPA's stance, the US Food and Drug Administration has advised individuals to sewer narcotics and controlled substances, including morphine and other opioids, in order to avoid harm to animals and humans, including children, who could gain access to these powerful and dangerous drugs.