As an interior designer, I was contacted recently by a national pharmaceutical retail chain to design a store fixture to be located in the front of their stores. The only criteria given was where the fixture was to be located and the rough shape and dimensions of the space to be occupied. What merchandise was to go on the fixture was left open.
The idea developed into a preliminary presentation for an interactive fixture designed to educate the public about the need to dispose of pharmaceutical waste in an environmentally responsible manner. It incorporated bins where customers could drop off and separate unused pharmaceuticals.
The idea was pitched to the client and was well received. However, it was eventually turned down on the basis that the infrastructure to support the concept does not exist in Ontario. They were still receptive to the idea pending a paradigm shift in current medical waste collection and disposal practices currently outside their control.
A sense of how this problem is viewed by the government, retailers, industry, and the public emerged almost at once. Absolutely no one wants their name or their organization’s name associated in the media with the problem of what to do with pharmaceutical and medical waste. There’s a sound reason for this: No person or organization contributing medical waste to the disposal system wants to be seen as being part of the problem or an obstacle to the solution (for what is understood as an environmental safety issue that affects every living thing). It’s an issue that has been ignored to the point where the damage done by pharmaceuticals is global in scope.
The potential for a public backlash is a risk no one wants to take. But doing nothing about the problem risks an even greater backlash.
The idea for the drop-off unit went on the back burner for a while until I had time to discuss the issues with the largest end users: the hospitals. In the hospitals, medical waste disposal is a problem that is on everyone’s mind and again, while no one wanted their names attached to the issue, there was urgency — even eagerness — from everyone I spoke to at every level. They all wanted to make sure my questions were answered.
What came to light was that pharmaceutical and medical waste disposal is currently in a state of barely controlled chaos that’s regulated but not fully enforced due to the lack of realistic legislation, infrastructure, equipment and funding. I got the impression that my contacts at every level were begging me to come up with a cost-effective solution. Everyone is aware that the Ministry of the Environment has created an entity called Waste Diversion Ontario to address such matters but no one knows what’s going on. While the ministry has invited input, many stake holders are afraid to participate for fear of being singled out later.
Where the rubber meets the road in this business is with what are known as “sharps.” The term refers to the needles and scalpels, etc. that are part of the waste deposited into the bins. Ontario hospitals are required to use one-way disposal bins but the cost of single-use bins is high (if you multiply how many are needed on a daily basis per floor per hospital). It’s easy to see how the system-wide cost of such bins could alter how medical care is delivered if this policy is allowed to stand without allowances being made for the ability to reuse bins. Consequently, the bins are not strictly one-way bins in a number of cases. Rather, they’re lined with plastic bags and the bags go from one bin in, say, an operating room, to a collection bin and from there into a one-way bin.
In hospitals, no distinction is made between medical waste surgical tools and pharmaceuticals. This is a crucial point because different types of waste can be treated in different ways with varying levels of cost and infrastructure requirements.
The public doesn’t understand the acute shortage of space in typical medical, dental or pharmaceutical environments. Buildings and business environments are not currently built to manage hazardous wastes because the architects and designers are not made aware of the problems and therefore cannot provide solutions for absent support services.
A conversation with the owner of the Canadian company that supplies sharps bins to hospitals brought me up to speed on how Saskatchewan deals with its medical waste problem. In that province pharmaceutical waste is disposed of in metal or plastic waste bins provided by municipalities. Information about proper disposal is published from time to time in local newspapers. People are told to put the pharmaceutical disposables in small metal or plastic containers. They are to be taped shut and they go into the bins on the day they’re to be picked up by municipal waste staff.
In addition, there’s a participatory pharmaceutical program that operates under the auspices of the Saskatchewan Pharmaceutical Association whereby pharmacists — on a volunteer basis — advise their clients (including doctors) to return sharps and unused or outdated drugs and prescription medicines to the pharmacy where they were purchased. The used and surplus meds are collected by medical waste specialists and destroyed in a provincially approved manner. The cost of this is borne by the pharmacies.
While pharmacies may provide this service in Ontario, the general public is largely ignorant of this opportunity and the hazard of simply flushing unused meds down the toilet or throwing them unprotected into the garbage. Consequently, our waterways and municipal sewage are contaminated with all kinds of drugs that have a negative effect on biota and fish, birds and animals. A partial recovery system operates in Ontario, wide gaps exist in the system. Some of this waste stream is trucked to Saskatchewan for disposal.
Another weakness in Ontario’s system is the vulnerability of waste collection staff who must pick up household waste at the curb regardless of what it might contain.
Is the ministry working on the issue? Yes it is. Does it want to do the right thing? Absolutely. But doing the right thing with complex issues like this does take time and the legal implications are formidable. But the clock is ticking and accidents don’t run on schedule. It’s time for the governments in every province to act and introduce a product stewardship program and robust return-to retail system (or something equally effective) for drugs and sharps.
John Newell is with Jondy Retail Interiors Inc. in Pickering, Ontario. Contact John at firstname.lastname@example.org
“No one wants their name associated in the media with the problem of pharmaceutical waste.”