Drug Waste: Protecting Each Other and the Earth During Cancer Treatment

When a member of the Patient Power community noticed their oncology nurse wearing gloves to handle their chemotherapy medications, they wondered, “What happens to medical waste if it’s something humans can’t even touch?” In honor of Earth Day, we asked the experts.

“Like many healthcare facilities, cancer centers generate many different types of regulated wastes which is necessary during the course of care,” said Cara Simaga, senior director of Regulatory Affairs at Stericycle in Bannockburn, Illinois. “This could include hazardous waste, regulated medical waste, sharps waste, and trace chemotherapy waste.”

Hazardous waste is not just pharmaceuticals. It can also include alcohol-based hand sanitizer, batteries, and other byproducts of cancer care. Simaga said it is essential that waste be correctly collected, segregated, treated, and disposed of every time.

“Improperly disposed of hazardous waste pharmaceuticals can leach into landfills and waterways and potentially damage ecosystems and communities,” Simaga explained. “Sending pharmaceutical waste for incineration prior to disposal helps to keep active pharmaceutical ingredients out of the environment.”

What Cancer Centers Can Do to Protect the Environment

Many medical waste organizations provide educational materials and resources to train providers, administrators, and other healthcare staff on the unique compliance requirements around waste stream management.

“Cancer centers and all of our customers can aid in the safe disposal process by educating those responsible for waste disposal on the importance of proper waste segregation,” Simaga said. “This means ensuring that the right waste is going into the right container.”

For instance, “[Stericycle’s] instructions for packaging the waste correctly in the containers are key to keeping the waste secured in transit and protecting the safety of our workers who handle the containers later,” Simaga said.

Medical waste organizations also may provide cancer centers with waste acceptance policies and educational materials that outline what can and cannot be accepted. Ultimately, it is the responsibility of the cancer center to separate and label their waste correctly, Simaga said.

“Many pharmaceuticals used to treat cancer are regulated by the United States Environmental Protection Agency (EPA) as hazardous waste,” Simaga said. “[My organization] also includes information on which pharmaceuticals are found on the National Institute of Occupational Safety and Health’s (NIOSH) List of Antineoplastic and Other Hazardous Drugs. Customers simply need to provide the National Drug Code (NDC) for the pharmaceuticals they need to dispose of.”

Handling Cancer Drugs at Home

While Stericycle and similar organizations partner with cancer centers to dispose of oncology waste in an environmentally friendly way, what about people who take oral cancer drugs at home? Along with understanding how and when to take medications as prescribed, knowing how to handle, store, and dispose of pharmaceuticals is essential.

“Anticancer drugs may be potentially harmful to those who do not have cancer, including pets,” said Lisa Holle, PharmD, BCOP, FHOPA, FISOPP, clinical professor at the University of Connecticut School of Pharmacy. “Thus, it is important to store oral anticancer medications out of reach and leave them in the provided packaging until ready to use. If a care partner is going to be handling oral anticancer medications, they should do so with precautions.”

Dr. Holle said that if your care partner is helping you with your medications, they should wear gloves. Ideally, your care partner will give you the medication directly or put it into a disposable pill cup and then dispose of the cup and gloves immediately. Also, while separating your pills by day and time may seem like a safe and easy way to ensure that you adhere to your treatment plan, it is safer for some medications to stay in their original container.

“If a daily pill box or reminder is to be used, talk with your pharmacist first,” Dr. Holle said. “Some anticancer medications should not go into a pill box or reminder device.”

Seek Guidance Before Disposing of Drugs at Home

When disposing of pharmaceuticals, ask your doctor for guidance. The U.S. Food and Drug Administration (FDA) has a flush list that indicates which drugs can be flushed down the toilet, but your healthcare provider is your best resource for questions about cancer medications.

“Anticancer drugs are not listed on the FDA flush list and should not be flushed in the toilet,” Dr. Holle explained. “To know how to best dispose of your anticancer drug, contact your hematologist/oncologist or hematology/oncology pharmacist.”

In 2014, Dr. Holle and her colleagues launched a drug disposal pilot program at the Carole and Ray Neag Comprehensive Cancer Cen­ter at the University of Connecticut. For one year, they asked patients to return unused or expired oral cancer medications, empty bottles, and packaging to the cancer center for proper disposal. The team found that the program benefited their patients without creating additional costs for the facility, but the process has not been widely adopted.

“This type of program has not become more mainstream,” Dr. Holle said. “One of the reasons take-back disposals of anticancer drugs have not become more mainstream is that it may depend on the state regulations regarding waste management and hazardous drugs.”

Making it easy for patients to return medications for proper disposal could lead to less hazardous waste ending up in the environment, where it can affect other people and the planet.

How You Can Help

Whether you just started treatment or have been taking oral cancer drugs for a while, consider using Earth Day as an annual reminder to assess how you:

• Store,

• Handle, and

• Dispose of your medications.

Simaga said cancer centers should provide guidance on how to manage any pharmaceutical wastes patients may have to discard at home. Others point out that it should also be included in the highlights of prescribing information as well.

“According to our 2022 Healthcare Workplace Safety Trend Report, 91% of providers agreed that patients need more information and resources about how to properly dispose of pharmaceutical and medical waste at home – a challenge that will likely increase with the rapid growth of at-home care,” Simaga said. “Some solutions include offering consumer medication mail envelopes when prescribing medication or providing information on local medication collection kiosks to dispose of any unused medication.”

If you have questions about storing, handling, or disposing of cancer medications, ask your healthcare provider. Together, we can protect Mother Earth and each other.