Drugs down the drain: When nurses object

Abstract

The authors examine the nursing practice of disposing unaltered controlled substances into public water systems as an issue for nurses concerned with the environmental harm it can cause. A summary of the history of controlled substance management reveals inconsistencies in the interpretation of current regulations that have led to disposal policies that vary by institution, according to a benchmarking survey of regional hospitals. Much attention has been given to the phenomenon of conscientious objection in the context of patient care that conflicts with a nurse's moral integrity. Nurses who are compelled to dispose narcotics down drains may also face this struggle. The authors submit that this disposal method is based on a type of double effect logic where preventing diversion is viewed as a good effect of flushing unused controlled substances that outweighs any harm it may cause, though there is little evidence to support this conclusion. Consequently, the topic deserves further study so that nurse managers and administrators can support and offer alternatives to nurses who object to flushing drugs down the drain.

Communication of Recommendations for the Disposal of Unused Prescription Opioid Medications by Stakeholders in the News Media

“…Additionally, the FDA [9] released a list of medications, which contains primarily opioid medications, that should be "flushed down the toilet as soon as they are no longer needed" if a take-back program is "not readily available." There may be reluctance to flush unused medications due to previous widespread communication that pharmaceuticals (e.g., estrogens and antibiotics) negatively impact the aquatic environment [10][11][12][13][14][15][16]. However, different classes of pharmaceuticals pose varying levels of risk to humans and ecosystems.…”

How the hospital context influences nurses’ environmentally responsible practice: A focused ethnography

“…Nurses are encouraged to critically examine their own practices to discover activities that could be done differently. For example, nurses identified that the disposal of controlled substances into the sewer system was harmful to the environment and are now working to change these practices (King & McCue, 2017). Nurses can develop and lead ‘green teams’, which are responsible for examining hospital‐wide practices, identifying those that are harmful to the environment, and offering alternatives (Huffling & Schenk, 2014; Lilienfeld et al, 2018; Sayre et al, 2010).…”

Controlled Substance Waste: Concerns, Controversies, Solutions

“…While concern about this practice has been raised with respect to numerous pharmaceutical products, even to the extent that specific protocols for the disposal of certain non-controlled drugs have been issued, controlled substances are often still sewered. Nurses and other hospital staff members tasked with such disposal have raised concern and even conscientious objection to the practice of letting controlled substances enter the wastewater system [ 23 ]. In a survey of hospice home care nurses, 55% said they always or often flushed the unused controlled substances, despite their own doubts about the environmental safety of such practice [ 24 ].…”