Pharmacies Integral to Success of Syringe Disposal Program
Pharmacies Integral to Success of Syringe Disposal Program
Nearly 2 Million Needles Kept Out Of San Francisco Waste Stream
New laws that permit OTC sale of hypodermic syringes and needles have been well chronicled in Pharmacy Today in recent issues. This expanded access has been hailed by members of the health care community as an important step toward decreasing the transmission of blood-borne diseases. But a concern that has not been as effectively addressed is syringe disposal. Again, pharmacies are being viewed as a solution for this complex community health problem.
Access is Key Factor
Since 1991, San Francisco residents have been able to receive free, 2.2-quart needle containers from area pharmacies through the San Francisco Safe Needle Disposal Program. Original participants in the program included Walgreens, which now has 44 participating pharmacies, University of California at San Francisco-affiliated pharmacies, the San Francisco County General Hospital Pharmacy, and the San Francisco District Health Clinics.
"Distribution seemed to be most successful through pharmacies. Pharmacists appear to be the best link with the population that uses the program," said Jacob Michaels, program coordinator. "Diabetics and other needle users can pick up a container while picking up prescriptions and needles. Pharmacists do the actual handing out of the new, and taking back of the full, containers. The biohazard box used for storage of full containers is usually right in the pharmacy area."
According to Michaels, 14,000 sharps containers were distributed in 1999, which kept an estimated 2 million needles out of the residential waste stream.
Fifty-four pharmacies are now associated with the program: Kaiser Permanente Health Plan Pharmacies and the San Francisco Veterans Affairs Medical Center joined the program 3 years ago, and Stadtlanders Pharmacy joined last year. Participating sites must pay a $200-per-pharmacy annual registration fee.
The program is administered by the Norcal Waste/Sanitary Fill Company (with oversight by the City of San Francisco Solid Waste Management Program).
Minor Problems Solved
The process is fairly simple, but Michaels said there have been some legal issues surrounding safe syringe disposal.
Once full, a sharps container can be returned to any participating pharmacy for proper disposal. The biohazard boxes used by pharmacies that do not have a separate medical stream to dispose of the containers -- such as a hospital -- are picked up by a medical waste hauler. But storage of the used needles in the boxes became an issue. State law required that used medical waste not be stored for more than 1 month at a particular site. An exception was made for needle disposal programs, Michaels said. Drug paraphernalia laws also became an issue, but transportation of used needles in a sealed phlebotomy container appears to have taken care of this problem.
"The willingness of pharmacists to handle the used needles in containers appeared to be the biggest issue, but so far Walgreens and other pharmacists have been more than happy to do this," Michaels said.
Outreach Increases
Pharmacists from across the United States and Canada have contacted Michaels for information about the program, which was set up primarily for the safety of sanitation workers. Practitioners can get involved by contacting their local health department; solid waste utility if garbage pickup falls under city jurisdiction (or a private solid waste facility if the city government is not involved); or their local fire department.
With very little public controversy in San Francisco, the program has flourished enough to warrant increasing outreach efforts to the gay community, non-English-speaking Asian and Hispanic communities, substance abuse counseling organizations, and patients with diabetes. In the future, information will be disseminated to needle exchange programs, hospitals, medical centers, physicians, and home health care nurses.
"Pharmacists complain only when they run out of containers to give out. Users of the program have been overwhelmingly supportive," Michaels said.
T. Stephen Jones, MD, associate director for science in CDC's HIV/AIDS Prevention Division, is a proponent of pharmacist involvement in needle disposal programs.
"These programs illustrate clearly how effective and efficient a pharmacy-based system for disposal of used syringes can be," Jones said. "[The process] works well for the pharmacists and their patients, and helps substantially reduce the risk of accidental needle stick injuries for sanitation workers. Everybody wins."
According to Jann Skelton, APhA senior director of professional practice development, "APhA, working with the American Medical Association, CDC, the National Association of Boards of Pharmacy, and others, has had significant success in decreasing barriers to syringe access by supporting changes in state regulations. In concert with these efforts, we must also focus on ways that pharmacists can provide safe and convenient mechanisms for all patients to dispose of syringes safely."
Nearly 2 Million Needles Kept Out Of San Francisco Waste Stream
New laws that permit OTC sale of hypodermic syringes and needles have been well chronicled in Pharmacy Today in recent issues. This expanded access has been hailed by members of the health care community as an important step toward decreasing the transmission of blood-borne diseases. But a concern that has not been as effectively addressed is syringe disposal. Again, pharmacies are being viewed as a solution for this complex community health problem.
Access is Key Factor
Since 1991, San Francisco residents have been able to receive free, 2.2-quart needle containers from area pharmacies through the San Francisco Safe Needle Disposal Program. Original participants in the program included Walgreens, which now has 44 participating pharmacies, University of California at San Francisco-affiliated pharmacies, the San Francisco County General Hospital Pharmacy, and the San Francisco District Health Clinics.
"Distribution seemed to be most successful through pharmacies. Pharmacists appear to be the best link with the population that uses the program," said Jacob Michaels, program coordinator. "Diabetics and other needle users can pick up a container while picking up prescriptions and needles. Pharmacists do the actual handing out of the new, and taking back of the full, containers. The biohazard box used for storage of full containers is usually right in the pharmacy area."
According to Michaels, 14,000 sharps containers were distributed in 1999, which kept an estimated 2 million needles out of the residential waste stream.
Fifty-four pharmacies are now associated with the program: Kaiser Permanente Health Plan Pharmacies and the San Francisco Veterans Affairs Medical Center joined the program 3 years ago, and Stadtlanders Pharmacy joined last year. Participating sites must pay a $200-per-pharmacy annual registration fee.
The program is administered by the Norcal Waste/Sanitary Fill Company (with oversight by the City of San Francisco Solid Waste Management Program).
Minor Problems Solved
The process is fairly simple, but Michaels said there have been some legal issues surrounding safe syringe disposal.
Once full, a sharps container can be returned to any participating pharmacy for proper disposal. The biohazard boxes used by pharmacies that do not have a separate medical stream to dispose of the containers -- such as a hospital -- are picked up by a medical waste hauler. But storage of the used needles in the boxes became an issue. State law required that used medical waste not be stored for more than 1 month at a particular site. An exception was made for needle disposal programs, Michaels said. Drug paraphernalia laws also became an issue, but transportation of used needles in a sealed phlebotomy container appears to have taken care of this problem.
"The willingness of pharmacists to handle the used needles in containers appeared to be the biggest issue, but so far Walgreens and other pharmacists have been more than happy to do this," Michaels said.
Outreach Increases
Pharmacists from across the United States and Canada have contacted Michaels for information about the program, which was set up primarily for the safety of sanitation workers. Practitioners can get involved by contacting their local health department; solid waste utility if garbage pickup falls under city jurisdiction (or a private solid waste facility if the city government is not involved); or their local fire department.
With very little public controversy in San Francisco, the program has flourished enough to warrant increasing outreach efforts to the gay community, non-English-speaking Asian and Hispanic communities, substance abuse counseling organizations, and patients with diabetes. In the future, information will be disseminated to needle exchange programs, hospitals, medical centers, physicians, and home health care nurses.
"Pharmacists complain only when they run out of containers to give out. Users of the program have been overwhelmingly supportive," Michaels said.
T. Stephen Jones, MD, associate director for science in CDC's HIV/AIDS Prevention Division, is a proponent of pharmacist involvement in needle disposal programs.
"These programs illustrate clearly how effective and efficient a pharmacy-based system for disposal of used syringes can be," Jones said. "[The process] works well for the pharmacists and their patients, and helps substantially reduce the risk of accidental needle stick injuries for sanitation workers. Everybody wins."
According to Jann Skelton, APhA senior director of professional practice development, "APhA, working with the American Medical Association, CDC, the National Association of Boards of Pharmacy, and others, has had significant success in decreasing barriers to syringe access by supporting changes in state regulations. In concert with these efforts, we must also focus on ways that pharmacists can provide safe and convenient mechanisms for all patients to dispose of syringes safely."