The ProblemThere exists in the United States a critical public health problem: limited options available for the safe disposal of used needles and other sharps in the community at large. Safe disposal of these needles will protect workers and the public from unnecessary injury and possible infectious disease transmission. In efforts to educate the public about this issue and effective alternative solutions to discarding used sharps into the solid waste system, a coalition of concerned organizations including business, associations, and government agencies was formed, called the Coalition for Safe Community Needle Disposal (referred to throughout the document as “the Coalition”).
Because options for safe syringe and needle disposal in the community are often limited or poorly understood, it is the goal of this Coalition to educate, inform and encourage changes among state and federal leaders for safer needle disposal practices; inform, educate, and change the way the individuals dispose of used needles by developing and implementing safe, affordable and convenient disposal solutions; and ultimately removing needles from the solid waste stream, which will protect workers and the public from potential needle stick injuries.
The Coalition for Safe Community Needle Disposal is a collaboration of businesses, community groups, non-profit organizations and government that promotes public awareness and solutions for the safe disposal of needles, syringes and other sharps in the community.
In the community, improperly disposed used sharps pose a public health hazard to both workers and the public. The Coalition will work to educate and inform individuals and policy makers about alternatives and options available to communities to assure safe needle disposal.
"At-Home" Needle Use
In one year, approximately 9 million syringe users will administer at least 3 billion injections outside traditional health care facilities. Nearly two-thirds of these "at-home" injectors are poeple with diabetes and patients administering home health treatment for allergies, infertility, arthritis, migraines, HIV, and Hepatitis C and other ailments. Many self-injectors are unaware of safe disposal methods available to them and simply throw their used needles in the trash or flush them down the toilet, posing a risk of injury or potential infection from diseases such as Hepatitis B or C and HIV to anyone who encounters them.
The largest group of self-injectors is people with diabetes — 23.6 million people, or 7.8% of the population have diabetes in the U.S., and that number is growing at an alarming rate. The CDC predicts a 165% increase in Americans diagnosed with diabetes over the next 50 years. In addition, as patient care moves from the traditional healthcare setting back into the home, pharmaceutical companies are developing more self-injecting drugs to treat at-home patients.
Biologics or “designer” drugs are manufactured using complex processes. These drugs are fragile and require special handling in distribution (specialty pharmacies) to control temperature and light. Most biologics are made up of molecules that are too large and can be destroyed in the digestive system, therefore they are administered through injection or infusion. Biologics are expensive to develop, manufacture and deliver.
Yet spending on biologics is projected to grow from an estimated $40 billion (19% of total drug spending) in 2005 to $90 billion (28% of total drug spending) in 2009.
A recent survey of biotechnology pipeline identified 418 biotechnology medicines in development for more than for more than 100 diseases. Biotechnology is increasingly focused on chronic conditions, such as cardiovascular diseases, diabetes, digestive disorders and respiratory disorders.
The benefits of biologics are currently being considered among healthcare providers, businesses, insurance payers and manufacturers. In question is - does the cost to deliver these designer drugs override traditional treatment of diseases? Typically, biologics are designed for chronic diseases and are believed to bring patients into compliance of their disease. In many cases, patients using traditional treatment (oral medications) either cannot reach or cannot maintain compliance of their treatment. In many cases, one disease not being treated effectively results in co-morbidity.
Who's At Risk?
The greatest population at risk of potential needle stick injuries is the environmental services workers (waste and recycling workers, sewage treatment workers, janitorial and housekeeping workers).
Waste industry experience shows that most state needle disposal practices pose a health risk to waste workers. For example, recommended plastic disposal containers break open at recycling centers, materials recovery facilities and landfills, exposing hundreds of needles.
When maintenance activity occurs on machinery used at landfills, sometimes needles are lodged in the equipment exposing workers to possible needle sticks. At MRFs, when containers holding hundreds of used needles break open in mechanical sorting equipment, workers must remove each needle by hand, again exposing workers to possible needle sticks.
Also, many self-injectors disregard current EPA suggestions of using a household container to store used needles – instead they are throwing needles directly into household trash. This poses a problem for waste workers when picking up the garbage, it also poses a potential problem if animals tear open the bags. These used needles are then exposed to neighbors and possibly children.
In addition, sanitary or janitorial workers who work in public and private facilities (airports, parks, arenas, casinos, hotels, etc.) are also at risk when handling garbage. Many self-injectors will throw needles into the trash receptacles in those facilities exposing janitorial workers to possible needle sticks.
Unfortunately, options for safe syringe and needle disposal in the community are often limited and poorly understood. Laws and regulations governing medical waste (including needles and other sharps) were primarily designed for health care facilities and medical waste operations. These laws and regulations are separate from household waste.
The Environmental Protection Agency (EPA) is the only Federal agency that addresses the issue of safe needle disposal. In the past the EPA recommended that patients use a sturdy household container to store their used sharps and when that container was full, secure the lid tightly, wrap the lid in tape, write DO NOT RECYCLE on the outside of the container and throw in the household garbage. Because this was the only recommendation on disposal, most states and communities adopted this disposal solution.
In October 2002 the Coalition began working with the EPA to change its recommendation on sharps and needle disposal to EXCLUDE the household trash. With the help of the Coalition the EPA completed its brochures (individual and state/local government) in December 2004.
The majority of “community needles” are discarded into the public solid waste system, posing a risk of injury and infection to anyone who encounters them.
Despite the growing problems associated with improper disposal of sharps outside health care facilities, there are no consistent regulations or guidelines for their safe disposal.
The greatest obstacle in safe needle disposal is cost. To develop or provide a needle disposal option requires a fee. The question is “who pays for disposal?” Is it the end-user, is it the device manufacturer, is it the pharmaceutical manufacturer, is it the Federal Government, is it state or local government, the waste industry, is it the healthcare provider, or is it the pharmacists or point-of-sale.
The answer is really all of the above.