Pharmaceuticals in the water

Pharmaceuticals in the water

Waste Management Review speaks with Ace Waste about a waste definition loophole that’s seeing upwards of 525,000 kilograms of pharmaceutical waste landfilled in Victoria each year.

Following a two-year testing period of Melbourne water streams, a 2018 study, published in Nature Communications, found traces of 69 different drugs in observed insects and spiders.

According to the study, a platypus living in a stream on Melbourne’s fringes could receive more than a half human dose of anti-depressants each day.

The study did not specifically address how the drugs ended up in Melbourne’s waterways. That said, the research team suggested that they likely entered via the sewer system.

Similar studies have been conducted into the result of household flushing of pharmaceuticals, such as a 2017 Environmental Pollution report that found pharmaceuticals in surface water in Antarctica. Investigations into the phenomenon from the context of hospitals, however, yield little results.

While pharmaceuticals entering the environment via hospitals hasn’t sparked significant publicly accessible research, Ace Waste’s directors believe it’s a significant issue.    

Under Australian federal law, all pharmaceutical waste must be incinerated to ensure it is disposed of in the safest way possible. Clinical waste however, which includes any material resulting from medical, nursing, dental or otherwise health related activity, can legally be either incinerated or treated before landfill.

While on the surface the distinction seems apt, a half-full vial of codeine poses more environmental and human health harm than a disposable medical glove, the standard makeup of clinical waste complicates the situation.

Managing Director John Homewood says Ace Waste has been working in this industry for 31 years and as part of its central business practice, conducts regular waste audits.

“We’ve found that on average, 15 per cent of clinical waste is pharmaceutical, including physical drugs and chemical residue.”

For example, Executive Director Alex Homewood says when a patient is injected with morphine or other scheduled drugs, residual liquid remains inside the sharp or syringe.

“That sharp then goes into a sharps container, but the residual morphine remains present,” he says.

“Residual pharmaceutical additives also remain in infusion bags and IV lines, which can hold in excess of 100 millilitres.”

Currently, no public hospital in Victoria incinerates its waste according to Alex, meaning all clinical and related waste in the state is treated and landfilled.

“It has simply been that way for many years, and whether Melbourne health facilities have done audits to satisfy themselves I do not know, but what I do know is that our audits show 15 per cent of clinical waste contains pharmaceutical residue, if not pharmaceuticals,” he says.

“That fact implies that all Victorian hospitals are inadvertently breaking the law.”

In contrast, Alex says all public hospitals in South East Queensland use incineration to process clinical waste.

“All hospitals from Wide Bay right down to the border insist on high-temperature incineration because they recognise the problem of pharmaceutical waste residues,” Alex says.

While the Victorian EPA is responsible for regulating the storage, transport, treatment and disposal of clinical and related wastes in Victoria under the Environment Protection Regulations 2009, its Clinical and Related Waste Operational Guidance resource highlights generator responsibility.

Generator responsibility, broadly, refers to the concept that a producer of waste is responsible for its accurate definition and subsequent disposal.

According to the EPA guidance paper, generators must take all necessary precautions to minimise potential hazards, and ensure they manage clinical and related wastes safely and legally.

While the EPA guidance resource was published in 2009, at the time of writing, it is the only related resource available on the EPA Victoria website.

“I can’t speak to internal processes and whether or not individual hospitals are aware of the problem, but when hospitals are branding pharmaceutical waste clinical and related, and therefore sending it to treatment and landfill, that’s a breach of the law and a basic responsibility to protect human health and the environment,” John says.

While the knowledge of individual hospitals isn’t clear, John and Alex say they have informed the Victorian Health Department (VicHealth).

“The Health Department is aware, and they need to start taking serious steps to address the problem,” John says.

In an average year, 3.5 million kilos of clinical waste is produced in Melbourne Metro, using Ace Waste audits, that equates to 525,000 kilograms of mistreated waste. John says expanding that figure to Victoria at large highlights a real problem of scale.

“If Victorian hospitals don’t change the way they operate in this space, the health risks are huge, but it’s not that complex, there are very clear avenues available to address it,” he says.

John adds that rectifying the issue will not require huge investments in new waste infrastructure, because the capacity already exists. When you include Ace Waste, there are two companies currently capable of incinerating Victoria’s clinical waste, he says.

“If the state’s hospitals don’t implement strict procedures to separate clinical and pharmaceutical waste at the source, which given the fact medical professionals operate in stressful and often life-threatening situations, would be borderline impossible, VicHealth needs to begin enforcing incineration,” he says.

“Treating and landfilling residual pharmaceuticals is not only contributing to our current environmental problems, but actively making them worse.”

At the time of writing, VicHealth had not responded to Waste Management Review’s request for comment.

This article was published in the December edition of Waste Management Review. 

Related stories:

X