Pharmaceutical Waste

What is pharmaceutical waste? Pharmaceutical waste is often defined as an expired or unused medication classified as hazardous or non-hazardous, dependent on the drug’s chemical properties. Pharmaceutical waste applies to prescription drugs, over-the-counter (OTC) medications, and waste products left over from their manufacturing processes. These waste products may include sharps, personal protective equipment (PPE), or anything that comes into contact with pharmaceuticals. Pharmaceutical waste comes from healthcare facilities and can originate from households. It is essential to know the proper rules and regulations regarding its handling, storage, and disposal. Several government agencies provide guidance when it comes to such regulations. In the United States, federal management of pharmaceutical waste is regulated by the Food and Drug Administration (FDA), Environmental Protection Agency (EPA), and the Department of Transportation (DOT). There are also state regulations that mirror federal rules because they are more restrictive in some instances. The Resource Conservation and Recovery Act (RCRA) was implemented in 1976 and is the principal federal law in the United States governing solid and hazardous waste disposal. Waste and chemicals are given a letter designation that denotes the toxicity of the chemical or where the waste originates from. This act aims to help promote proper disposal of pharmaceutical waste to reduce waste and encourage recycling. In the United States, there is also a drug schedule ranking from Schedule I to Schedule V. Schedule I designates drugs with high abuse/misuse potential with no accepted medical use. Schedule V classifies medications with the least potential for abuse/misuse among the controlled substances.

Pharmaceutical waste does drastic harm to our environment. It results in frogs and fish having reproductive toxicity, alters fish behavior, and reduces algae and fish growth. Pharmaceutical waste also affects humans, but how? Pharmaceutical waste plays a role in human antibiotic resistance, ecotoxicity and genotoxicity, and an increased risk of contracting disease. We need to practice a reverse distribution method to keep these waste products out of the environment. The reverse distribution (RD) method strives to return potential creditable pharmaceuticals using RD vendors, waste determination and management at the RD facility, and pharmaceuticals not meeting the manufacturer’s policy become “waste” once the decision is to discard them. The EPA supports this practice as long as it is not the sole waste management practice. So, how can I, as a dental hygienist and my patients, not add to the pharmaceutical waste problem? We can make behavioral changes, properly dispose of our pharmaceuticals, and advocate for policy changes. Behavioral changes will start with counseling patients on proper disposal when fit is necessary. I will encourage my patients to dispose of their pharmaceuticals at a drug take-back location or use the at-home disposal companies that are available. I will advocate for policy changes through more education and research, advocate for “green” pharmaceuticals, new technologies to upgrade wastewater and drinking water treatment plants and improve disease prevention and precision medicine.

Navigating Cultural and Disability Biases

Cultural and disability biases often affect how people are seen and how people are treated in a healthcare environment. As healthcare professionals, we need to be able to recognize how cultural identity and disability inform patient experience, learn how cultural responsiveness improves patient outcomes, recognize potential internal bias, and identify strategies to reduce bias. But how do we do this? The population of Maine is changing, with more people seeking to make Maine their home. About 4% of Maine’s population are immigrants, with recent trends from Burma, Congo, Iran, Iraq, Ethiopia, Somalia, Sudan, and more. They are seeking to make Maine their home for many reasons, including their homes are areas of high conflict, political and social destabilization, or natural disaster. These people are typically known as refugees, asylum seekers, or migrants. A refugee flees the country because of serious human rights violations, armed conflict, or persecution. They are unable to return to their home safely. Refugees can receive services upon arrival for primary applicants, spouses, and children under 21. An asylum seeker leaves their home country because of serious human rights violations or threats to safety or persecution. If they leave the United States, the process starts over. Asylum seekers are eligible to receive services and benefits beginning on the date of their final grant of asylum. A migrant moves to better their lives. They have no direct threat or persecution, can freely travel, and are not forcibly detained or returned to their home country. Migrants have a five-year wait after qualifying status. Pregnant people and children may be eligible for Medicaid or the Children’s Health Insurance Program (CHIP) immediately.

There are differing viewpoints within a culture and between cultures. Disability is sometimes thought of as a quirky characteristic, an issue that needs to be corrected, shameful to a family, inviting pity for the community, a blessing from god, or a difference that requires accommodations from others. Cultural responsiveness is a term used to help manage situations that may be unfamiliar, which a hygienist needs to implement and practice more often. Acknowledging, addressing, and understanding individuals’ attitudes, behaviors, and values is an ongoing process. Cultural responsiveness helps demonstrate respect for each person’s ability, age, culture, ethnicity, gender, language, national/regional origin, race, religion, sexual orientation, and socioeconomic status. It helps to identify appropriate information, intervention, and assessment strategies needed for every individual. To do this, I need to adjust my clinical approach to be sure that I am not violating the individual’s beliefs or principles and that I do not alienate them from their clinicians, community, or support systems. To make myself a more inclusive dental hygienist, I must give my patients the proper attention and time and increase their opportunities for contact. I must use transparent and inclusive everyday language and ask the individual about their language preferences to properly access interpreters. As a hygienist, I can also advocate for a universal design that involves inclusivity of every environment through physical space, signs, symbols, and care delivery.