Objective

To determine whether the Office of Addiction Services and Supports (OASAS) programs and the programs it oversees collect and dispose of unneeded drugs using environmentally sound methods. Our audit covered the period January 1, 2016 to April 27, 2019.

About the Program

Unused, unwanted, and expired pharmaceuticals present a range of potentially harmful environmental and societal consequences. Both controlled and non-controlled substances are inherently dangerous if used inappropriately, and controlled substances are particularly at high risk for diversion, misuse, abuse, and addiction. Therefore, unwanted and expired pharmaceuticals must be disposed of to mitigate those risks. Certain long-accepted disposal practices, such as flushing and garbage disposal, have led to the contamination of environmental resources. However, more environmentally sound disposal options, such as approved drug take-back programs, are available. Since 2008, the Department of Environmental Conservation (DEC), the State’s environmental regulatory agency, has supported pharmaceutical collection as a best management practice alternative, and further reinforced this policy in its updated 2017 Guidance for Proper Pharmaceutical Disposal.

The disposal of unused and unwanted controlled substances in New York State is regulated at the federal level primarily by the U.S. Drug Enforcement Administration (DEA) and at the State level by the Department of Health’s (DOH) Bureau of Narcotic Enforcement. While the DEA and DOH primarily support pharmaceutical collection and other environmentally sound disposal methods, they also allow flushing when such options are not available.

OASAS oversees one of the nation’s largest addiction services systems. Due to the nature of addiction treatment, OASAS programs and the programs OASAS oversees frequently manage client pharmaceuticals, and are thus responsible for ensuring that any unused, expired, or otherwise unwanted drugs are properly disposed of.

Key Findings

• Overall, OASAS addiction treatment centers and OASAS-certified providers (Providers) have met the regulatory requirements for collecting and disposing of unneeded drugs. However, there are improvement opportunities in some of their pharmaceutical management practices. While some of the sampled Providers had effective controls over the drug disposal process, which followed the regulations and were environmentally friendly, others did not use environmentally sound methods of disposal whenever possible.
• Based on our review of records from 20 Providers, 47,566 doses (53 percent) of controlled substances were flushed down the drain during the 40-month period January 1, 2016 through April 27, 2019. Although Providers should develop drug disposal policies
  and procedures that align with applicable regulations, including environmentally sound methods, not all Providers were compliant with their own policies and, in some cases, not even familiar with them.
• Since 2008, the State has been shifting away from flushing as an acceptable option and toward a policy of environmentally sound drug disposal. In support of this effort, OASAS should encourage Providers accordingly when establishing their disposal policy.

Key Recommendation

• Review Provider pharmaceutical management, including drug disposal policies and procedures, during recertification inspections and encourage the inclusion and use of environmentally sound disposal methods.