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Pharmaceutical sustainability in Northeast Tennessee

Updated: Mar 5, 2021

The pharmaceutical industry continues to have negative impacts in the Southern Appalachia region, but not all are not strictly health related.

Improper waste disposal of pharmaceuticals and the impact it has on the environment in Appalachia has been a long concern

“With most medications, a lot of times if people are discarding the medication they will flush it, and for a long time that’s actually what we told patients to do with medications that they didn’t need because that was the safest way to keep it out of children’s hands and people that wasn’t supposed to be taking the medication,” said pharmacist Kristin Perkins from Pharmacy Network Services. “We thought that that didn’t have any impact on our environment at all, but it turns out that those medications have made their way into water supplies.”

The aftermath of improper disposal of drugs can cause disturbances or imbalances in ecosystems, resulting in declines or outbreak of plants, animals or microbes due to toxicity of a particular chemical.

“The half-life is so long that they don’t go away as quickly as we think that they do or we hope that they do and so they are actually maintaining levels in water supplies that are high enough to affect the wildlife,” said Perkins.

In response, the state of Tennessee put in effect the Unwanted Household Pharmaceutical Takeback Program. The program was launched in 2011 and gave access to drug Take-Back boxes which provide a way for unused prescription drugs to be discarded safely in pharmacies and law enforcement hands. Medications that can be taken to the Take Back boxes include prescriptions, liquid medications, medicated ointments, lotions, or drops, pills in packaging, over-the-counter medications and pet medications. The process includes taking the boxes and fiber containers and delivering them for the incineration process.

There are currently permanent disposal bins in Anderson County, Johnson County, Elizabethton City, Johnson City and many more locations throughout the state of Tennessee.

Similar to the Drug Take-Back Boxes, the ETSU Addiction Science Center works with groups that are part of a program called “Count it Lock it Drop it” which provides appropriate safety and disposal protocol of medications.

“Our center for addiction science started sort of as a community working group engaging folks in the community in 2012, so we partner with local anti-drug coalitions that are funded,” said Angela Hagaman, the director of operations at the Center for Prescription Drug Abuse Prevention and Treatment.

The center works with these coalitions to help the Central Appalachian region become free of the consequences that come from drug abuse.

The Tennessee Department of Environment and Conservation estimated that around 30% of streams in the state cannot support a healthy population of fish and other wildlife due to the poor water quality, and 40% of streams are not fit for human recreation.

“Pharmaceutical waste in our region is certainly a concern of mine,” said pharmacist Rhett Byrne from PNS. “The DEA and other governing bodies have given requirements and recommendations to help this issue and I trust their guidance.”

Improper waste disposal of drugs and other hazardous items cause the quality of water supplies to continue to be inhabitable and recreational to the Tennessee and neighboring regions.

“There have been cases where patients have had inappropriate hormonal development, now a lot of it is coming from what we put in food and that’s known but some of it is coming from water supplies,” said Perkins.

The improper disposal of opioids do not have much effect in pill form, however patches that are used for drugs such as Fentanyl are still dangerous after the patient takes them off and could potentially harm any wildlife that may come across the patches.

“We are careful about not putting things down the drain,” said Perkins. “In some places when you have liquid waste they just put it down the drain and that can get out into the water supply and leak into the land, so we do not do that. If we do have some it goes into a special container that gets put into the trash.”

The FDA provides a list of drugs that should be flushed or properly discarded in one’s trash with instructions if there are no drug take back sites in the area. Instructions for safe discard include mixing the liquid or pill with an unappealing substance, placing the mixture in a sealed bag, throwing away the original container in your trash at home and finally delete all personal information on the prescription label.

“I definitely feel like there is more that could be done,” said Perkins. “I think that most people just aren’t educated on how important their medications are, so I think while we are following our regulations we are not getting the word out well enough and educating people.”

For more information on what or how to discard household medications and keep them safe from children visit


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