More than 7.8 billion needles are used each year by the 13.5 million people who self-inject medications outside of a healthcare setting. That 7.8 billion number doesn’t take into account the lancets that are used by those with diabetes who test their blood sugar. Self-inject medications are used for treating a wide range of conditions, including osteoporosis, multiple sclerosis, HIV, AIDS, hepatitis C, migraines, cancer, kidney disease, and psoriasis. In addition, patients administer blood thinners, growth hormones, infertility drugs, vitamin B-12, and allergy shots. As the number of drugs injected at home continues to grow, the use of sharps in the home will dramatically increase as well. Where will all these needles go? Too many times, patients throw them in the trash, creating significant health concerns.

Scope of the problem

Upon discharge from a hospital, long-term facility, or a homecare agency, patients may be given a needle disposal container, but facilities for needle disposal are often not available, as only few states have needle disposal programs or options for disposal other than household trash. Previously, hospitals and doctors’ offices were willing to accept this as medical waste, but due to the high cost of medical waste disposal this courtesy is usually no longer available.

As a diabetes educator, I find it amazing that patient’s may dispose of the needles, syringes, and lancets in the household trash or into the sewage system. Typically needles, syringes, and lancets are placed in soda bottles, coffee cans, and detergent bottles and then disposed of in household trash. This trash is then compacted, crushing the container and spilling needles into the landfill or clogging conveyor belts, requiring sanitary workers to hand pick syringes with exposed needles out of the system.

This is serious health concern for many individuals who are untrained regarding the health risk to which they are exposed on a daily basis. A surprise encounter with a used syringe, needle, or other sharp in a playground, park, or at work can provoke intense fears of injury and life-threatening infections. If a needle stick injury occurs, the costs of providing post-injury counseling and prevention measures are significant. While there are limited data on these occupational and nonoccupational risks, problems that can arise from unsafely discarded used sharps include needle stick injuries and potentially fatal blood-borne infections.

Coalition for Safe Needle Disposal

As nurses, we have lobbied long and hard for safe needle and sharp safety in hospitals. We now need to raise awareness in communities, local governments, and state governments about the need to provide a safe needle disposal option in communities, and we need to educate the public on the problem and possible solutions.

The Coalition for Safe Needle Disposal encourages grass-roots efforts to be organized by stakeholders throughout the United States. The Coalition hopes to raise awareness of the need for proper needle disposal programs to be established in all communities. It is vital that all healthcare providers become involved as they play an important role in awareness campaigns, in forging of partnerships, and in changing regulations, policies, and laws to guarantee access to safe disposal programs.

In 2004, the Environmental Protection Agency (EPA), in collaboration with the Coalition for Safe Needle Disposal, published new guidelines for safe needle disposal outside traditional healthcare settings. The guidelines request that individuals using sharps participate in a safe needle disposal program and not throw needles, syringes, or lancets into household trash.

These new recommendations are found in the publication “Protect Yourself, Protect Others: Safe Options for Needle Disposal” (http://www.epa.gov/osw/nonhaz/industrial/medical/med-home.pdf) and a second publication “Community Options for Safe Needle Disposal,” (http://www.epa.gov/osw/nonhaz/industrial/medical/med-govt.pdf) which provides information for local governments on the establishment of needle disposal programs in their community.

Unfortunately the EPA, a regulatory agency, has no power to enforce laws or write regulations although it may make recommendations. Therefore, it is the responsibility of local governments, communities, and waste management programs to establish programs. Few states have passed any legislation or instituted any regulations regarding needle disposal programs outside of healthcare settings. As awareness of this problem has increased, some hotels and public facilities have opted to provide needle disposal systems in restrooms in an effort to protect their employees. These facilities contract with a medical waste disposal company to monitor these systems. Some hotel chains offer needle disposal containers to those who request the service.

Unfortunately, laws and regulations governing medical waste (including needles and other sharps) were primarily designed for healthcare facilities and medical waste operations. These laws and regulations can hinder community efforts to gather and consolidate household sharps for safe disposal as medical waste, for example, at fire stations or pharmacies.

Most people who give themselves injections have received limited and at times contradictory guidance about safe disposal of used sharps. Physicians, pharmacists, and diabetes educators, to whom they would most likely turn for help, are often uncertain of what to advise. For illegal drug users, the criminal penalties for syringe possession are strong disincentives to safe disposal of their potentially infectious used syringes and needles. Many are unwilling to participate in safe disposal because of the real risk of arrest for possession of drug paraphernalia.

A complete listing of all state laws and regulations can be found on the Coalition for Safe Community Needle Disposal website.

Needle disposal options and programs

Several options for disposing of needles outside of a health-care setting exist.

Community-based programs

Community-based programs offer drop-off locations for used needles. Drop-off programs may exist at police stations, fire stations, physicians’ offices, hospitals, clinics, health departments, or medical waste facilities. An example of a community-based effort is found in New York State, which uses a program available through Chrysalis Environmental Services. This company, which produces products, services, and educational programs to ensure the safe and environmentally friendly disposal of residential medical waste, has established a kiosk program, a joint effort between participating pharmacies or other organizations, and a medical waste hauling company. As part of the program, electronic kiosks, called “Zeedles,” are placed in facilities to accept residential medical waste. Individuals may dispose of their used needles and syringes in a needle disposal container or into a container a home that they drop it into the kiosk. Additional information about the program is available at http://www.aboutneedledisposal.com

Residential pickup

Residential special waste pick up works well in small communities. Special recycling containers are placed outside the home to be picked up by trained waste workers. This may be done on a regular schedule or as a requested service.

Syringe exchange

Syringe exchange programs allow illegal drug users to exchange used syringes and needles for new ones. The used needles are then properly discarded at a medical waste collection site. These types of programs are usually run by nonprofit groups and are frequently not publicized. They offer educational programs and services for people with HIV and AIDS. For more information on the availability of a needle-exchange program in your area, contact the North American Syringe Exchange Network at 253-272-4857 or online at www.nasen.org.

Hazardous waste collection

Household hazardous-waste collection sites are similar to a recycling center, in which needle disposal containers are placed in a designated medical waste collection container. Many of these programs provide a new sharps container when a person disposes of his or her used container. Sharps containers may be purchased at a local drug store or durable medical equipment company.

Needle destruction devices

Needle destruction devices are available for use in the home. These devices bend, break, or shear the needle. However, the problem still exists as to what to do with the needles, and this solution does not work well for lancets.

Mail-back programs

Some companies offer a sharps container mail-back program in which a sharps disposal container is purchased at a pharmacy or a durable medical equipment company. An additional charge is added to the price of the container to cover the cost of a mailing envelope provided to ship the container to a medical waste facility. Unfortunately, this program is not covered by insurance and the patient is required to pay for the needle disposal container and the mailer, further increasing their financial burden. Patients taking Humira (Abbott Labs) are eligible for a free mail-back program by calling 1-800-448-6472 or signing up on line at http://www.myhumira.com/Disposal/Default.aspx. Patients taking Simponi (Johnson and Johnson) are eligible for a free mail-back program by calling 1-877-697-4676.

What should you tell your patients?

Learn what needle disposal options are available in your community so you can provide your patients with accurate information. It’s also important to assess the needs of your patients when advising them on how to dispose of their sharps. For instance, if your patient will only be administering injections for a short period of time, a mail-back option is probably the best solution. Patients who will require long-term treatment for diabetes, HIV, or other chronic conditions should be counseled in the use of a home needle destruction device as this will be the most economical solution. For those patients using therapies for infectious diseases such as HIV or Hepatitis C, it is imperative that they receive instruction regarding the importance of proper needle disposal in order to protect the community.

If you do not have needle-disposal programs in your area, instruct your patients to:

• Put needles into a container that has a lid and is strong enough to keep the needles from sticking through the sides, such as a liquid detergent bottle or metal can.
• Throw the container away before it is full all the way to the top.
• Put the container lid on tight and use heavy tape to keep it on.
• Put the container in the center of your garbage.

For more information and an instructional brochure, What Do I Tell My Patients, contact the Coalition for Safe Needle Disposal at 800-643-1643 or print it from their web site: http://www.safeneedledisposal.org/.

Other resources for you and your patients include:

• United States Environmental Protection Agency. Protect yourself, protect others: safe options for needle disposal. Washington, DC: EPA; June 2006. Pub. no.: EPA530-F-06-014. May be ordered from EPA at 800-490-9198; also available at http://www.epa.gov/epaoswer/other/medical/med-home.pdf.
• United States Environmental Protection Agency. Community options for safe needle disposal. Washington, DC: EPA; October 2004. Pub. no.: EPA530-K-04-001. May be ordered from EPA at 800-490-9198; also available at http://www.epa.gov/epaoswer/other/medical/med-govt.pdf.
• Journal of the American Pharmaceutical Association. Supplement to the Journal of the American Pharmaceutical Association. 2002;42(6)suppl 2:S1- S119 at http://www.aphanet.org/JAPhA/suppl2_cdc.pdf

A call to action

Nurses can help address 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 will protect workers and the public from injury and possible infectious disease transmission. Join the Coalition for Safe Needle Disposal to help educate the American public about this issue and effective alternative solutions to discarding used sharps into the solid waste system that best suit your community. If you are interested in obtaining more information or starting a sharps-disposal program in your community, contact Jenny Schumann of the Coalition for Safe Community Needle Disposal at 800-643-1643 or at jschumann@safeneedledisposal.org.

Kathy Gold is director of outreach and education for the Diabetes Research and Wellness Foundation in Washington, D.C.