Now that weird malformations have been observed in fish swimming in streams where traces of hormones, steroids, and other medications have been found, it’s time to consider how to dispose of prescription drugs responsibly. Dumping them down the drain or into the trash is not the answer.

That said, what the answer is depends on whom you ask. Federal drug control agencies still advise putting unwanted and expired medications out with the rest of your trash, after first making sure nobody can retrieve them. In guidelines published in February 2007, “Proper Disposal of Prescription Drugs,” the White House Office of Drug Control Policy suggests mixing the drugs with “an undesirable substance, like used coffee grounds or kitty litter,” putting them in “impermeable, nondescript containers,” then throwing these into the trash. Certain drugs, however, should be flushed down the toilet, according to these guidelines. These are listed by the Food and Drug Administration (FDA) and contain controlled substances considered to be potentially addictive. Among them are Actiq, Percocet, Ritalin, Valium, and OxyContin. In tacit acknowledgment that this advice may be problematic, these federal guidelines add that if your community has a program that accepts drugs for disposal, you should take yours there instead.

The effect of the White House office’s guidelines, however, is to encourage just what agencies responsible for wastewater treatment, water quality, public health, and fish and wildlife are trying to prevent: the continued flow of pharmaceuticals into wastewater and the environment. Those trying to keep drugs out of water are in a quandary.

“To my knowledge, they [the federal drug control agencies] didn’t consult with wastewater agencies” before issuing their disposal guidelines, said Jen Jackson of the East Bay Municipal Utilities District (EBMUD). “In California, our message is: No drugs down the drain. Period.” Still, the trash isn’t such a good place to put pills and vials, either.

The federal Controlled Substances Act of 1970 provides that only law enforcement officers may accept and dispose of narcotics and certain other controlled substances with addictive potential. Law enforcement agencies, however, will rarely accept them, except at special events. Posting police at potential drug disposal sites, such as hazardous waste dumps and pharmacies, is simply not practical.

Speaking for the White House Office of Drug Control Policy, Jennifer DeVallance explained that “prescription drug abuse is the second-largest drug abuse problem in the nation [after marijuana]. More than six million people abuse prescription drugs to get high.” The federal restrictions are in place because of “high potential of diversion and abuse,” she said.

The drug disposal dilemma began to rise to public attention after the U.S. Geological Survey (USGS) published a study in March 2002 indicating that organic wastewater contaminants, mostly pharmaceuticals and pesticides, were present in 80 percent of 139 streams sampled in 30 states. Most of the sample sites were downstream from large urban centers or livestock activity. Earlier, links were found between the presence of artificial hormones, such as those in birth control pills, and feminization of male fish. More recently, a five-month Associated Press investigation reported traces of pharmaceuticals in drinking water.

Alerted by the disturbing USGS report and related findings, public agencies and community groups began educational campaigns to discourage people from dumping drugs into trash or the toilet, instead taking them to hazardous waste facilities, or to pharmacies willing to accept them. That’s when the conflict with federal drug control laws came to the fore.

“If you knowingly possess controlled substances, you are potentially liable, so many [people] are afraid,” said Jen Jackson of EBMUD, who has been working with people in other local, state, and federal agencies, including police authorities, to find a way out of the predicament. She is an organizer for a statewide “No Drugs Down the Drain” campaign (www.nodrugsdownthedrain.org).

Some pharmacies will take back prescription drugs (except those containing controlled substances). Many of these, as well as scheduled take-back events and other disposal sites, are listed on the website of the nonprofit Teleosis Institute (www.teleosis.org), as well as on other sites, including that of Save the Bay, which entreats: “Don’t medicate our bay!”

Practices at local hazardous waste facilities vary. The City and County of San Francisco had been accepting prescription drugs for disposal at its hazardous household waste facility for 16 years without running into problems, according to Marjaneh Zarrehparvar, residential toxics coordinator for the City’s Department of the Environment. In 2007, an attorney warned that it might be violating federal drug-control law and exposing contractors to liability if it took in any controlled substances. The City shut down its take-back program and told residents who brought in drugs to take them back home and keep them in a safe place until something could be worked out with the DEA. The program has not resumed.

At some other hazardous waste facilities a “don’t ask” policy seems to prevail. Publicizing that they are not permitted to accept controlled substances, they count on people to bring in only legally acceptable medications.

“It’s kind of a tricky business right now,” said Linda Brown, hazardous waste program coordinator of the northern California region for the Philips Service Corporation, which collects hazardous waste from facilities in all nine San Francisco Bay Area counties, ships it to Kent, Washington, to be consolidated with waste from elsewhere, then sends it to Argonite, Utah, to the company’s Clean Harbors incinerator. (California does not permit incineration because of air quality concerns.) “We state that it’s not in our permit to accept controlled substances. We don’t want residents to bring these in. If some do come, we don’t know.”

The City of Los Angeles conveys a clear message. Its N3D (No Drugs Down the Drain) poster features a photograph of an unhappy-looking woman pouring tablets down the toilet, watched by three disapproving children. A circle with a slash is superimposed. The City is collaborating with Los Angeles, Orange, and San Diego Counties. “We’re trying to figure out how to work with the DEA,” said Timeyin Dafeta, principal environmental engineer with the Bureau of Sanitation, Department of Public Works. When asked how, he said. “There’s nothing active right now. Basically they just say that we can’t accept controlled substances.”

In the absence of an adequate federal disposal alternative, communities and organizations have been improvising as best they can. The only county that has managed to find a solution is San Mateo, sparked by County Supervisor Adrienne Tessier. People can drop off any kind of prescription drug in bins set up at 13 police substations. “We’re the only program in California that can legally accept controlled medications,” said Tissier’s aide Bill Chiang. “The program started with the sheriff’s office. Law enforcement is critical in making this program work. Participating departments deserve the bulk of the credit.”

The cost is low, Chiang said: “For less than $2 a pound (which includes pickup and disposal), this county is diverting tons of medications from the household waste stream. From September 2006 through the end of July 2008, we’ve exceeded 8,400 pounds.” Yet after two years, this is the only such program in the state. Why? Chiang believes that “the controlled substances aspect makes people nervous.” In addition, many police departments are too short-staffed and busy to take on one more task.

As with many national problems, the solutions sometimes grow from the ground up. In San Jose, pharmacist Robin Shalinsky became interested in drug disposal after working with Hospice of the Valley. The hospice asked her what to do with medications after a patient died. She tried to find out and learned there was no place to take these drugs. She talked with Charles Leiter, who with his father owns a pharmacy in San Jose, and in November 2007 they set up a large green metal box at Leiter’s Pharmacy and invited customers to put unwanted drugs into it--all except narcotics. In the first three days several hundred pounds were dropped in. Leiter has a contract to have the drugs hauled away for incineration.

Although in the long run the drug disposal problem needs a national solution, there is now some hope for at least a statewide approach. Senator Joe Simitian’s SB 966, signed by Governor Schwarzenegger in October 2007, requires the Integrated Waste Management Board to create model disposal programs by the end of 2008 and to report to the Legislature on their potential statewide implementation. The board is looking at various approaches being tried both in this country and abroad.

According to the National Association of Chain Drug Stores, pharmacists fill about 3.3 billion prescriptions a year. Studies have shown that between 35 and 53 percent are not used. A lot continue to flow into landfills and streams and the ocean. Reducing the volume will take much more effort.

Ryan Buchan is a fourth-year journalism student at San Jose State University with a minor in environmental studies. He grew up in South Lake Tahoe, and has written about football for the Pacifica Tribune.