Sharp thinking
For years, patients could throw their needles in the trash. That's about to change.
You have to be kidding.
That's the incredulous refrain Andrea Penney hears all the time when she tells newly diagnosed diabetics that they can plop their used needles in detergent jugs or other plastic containers and leave them out for the garbage collector to fetch, right next to the other remains of daily life.
"They're totally surprised by that," said Penney, who teaches patients about the basics of their disease at Joslin Diabetes Center.
Each week in Massachusetts homes, patients use an estimated 2 million needles to inject medication to treat diabetes, arthritis, multiple sclerosis, and other ailments. Needles can be necessary, too, for women undergoing fertility treatments. And tens of thousands of needles deliver life-preserving drugs to ailing pets.
There are so many needles -- and so many more patients expected to need them -- that Massachusetts health authorities are moving to end the practice of patients depositing them with the rest of their waste.
Kiosks that look like black mailboxes have begun popping up at pharmacies and in city halls so that needles can be dropped off, disinfected, and destroyed. Plans are being hatched to let the elderly and infirm mail their carefully packaged needles directly to a medical waste company, sparing patients a trip to disposal sites.
And, in the most sweeping measure of all, it will be illegal starting in July 2010 for patients to place their needles with their regular household waste, making Massachusetts just one of a handful of states to embrace such an aggressive policy.
"It's no different than if you were stripping furniture in your back yard," said Suzanne Condon, director of the state's Bureau of Environmental Health. "You wouldn't be able to put that turpentine out."
For years, patients have been instructed to place needles in a sealed plastic container, rather than just dumping such sharp objects in a garbage bag also brimming with coffee grounds and paper towels.
Still, specialists are increasingly concerned about errant needles jabbing waste workers or landing in the hands of children. They're worried, too, about medical waste choking landfills, especially as the legion of needle-users climbs, fueled by an aging population and the growing number of diabetics, millions of whom depend on daily insulin injections.
Condon as well as Jenny Schumann, executive director of the national Coalition for Safe Community Needle Disposal, conceded that there's no systematic tracking of injuries caused by needles outside of healthcare facilities, making it impossible to determine the magnitude of the problem.
But there's ample anecdotal evidence, said Schumann, whose group is underwritten by waste and needle companies. "My boss, his son was at a basketball game and he sat down on the bleachers and was stuck with a diabetic's needle," she said.
Theoretically, used needles have the potential to spread disease. Hepatitis, which can result in lethal liver complications, is the prime concern.
Unlike the virus that causes AIDS, which loses its ability to infect almost immediately after it leaves its human host, hepatitis germs can be transmitted even if they have sat in liquid blood inside a needle for a week or two.
But the threat posed by wayward needles "is far more a safety issue than a disease transmission issue," said Dr. Bela Matyas, a top disease tracker at the state Department of Public Health. "You stab yourself in the wrong place, and you can be causing damage to organs or blood vessels. The needle can be long enough that it can penetrate into more than skin or muscle."
That's why Ruth Clay, health director in Melrose, began collecting needles in her city office four years ago. For one thing, Melrose still maintains its own fleet of sanitation workers - unlike many cities and towns that contract with outside companies - so the prospect of an employee being stabbed by a needle loomed as an expensive workers' compensation injury.
And then there were the stories that she kept hearing from Melrose residents - stories of detergent bottles and coffee cans stashed on a shelf, overflowing with needles.
"People were calling us and saying, 'I have all these needles, I'm trying to do the right thing, and it just doesn't feel right to throw them in the trash,' " Clay recalled.
So Clay worked out a deal with a hospital: I'll collect the needles, she promised, if you will dispose of them. Historically, hospitals and drug stores have been reluctant to accept medical waste generated in patients' homes, in part because of financial concerns.
But Clay was able to assuage hospital administrators' worries. On average, she takes about 15 pounds of needles every month for disposal. The haul on the most recent needle run: two one-gallon containers, seven quarts, two coffee cans, and a plastic milk bottle. Over four years, she has accepted 463 containers packed with needles.
Some of them have come from Dale McLennan. When her pug, Jenny, was first diagnosed with a form of diabetes requiring insulin, McLennan initially took the spent needles to a veterinarian. But after the vet's office said it would have to begin charging for needle disposal, McLennan starting leaving the needles with Clay.
"I would feel kind of odd about putting them out in the garbage," she said.
The future of needle disposal arrived recently at Melrose City Hall. It was among the first sites to receive the 40 disposal kiosks provided by the state, which is spending about $75,000 this year on the initiative.
Like Clay, North Andover public health nurse Debra Rillahan had been accepting needles at her office. But North Andover's health department sits inside a building with serpentine hallways at the edge of town. It pained her, Rillahan said, to watch ailing patients struggle to make their way through the warren of offices just so they could drop off their needles.
"Can you imagine these little old ladies having to come in here?" Rillahan said. "People bringing these needles in are not exactly the healthiest people, and we're not making it convenient."
So Rillahan, a wiry woman with a determined bearing, went on a mission when she heard that
After some arm-twisting, CVS agreed.
A Natick firm, Medical Waste Disposal Co., will retrieve boxes when they're full and ship them to New York to be sanitized and shredded. A subsidiary of
One day last week, the 10-day-old kiosk was already more than half full with a green detergent bottle, a coffee can, and a red box specially designed for used needles.
"Usually," said the CVS manager, Mike Szczapa, "somebody has to get hurt before something happens. Maybe this is an example of getting ahead of the problem."
Stephen Smith can be reached at stsmith@globe.com.
