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San Francisco General Hospital Staff Are Being Told to Flush Drugs Down the Toilet

Sorry, fish.


Flushing exotic items down the john—cherry bombs, sanitary products, baby alligators—tends to be frowned upon. And yet, at San Francisco General Hospital (where the letterhead now reads “Priscilla Chan and Mark Zuckerberg San Francisco General Hospital and Trauma Center”) that’s just what workers are being told to do. Beginning late last year, medical staffers were jarred to find the hospital plastered with fliers urging them to dump all surplus controlled substances (your OxyContin, your Fentanyl, your Dexedrine, your Adderall) down the drain, where they would end up, eventually, in the San Francisco Bay. 

Why ask them to do this? “That’s the million-dollar question,” says Aaron Cramer, a veteran SFGH nurse. “That’s what all the nurses are so confused about.” 

Disposing of drugs not used by patients has always been a confusing process. In the past, all unused medications (of which there are many—“We waste narcotics frequently,” Cramer assures) were dumped into a large receptacle called the “blue/white bin” under the watchful eye of a hospital employee, who was supposed to ensure that hard drugs were actually being properly disposed of. The bin’s contents were then summarily incinerated. 

But the problem with this approach, apparently, was that it was not sufficiently junkie proof. In order to get at those drugs after they’ve been spilled into the blue/white bin, all you’d have to do was to pry open a sealed protective container. That’s the easy part, though. If you managed to open the bin, you’d reveal a toxic junkyard of seeping drugs and plastic tubing. “It’s gross,” Cramer attests. However, this scenario, the nurse believes, is extremely far-fetched. Thieves would naturally target the store room rather than go for a Jackson Pollock splatter-painting of narcotics in a sealed and monitored waste bin. “To think someone would steal that in public view of the whole department?” he says. “It’s completely ridiculous.” 

Don’t tell that to the Drug Enforcement Administration, whose agents are the authorities behind the new dumping policy. In 2014, SFGH received a letter from the DEA insisting that “controlled substances”—namely heavy narcotics of the sort that make Rush Limbaugh happy—could no longer be tossed into “collection receptacles” where they’re vulnerable to “diversion.”  

But isn’t “diverting” drugs into the city’s sewage system a pretty bad option as well? Won’t our local herring stock soon be tripping out on trace levels of opiates? Medical staff, like the rest of us, have been told all their lives not to flush medications down the toilet. SFGH, however, assures its staff that the city’s Public Utilities Commission (PUC) has given its blessing to flush controlled substances, which it claims will not wreck the water treatment system or befoul the ecosystem. Staff hoping to steal medications other than “controlled substances,” meanwhile, are in luck: Those are still going into the blue/white bin. 

Rendering this byzantine process even more so, only the “controlled substances” currently being used at SFGH may be flushed; other hospitals have not received clearance from the PUC to flush their drugs. That means a doctor or nurse working at multiple city hospitals is now required to dispose of surplus drugs differently from jobsite to jobsite.

That could end up being a problem—and the union that represents hospital nurses, SEIU 1021, this week is conferring with SFGH management about the new dictates. It remains to be seen if the union’s effort will change hospital policy or, like so many wasted narcotics, end up swirling in the bowl. 


Update, January 27: The San Francisco Public Utilities Commision has stated that the PUC chemist who greenlit San Francisco General Hospital's "sewering" of drugs did so erroneously. Flushing drugs down the toilet, in fact, contravenes city policy. SFGH will be forced to cease the practice. 


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