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U.S. Department of Health and Human Services

Archival Content: 1999-2005

letter head

August 5, 2002

Safe Community Disposal of Needles and Other Sharps

Dear Colleague:

We are asking for your help in addressing 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. We hope you will join our effort to educate the American public about this issue and effective alternative solutions to discarding used sharps into the solid waste system.

At least 3 billion injections occur yearly outside of health care settings. About 2 billion of these injections are administered by people with diabetes and patients receiving home health care. Approximately 1 billion are attributed to injection drug users (IDUs) using illicit drugs like heroin and cocaine. Most of the needles used for these injections end up discarded in household trash and community solid waste, putting workers and the public at risk of needle stick injuries and potentially fatal infections.

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 non-occupational risks, problems that can arise from unsafely discarded used sharps include needle stick injuries and potentially fatal blood borne infections, such as HIV, the virus that causes AIDS, and hepatitis B and C. To prevent such injuries outside of health care facilities, disposal methods for used needles and other sharps need to be dramatically improved and the public educated on the problem and effective solutions.

Unfortunately, options for safe syringe and needle disposal in the community are often limited and poorly understood. Laws and regulations governing medical waste (including needles and other sharps) were primarily designed for health care 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 (e.g., 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 IDUs, the criminal penalties for syringe possession are strong disincentives to safe disposal of their potentially infectious used syringes and needles. Many IDUs are unwilling to participate in safe disposal by keeping used syringes and taking them to disposal sites because of the real risk of arrest for possession of drug paraphernalia.

Dramatic reduction (and ideally complete elimination) of needles and other sharps from community solid waste would be the most effective approach to protect workers. Practical solutions are needed to eliminate needles from the community solid waste. While these solutions are being developed, there is a critical need for safe disposal guidelines for people who continue to deposit used sharps in solid waste.

To help address this public health problem, a meeting called Safe Community Syringe Disposal: Understanding the Barriers and Creating Solutions was held in Washington, D.C. in January 2001. This meeting brought together key representatives from professional associations, industry, government, and public health.

Based upon data presented and discussions at that meeting, the participants issued the following statement regarding the safe disposal of used syringes, needles, and other sharps in the community:

In the community, improperly disposed used sharps pose a public health hazard to both workers and the public. While this complex problem requires national leadership, successful solutions must be focused at the state, local and community levels. Collaborative efforts involving national, state, and local governments, the solid waste industry, labor organizations, syringe and pharmaceutical manufacturers, pharmacies and pharmaceutical distributors, and health associations are needed to identify, develop, and implement strategies to ensure safe disposal of used sharps in the community. Ideally, these strategies should reduce or eliminate sharps in solid waste, should be low-cost and convenient for the public, and should be easily implemented in the community.

We encourage organizations and state leaders in these fields to convene state and local governments, the solid waste industry, syringe and pharmaceutical manufacturers, pharmacies and pharmaceutical distributors, health associations, and other interested parties to review and improve the current options for safe disposal of used sharps generated in the community by patients and IDUs and to plan public education efforts on safe disposal. These reviews could include:

  • estimating the incidence, outside of health care facilities, of needle stick injuries to workers and the public;
  • determining the current practices, outside of health care settings, for disposal of used syringes and other sharps generated by patients and IDUs;
  • describing existing community sharps disposal programs and their potential for expansion and/or modification;
  • examining local and state regulations and legislation to determine if amendments will improve safe community disposal of used syringes and other sharps;
  • making recommendations about community syringe disposal programs for the state or locality; and
  • developing ways to educate the public about this issue and the recommended improvements.

The goal of these efforts is to create practical systems in the community for safe disposal of used needles and other sharps by patients and IDUs. We invite you to join us by raising awareness of this growing public health problem among your constituency, helping to design needle disposal programs that best suit your community, and advocating at a state and local level to have these systems incorporated into public policy.

The Coalition for Safe Community Needle Disposal is a newly-created, nonprofit 501(c)3 organization dedicated to

addressing the problem of limited options available for disposal of used needles and other sharps in the community. Start-up funding was provided by The Waste Management Charitable Foundation, Inc., and BD (Becton, Dickinson and Company) (NYSE: BDX). The six organizations who are signatories of this letter form the Coalition’s advisory council and will contribute guidance and expertise to assist the organization in its critical mission. The Coalition can provide extensive resources to help community and state efforts to develop programs for safe disposal of used needles and other sharps. For more information or to join, please contact the Coalition at 713-980-3120 (toll-free 1-800-643-1643) or visit the website, to a Non-CDC Link


Kathy Berkowitz, RNC, FNP, CDE
American Association of Diabetes Educators

Martha M. Funnell, MS, RN, CDE
President of Health Care and Education
American Diabetes Association

Michael D. Maves, MD, MBA
Executive Vice President
American Medical Association

John A. Gans, PharmD
Executive Vice President & CEO
American Pharmaceutical Association

George E. Hardy, Jr., MD, MPH
Executive Director
Association of State and Territorial Health Officials

Julie M. Scofield
Executive Director
National Alliance of State and Territorial AIDS Directors

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