Needling Change

An unexpected encounter with a used syringe, needle or other sharp object at a collection site, transfer station or landfill can provoke intense fears of life-threatening infections. If an injury involves a needle, costs can be significant. Unfortunately, options for safe disposal often are limited and poorly understood. Therefore, in June, the Coalition for Safe Community Needle Disposal met in Washington, D.C., to resolve this serious healthcare issue.

The problem begins with the generator community but trickles down to the waste industry because needles are used by self-injectors and individuals with diabetes, allergies or other diseases, then are placed into the municipal solid waste (MSW) stream. Although needle injuries at collection sites, transfer stations and landfills are low, a dramatic reduction or complete elimination of needles and other sharps from MSW is the most effective approach to protect workers.

Every year, self-injectors use more than 2 billion needles and syringes. Home healthcare also is a rapidly increasing source of used needles. Illicit drug users, who annually make about 1 billion injections, add to the waste stream.

Used needles can transmit bloodborne pathogens, such as the viruses that cause hepatitis B and C and AIDS. Despite potential injuries, there are no federal regulations for safe needle disposal at nontraditional healthcare settings because they fall outside the regulated medical waste definition, are not considered infectious or enforcement is viewed as impractical. Some state and local governments have developed disposal guidelines, laws and regulations, but many are ineffective or confusing to self-injectors. Often, self-injectors avoid safe disposal to protect their privacy or to avoid syringe and drug paraphernalia laws. Also, safe disposal can be costly.

The nonprofit coalition was formed following a January 2001 meeting held at the American Pharmaceutical Association, Washington, D.C., where 30 attendees from organizations discussed the public health implications of unsafe disposal. The coalition states that needle disposal programs must include:

  • Affordable options at all income levels;

  • Available tools for safe disposal. For example, devices and containers should be widely accessible over the counter;

  • Convenient disposal so that self-injectors can discard needles with little effort, time and travel;

  • Confidentiality that allows self-injectors to dispose of needles privately;

  • A distinct way to dispose of needles as a separate waste stream;

  • Full compliance with the Occupational Safety and Health Administration's (OSHA) requirements;

  • Well-publicized disposal information that is available to doctors, educators, nurses, pharmacists, drug counselors and others in contact with self-injectors;

  • Inclusive solutions that address self-injectors' needs; and

  • Community endorsement, showing support at all levels.

To ensure that such programs exist, the coalition first will garner support from stakeholders, such as state agencies, trade associations and healthcare groups. Fundraising will be an ongoing component, particularly because the coalition's goals are long-term. Comprehensive data collection will be necessary through studies that accomplish the following:

  • Estimate needlestick injury incidences outside of healthcare facilities. OSHA's new 300-log report will help to provide some of this information;

  • Determine current practices for used syringes and other sharps disposal outside of healthcare settings;

  • Describe community sharps disposal programs and their potential for expansion and modification;

  • Examine state and local regulations and legislation, and determine which amendments will improve or expand safe disposal practices; and

  • Educate the public about needle disposal issues and the recommended improvements.

Call the coalition toll-free at (800) 643-1643 or visit

Alice Jacobsohn is NSWMA's public affairs and industry research director. E-mail: