How You and Policy Makers Can Make a Difference

Call to Action!

The external hazards that certain cytotoxic cancer drugs pose to patients, their families and the general environment, have existed since the introduction of chemotherapy over half a century ago.  Public policy makers have just recently begun to address the problem which is expected to grow as more and more individuals receive cancer therapies, on an out-patient basis, whereby patients return to their homes shortly after treatment. 

The crux of the problem is that life-saving but highly toxic chemotherapy drugs can have side effects that extend well beyond loss of hair and nausea. Chemotherapy drugs can actually cause cancer – as well as birth defects and miscarriages - in others.   Health care providers and family members can be at risk if they are exposed to still active drugs present in patient bodily secretions, such as urine, feces, vomit saliva and sweat. Because of such risks, hospitals have strict protocols to prevent employees’ accidental exposure to chemotherapy drugs.  Although there are no formal protocols required for patients and families in the home setting, the American Cancer Society has published a long list of recommended personal hygiene precautions for chemo patients and their families.  

They did this because the recognized danger of casual human exposure to chemotherapy drugs for the days following treatment is so significant.  Children and fetuses, with their many fast-growing cells, are especially susceptible to damage.   Unfortunately, the ACS recommendations also tell patients to flush twice after going to the bathroom, missing the point that disposal of human wastes containing still-active highly toxic chemicals poses an additional threat to water supplies and the greater environment. There is a growing body of scientific evidence showing that toxic chemotherapy drugs are entering public and private water supplies still intact, threatening humans and wildlife. A United States Geological Survey (USGS) study of ponds on Cape Cod, Massachusetts, concluded through DNA testing that chemotherapy drugs were most likely a cause of high level (>50%) of fish had cancer in the surveyed ponds. A Barnstable County (Cape Cod) study ) identified chemotherapy drugs in the water supply to be a priority issue, with chemo drugs designated as “Contaminants of Emerging Concern,” or CECs.  
The issue of chemotherapy drugs as it relates to human and environmental attention is gaining attention from and traction with governmental agencies ranging from local authorities up to the US Environmental Protection Agency (EPA). Environmental enforcement agencies would do well to be concerned, even alarmed: memorandums for Rhode Island (link to Memorandum Chemo drugs RI Law) and Massachusetts (link to Memorandum Chemo drugs MA Law) produced by Adler Pollock and Sheehan P.C., Rhode Island’s most respected environmental law firm, concluded that discharge of wastes tainted with cytotoxic (chemotherapy) drugs violates both the “letter and spirit” of strict Groundwater Protection Act and Groundwater Rules. A reasonable inference can be made that casual discharge of human wastes containing cytotoxic drugs also violates the letter and spirit of many state and local clean water and environmental laws and regulations.

Legislative Activity

In the effort to educate providers and patients about the personal and greater environmental hazards of chemotherapy involved with patient human wastes, and to provide a practical, achievable, affordable solution to the practice of discharging toxic chemotherapy drugs into the waste stream and water supplies, Massachusetts and Rhode Island have taken the lead. 

In both states, legislators introduced bills during 2012 to address the chemotherapy waste issue (Massachusetts Senate 1089, Rhode Island Senate 2640). Essentially, the MA and RI bills are similar: both would require providers to inform patients about the post-treatment hazards of chemotherapy drugs in their personal home and work environment, including exposure of household members to human wastes for a defined period after treatment; both would require relevant agencies to produce and publish a list of affected drugs; both would require providers to supply patients with a means to collect and safely dispose of human waste for a defined time after treatment; and both would require public and private health insurance payers to cover waste collection supplies and disposal fully as a part of the chemotherapy treatment.

At the end of the Rhode Island legislative session, the Assembly substituted a new draft (2460 Substitute A) for the original bill. This legislative resolution creates a special legislative committee to study public health threats from pharmaceutical human waste contamination in the Rhode Island Water supply, with a strong focus on chemotherapy drugs. To be chaired by Senator John Tassoni, lead sponsor of Senate 2640, the Special Legislative Commission includes three legislators, the state’s Attorney General, and the Directors of the Departments of Health, Environmental Management, and Human Services. The Commission is tasked with doing a comprehensive study and producing a report and recommendations by March 5, 2013. The report and recommendations will be posted on this site as soon as they become available.
In Massachusetts, Senate 1089 will be refiled when the 2013 – 2014 session commences in January 2013.  Its language will be a redraft of the original bill.

Citizen Action

Citizens in Massachusetts and Rhode Island should call or write their state senators and state representatives urging them to support legislation designed to protect people and keep cytotoxic drugs out of the environment, referring to the bills filed in 2012,  Rhode Island Senate 2640 and Massachusetts Senate 1089. Citizens should also ask their legislators to sponsor these bills as they are refiled in 2013 (this website will announce the new bill numbers once the 2013 legislative sessions commence in January).
Citizens outside of Massachusetts and Rhode Island should contact their local senators and reps and urge them to file legislation similar to what has been offered in MA and RI. To assist we have created two downloadable model bills, a stand-alone law and an amending law as well as an issue fact sheet that you can send to your representatives.
If you want to determine the name and contact info of your state senator and state representative/assemblyman, please clink here.

Legislator Staff Action

Legislators and staff in Massachusetts and Rhode Island can refer to the above section and join in to sponsor and support legislation that will be filed for the 2013 – 2014 session.
Legislators and staff in other states are urged to follow the lead of the two New England states and file legislation appropriate for your locality. Feel free to use the technical language we created for a stand-alone law and an amending law as well as an issue fact sheet if appropriate to create your own legislation. Pharma-Cycle (Link to is available to support your efforts.  Your constituents – including patients, patient families, indeed all who deserve a healthy future and a toxic-free environment – will thank you for your vision and courage.

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