Editor's note: Diana J. Mason is editor-in-chief emeritus of AJN.

Thank you for the article "Leftover Drugs in the Water Supply: Don't Flush Those Pills!" (Environments and Health, August). It's a great example of nurses' activism to protect our environment. But I was left wondering: what happens to these drugs? Are they incinerated or dumped into hazardous waste sites that prevent leaching into groundwater?

I know of one workplace where employees carefully placed paper in the recycling bins, only to discover that the employer didn't pay for recycling and simply dumped the paper with the other garbage. Should part of the process of dealing with leftover drugs be following the disposal process to its end?

Diana J. Mason, PhD, RN, FAAN

New York City

Author Michelle F. Lauer responds: All of the medications collected at our take-back events were disposed of in a hazardous waste incinerator that meets strict safety and environmental guidelines. While this certainly isn't an ideal disposal method (none exists), it's preferable to flushing, and, unfortunately, everything must go somewhere.

Encouraging product stewardship is one way nurses can play an active role in protecting our environment. Another is by helping to reduce the amount of medications prescribed; for example, by educating patients about proper usage and actual need (many people just want a "pill" fix, such as antibiotics for viral infections) and by encouraging prevention and health maintenance. In addition, advanced practice nurses can engage in mindful prescribing practices, including the judicial use of samples and the prescription of small quantities initially, so that adverse effects can be monitored before a larger amount of the drug is prescribed.