{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T01:58:15Z","timestamp":1787882295448,"version":"build-2784847793"},"reference-count":36,"publisher":"SAGE Publications","issue":"4","license":[{"start":{"date-parts":[[2015,12,7]],"date-time":"2015-12-07T00:00:00Z","timestamp":1449446400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Nurs Ethics"],"published-print":{"date-parts":[[2017,6]]},"abstract":"<jats:p>The authors examine the nursing practice of disposing unaltered controlled substances into public water systems as an issue for nurses concerned with the environmental harm it can cause. A summary of the history of controlled substance management reveals inconsistencies in the interpretation of current regulations that have led to disposal policies that vary by institution, according to a benchmarking survey of regional hospitals. Much attention has been given to the phenomenon of conscientious objection in the context of patient care that conflicts with a nurse\u2019s moral integrity. Nurses who are compelled to dispose narcotics down drains may also face this struggle. The authors submit that this disposal method is based on a type of double effect logic where preventing diversion is viewed as a good effect of flushing unused controlled substances that outweighs any harm it may cause, though there is little evidence to support this conclusion. Consequently, the topic deserves further study so that nurse managers and administrators can support and offer alternatives to nurses who object to flushing drugs down the drain.<\/jats:p>","DOI":"10.1177\/0969733015614882","type":"journal-article","created":{"date-parts":[[2015,12,8]],"date-time":"2015-12-08T20:03:47Z","timestamp":1449605027000},"page":"452-461","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":7,"title":["Drugs down the drain: When nurses object"],"prefix":"10.1177","volume":"24","author":[{"given":"Camille","family":"King","sequence":"first","affiliation":[{"name":"Longmont United Hospital, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ann","family":"McCue","sequence":"additional","affiliation":[{"name":"Denver School of Nursing, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2015,12,7]]},"reference":[{"key":"bibr1-0969733015614882","volume-title":"Environmental health: action needed to sustain agencies\u2019 collaboration on pharmaceuticals in drinking water","year":"2011"},{"key":"bibr2-0969733015614882","unstructured":"Drug Enforcement Administration (DEA). Mission, 2015, http:\/\/www.dea.gov\/about\/mission.shtml (accessed 16 May 2015)."},{"key":"bibr3-0969733015614882","volume-title":"Code of ethics for nurses with interpretive statements","author":"American Nurses Association (ANA)","year":"2015"},{"key":"bibr4-0969733015614882","unstructured":"Food and Drug Administration (FDA). Medication disposal: questions and answers, 2015, http:\/\/www.fda.gov\/Drugs\/ResourcesForYou\/Consumers\/BuyingUsingMedicineSafely\/EnsuringSafeUseofMedicine\/SafeDisposalofMedicines\/ucm186188.htm (accessed 13 May 2015)."},{"key":"bibr5-0969733015614882","unstructured":"Environmental Protection Agency (EPA). How to dispose of medicines properly, 2015, http:\/\/water.epa.gov\/scitech\/swguidance\/ppcp\/upload\/ppcpflyer.pdf (accessed 7 September 2015)."},{"key":"bibr6-0969733015614882","unstructured":"Environmental Protection Agency (EPA). Pharmaceuticals and personal care products, 2015, http:\/\/www.epa.gov\/ppcp\/faq.html (accessed 14 June 2015)."},{"key":"bibr7-0969733015614882","unstructured":"The Chinese Exclusion Treaty of 1880 and the Chinese Exclusion Act of 1882, 2014, http:\/\/www.digitalhistory.uh.edu\/disp_textbook.cfm?smtID=3&psid=1099 (accessed 14 June 2015)."},{"key":"bibr8-0969733015614882","unstructured":"The Pure Food and Drug Act of 1906, Pub. L. No. 59-384, 34 Stat. 768 (Repealed in 1938 BY 21 U.S.C. Sec 329 (a)), 2015, http:\/\/www.fda.gov\/RegulatoryInformation\/Legislation\/ucm148690.htm (accessed 14 June 2015)."},{"key":"bibr9-0969733015614882","unstructured":"Federal Water Pollution Control Act (Clean Water Act) of 1948. Pub. L. No. 845, 62 Stat. 1155, 30 6 1948, http:\/\/www.fws.gov\/laws\/lawsdigest\/FWATRPO.HTML (accessed 10 April 2015)."},{"key":"bibr10-0969733015614882","unstructured":"Wisman P. 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Water issues worry Americans most, global warming least, 28 3 2011, http:\/\/www.gallup.com\/poll\/146810\/water-issues-worry-americans-global-warming-least.aspx (accessed 17 May 2015)."},{"key":"bibr15-0969733015614882","unstructured":"The Secure and Responsible Drug Disposal Act of 2010, Pub. L. No. 111-273, 12 10 2010, http:\/\/www.deadiversion.usdoj.gov\/drug_disposal\/non_registrant\/s_3397.pdf (accessed 3 May 2015)."},{"key":"bibr16-0969733015614882","unstructured":"Department of Justice, Drug Enforcement Administration. Disposal of controlled substances: final rule. Federal Register, 9 9 2014, vol. 79, no. 174, 53520\u201353570, http:\/\/www.gpo.gov\/fdsys\/pkg\/FR-2014-09-09\/pdf\/2014-20926.pdf (accessed 15 March 2015)."},{"key":"bibr17-0969733015614882","unstructured":"Rannazzisi JT. 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