Environmental Hazards of disposal of pharmaceuticals – health floats Carol A. Rayfield, Ph.D....

Environmental Hazards of disposalof pharmaceuticals – health floats

Carol A. Rayfield, Ph.D. studentWalden UniversityPUBH- 8165-3Instructor: Dr. Jeff WuSummer term, 2009

Environmental Hazards of disposalof pharmaceuticals – health floats

• Audience: Medical Surgical Nurses Meeting• Educational Outcomes: • Develop awareness of disposal practices of patient medications

within an acute care facility in the Las Vegas, Nevada community.• Educate registered nurses and the public regarding disposal issues

impacting the aquatic environment for the community of Las Vegas, Nevada.

• Stimulate discussion concerning developing a medication disposal site within the acute care facility.

• Develop awareness of the Safe Drug Disposal Act – 2009• Advocate the Chapter of Medical Surgical Nursing support the Safe

Drug Disposal Act.

Environmental Hazards of disposal of pharmaceuticals

Lifecycle of a

Medication

Purchasing

Distribution Prescription

Marketing

Production

Medication


• Individual responsibility & accountability concerning medication administration

• Associated cost issues • Change in medication• Change in dosage• Gastrointestinal disturbance• Adverse reactions• Showering and bathing


• Three Regulations to Protect Water

• Clean Water Act 1972

• Safe Drinking Water Act 1974 & 1996

• Resource Conservation & Recovery Act 1976


• 1999 & 2000 researchers from the U. S. Geological Survey found 80% of 139 streams contaminated with 82 out of 95 contaminants in the United States.

• Primary Contaminants – Coprostanol (indicator of fecal residue), Cholesterol, N-N Diethyltoluamide (DET), Caffeine, Tri(2-chloroethyl) phosphate (flame retardant), Triclosan (antibacterial & antifungal agent)


ClandestineDrug

Operations

Healthcare Facilities

Physician& Dentist PracticesVeterinarian

Offices

Military Bases

AgriculturalEnterprises

Educational Institutions

Correctional Institutions

WaterEnvironment

Contributors of Active Pharmaceutical Ingredients (API’s)

Environmental Hazards of disposal of pharmaceuticals- Methods of detection

Antibiotics

Steroids &

Hormones

Lipid regulators

Beta Blockers

AntidepressantsAntiepilepticsTranquilizers

AntiInflammatory /

Analgesics

Pharmaceuticals In

Environment

Environmental Hazards of disposal of pharmaceuticals – IMS National Sales Perspectives 2008

Rank

Prescription Market – U.S. 2008

2007

2006

2005

1 Antipsychotics 14.6 13.1 11.7 10.5

2 Lipid regulators 14.5 16.4 19.9 18.3

3 Proton pump inhibitors 13.9 14.2 13.7 13.0

4 Seizure disorders 11.3 10.2 8.9 8.0

5 Anti-depressants 9.6 9.4 10.7 10.3

6 Angiotensin II antagonists 7.5 6.6 5.8 5.1

7 Antineo Monoclonal Antibodies

7.5 6.8 5.8 4.0

8 Erythropoietins 7.2 8.7 10.1 8.7

9 Anti arthritics, Biological response modifiers

6.0 5.3 4.4 3.7

10 Anti-platelets - oral 5.3 4.5 4.2 3.8

Environmental Hazards of disposal of pharmaceuticals – Treatment Process for Las Vegas, Nevada

Several steps occur during the water treatment process:

Screenings, grit removal, primary sedimentation basins,

Trickling filters, secondary sedimentation basins, activated

sludge, biological nutrient removal, filtration facility,

disinfection, solids, and reuse.

Environmental Hazards of disposal of pharmaceuticals – Impediments to Drug Recycle

• Drug Control Agencies (1960) Bureau of Drug Abuse Control & Federal Bureau of Narcotics

• Drug Enforcement Administration, Department of Justice (July 10th 1973) – Controls Narcotic & Psychotropic Drugs - Regulatory Barrier

• Does not permit return of controlled substances to any pharmacy, physician, or drug manufacturer

• Agency does not work with other governmental agencies concerning waste or disposal issues concerning prescribed medications.

• The Safe Drug Disposal Act - 2009


• The Code of Federal Regulations (CFR) Sections 1308.11 to1308.15 breaks the schedules down based on their abuse potential, utility of medical treatment, and safety when used under medical supervision

• Schedule I is the most restrictive level, includes drugs or other substances with a high potential for abuse, no currently accepted medical use in theUnited States, and a low level of safety. Drugs and other substances in Schedule I are not approved for use, distribution, manufacture, or importation.

Examples include heroin, marijuana, and phencyclidine (PCP).


• Schedule II Pharmaceuticals• Schedule II drugs have high abuse potential but have currently

accepted medical use in treatment, though with severe restrictions.

Examples include methamphetamine, amphetamines (Adderall®), morphine, oxycodone, (OxyContin®), and methylphenidate (Ritalin®).


• Schedule III drugs have abuse potential less than that of Schedule I or II drugs and have currently accepted medical uses in treatment. Some drugs in this category include hydrocodone (Vicodin®) and butalbital (Fiorinal®).

• Schedule IV drugs have lower abuse potential than those in Schedule III and currently have accepted medical uses in treatment. These includes alprazolam (Xanax®), diazepam (Valium®), and propoxyphene (Darvon®).

• Schedule V drugs have low abuse potential and recognized medical uses.

Examples include cough medicines with codeine (Robitussin AC®).

Environmental Hazards of disposal of pharmaceuticals –Drug Recycle Programs

• 2000 - Six States with drug recycling programs

• Colorado• Florida• Kentucky• Minnesota• Nebraska• Wisconsin

Environmental Hazards of disposal of pharmaceuticals – Situation in Las Vegas

• No identifiable resources for drug disposal• Retail pharmacies will take back medication if

requested – although not advertised • Health care institutions dispose of medications in

sharp containers to be incinerated as a biohazardous material

• Recommendation for Nevada solid waste managers monitor emerging information on environmental impacts of pharmaceutical wastes and development programs

Environmental Hazards of disposal of pharmaceuticals – Teleosis Institute

• Goal – Zero pharmaceutical waste in the environment• Advocate of Green Pharmacy Program • Concerned with which drugs have the highest eco-

toxicity• Provides leadership in green healthcare: A course in

sustainable medicine• http://www.teleosis.org/ghcp.php• US National Registry for Unused or Expired Medications

http://www.iisgcp.org/UnwantedMeds/toolkit/3.2bV1(participant%20survey).pdf


• Consideration of Pharmaceutical Waste• Unused medications – various types• Unused pre-filled syringes – any syringe with

epinephrine is considered a hazardous waste product• Unfinished medications• Patient prescriptions• IV fluids


• Water – natural & vital resource – although not a • non-limited resource• Amount impacted by climate change & population

migration• Water contamination impacted by :• Surface runoffs • waste both solid, liquid, pharmaceutical components, • herbicides, pesticides• Individual and community practices


ReferencesAgee, L., J. (1975). Protecting America’s drinking water : Our responsibilities under the Safe Drinking Water Act.

Retrieved July 6, 2009, from http://www.epa.gov/history/topics/sdwa/07.htmAssociated Press - Fox News. Study finds traces of drugs in drinking water in 24 major U.S. regions. (2008). Retrieved

July1, 2009, from http://www.foxnews.com/story/0,2933,336286,00.htmlBerry, J. (2008). The state of medicine recycling. Retrieved July 5, 2009, from

http://earth911.com/blog/2008/10/06/the-state-of-medicine-recycling/City of Las Vegas, Water pollution control facility1-12. Retrieved June 27, 2009, from

http://www.lasvegasnevada.gov/files/BRO-WPCF_04.pdfCity of Henderson (2009). Water quality report. Retrieved June 30, 2009, from

http://www.cityofhenderson.com/utility_services/docs/2009_wqr_eBook/flash.html#/6/Code of Federal Regulations (2009). Part 1308 – Schedules of controlled substances. Retrieved July 6, 2009, from

http://frwebgate4.access.gpo.gov/cgi-bin/PDFgate.cgi?WAISdocID=175209326856+2+2+0&WAISaction=retrieveConerly, O. (2008). Approaches to screening for risk from pharmaceuticals in drinking water and prioritization for further

evaluation. Health and Environmental Criteria Division. Office of Water, Environmental Protection Agency. 1-16. Retrieved July 1, 2009, fromhttp://dels.nas.edu/best/risk_analysis/Documents/EPA%20Pharmaceuticals%20in%20water%20whit%20paper.pdf

Daughton, C. G., & Ternes, T. A. (1999). Pharmaceuticals and personal care products in the environment: Agents of subtle change? Environmental Health Perspectives, 197 (6), 907 – 938. Retrieved July 3, 2009, from http://www.ehponline.org/members/1999/suppl-6/907938daughton/daughton-full.html


References

Daughton, C. G., & Ruhoy, I., S. (2008). The afterlife of drugs and the role of pharmecovigilance. Drug Safety, 31(12), 1069-1082. Retrieved July 6, 2009, from http://web.ebscohost.com.ezp.waldenulibrary.org/ehost/pdf?vid=6&hid=9&sid=dd701b22-3ef3-4837-b32b-1f080478c84c%40sessionmgr2 Academic Search Premier database, Walden University

Hubbard, L., M. (2007). Analysis of Oregon stakeholder drug take back public policy process to reduce

pharmaceutical pollution in Oregon’s water resources. Retrieved, July 1, 2009, from http://ir.library.oregonstate.edu/jspui/bitstream/1957/6192/1/Hubbard_thesis.pdf

Johnson, M, D., & Mendenhall, D. L. (2005). Environmental division bets big on the flexible worker concept. Proceedings of the Water Environment Federation, 1 (10), 1011-1017, Retrieved July, 5, 2009, from http://www.wef.org/NR/rdonlyres/D8CD7507-D909-45DB-A6BB-4C6DD596B99C/0/CityofLasVegasEnvironmentalDivisionBetsBigontheFlexibleWorkerConceptWEFTEC05.pdf

Kennedy, J. & Christopher, E. (2002). Prescription noncompliance due to cost among adults with disabilities in the United States. American Journal of Public Health, 92 (7), 1120-1124. Retrieved from, http://web.ebscohost.com.ezp.waldenulibrary.org/ehost/pdf?vid=8&hid=9&sid=4e7fd92a-eee8-4ed7-b2f5-8ff760b475c7%40sessionmgr7, Academic Search Premier, database.

Kolpin, D. W., Furlong, E.. T., Meyer, M, T., Thurman, E., M., Zaugg, S. D., Barber, L. B., & Buxton, H. T. (2002). Environmental Science Technology, 36 (6). 1202-1211. Retrieved July 7, 2009, from

http://ace.orst.edu/info/tox513/PDF_files/2005/Pharmaceuticals%20in%20us%20waters%20(USGS)%202002.pdf

Kuehn, B. M. (2008). States try medication recycling programs. Journal of American Medical Association, 300(1), 28. Retrieved July 8, 2009, from http://jama.ama-assn.org.ezp.waldenulibrary.org/cgi/reprint/300/1/28, Journal of American Medical Association database, Walden University


ReferencesKuehn, B. M. (2008). Traces of drugs found in drinking water: Health effects unknown, safer disposal urged. Journal of

American Medical Association, 299(17), 2011-2013. Retrieved July 8, 2009, from http://jama.ama-assn.org.ezp.waldenulibrary.org/cgi/reprint/299/17/2011, Journal of American Medical Association database, Walden University

Kuehn, B. M. (2007). Drug disposal. Journal of American Medical Association, 297(12), 1307. Retrieved July 8, 2009, from http://jama.ama-assn.org.ezp.waldenulibrary.org/cgi/reprint/297/12/1307-a, Journal of American Medical Association database, Walden University

Lange, R. & Dietrich, D. (2002). Environmental risk assessment of pharmaceutical drug substances – conceptual considerations. 97-104. Retrieved July 1, 2009, from http://www.ub.uni-konstanz.de/kops/volltexte/2008/4982/pdf/Environmental_risk_assessment_of_pharmaceutical_drug_substances.pdf

Las Vegas Wash Coordination Committee(2008). Images Retrieved July 8, 2009, from Las Vegas Wash Coordination Committee Website (2008). http://www.lvwash.org/html/

Major water sources positive for pharmaceuticals. Retrieved July 8, 2009, from Google Images. http://www.msnbc.msn.com/id/23563705/

Moeller, D. W. (2005). Drinking water. In Environmental Health (pp. 158-187). Harvard University Press, Cambridge, Massachusetts.

Mireles, C., M. (2007). Unused and expired medicines: A national pandemic. The Journal of Ecologically Sustainable Medicine. 40-42. Retreived, July 8, 2009, from http://www.teleosis.org/pdf/symbiosis/UEM4.2.pdf

National Academy of Sciences. Global Health and Education Foundation. (2008). Safe drinking water is essential. Retrieved, July 1, 2009, from http://www.drinking-water.org/flash/en/water.html?_1_00_00

National Conference of State Legislatures. (2009). 2008 prescription drug statelegislation. Retrieved, July 6, 2009, from http://www.ncsl.org/Default.aspx?TabId=14418

Nikolaou, A., Meric, S., & Fatta, D. (2007). Occurrence patterns of pharmaceuticals in water and wastewater environments. Analytical and Bioanalytical Chemistry. 387. 1225-1234. Retrieved July 7, 2009, from http://web.ebscohost.com.ezp.waldenulibrary.org/ehost/pdf?vid=7&hid=9&sid=f2a3032c-811e-43d6-9497-ccf856ec4240%40sessionmgr8, Academic Search Premier database, Walden University


ReferencesOpen Congress. (2009). Text of H.R. 1191as introduced in house. Safe drug disposal act of 2009. Retrieved, July 6,

2009 from http://www.opencongress.org/bill/111-h1191/textSouthern Nevada Watery Authority. (2009). Water quality report. 1-2. Retrieved June 28, 2009, from

http://www.snwa.com/assets/pdf/wq_report_snws.pdfSouthern Nevada Water Authority. (2008). Water Quality. Image Retrieved June, 28, 2009, from

http://www.snwa.com/html/wq_treatment_facilities.htmlState of Nevada, Nevada Division of Environmental Protection, Bureau of Waste Management. 2007 Solid waste

management plan. 1-3. Retrieved July 6, 2009, from http://ndep.nv.gov/bvm/swmp/swp10.htmBoston University, Sloan Epidemiology Center. Slone Survey (2005). Patterns of medication use in the United States,

2005. 1-22. Retrieved July 2, 2009, from http://as111.http.sasm3.net/slone/SloneSurvey/AnnualRpt/SloneSurveyWebReport2005.pdf

Strom, S. (2005). Old pills finding new medicine cabinets. New York Times, Retrieved, July 2, 2009, from http://alamaro.home.comcast.net/~alamaro/New_York_Times_May_18_2005.htm

Synder, S. A., Westerhoff, P., Yoon, Y., & Sedlak, D. L. (2003). Pharmaceuticals, personal careproducts, and endocrine disruptors in water: Implications for the water industry. EnvironmentalEngineering Science, 20 (5), 449 – 469. Retrieved June 30, 2009, from Academic Search Premier database, Walden University

Teleosis Institute Health professionals in service of the global environment. (2009). The green pharmacy program. Retrieved, June 29, 2009, from http://www.teleosis.org/gpp-program.php

USA Today(2008). Associated Press. Cities rarely release water test results. 1-7. Retrieved July 8, 2009, from http://www.usatoday.com/news/nation/2008-03-10-cities-water_N.htm


References

United States Department of Health and Human Services. Food and Drug Administration, Consumer health information. How to dispose of unused medicines. (2008). Retrieved July 2, 2009, from http://www.fda.gov/downloads/Drugs/ResourcesForYou/Consumers/BuyingUsingMedicineSafely/UnderstandingOver-the-CounterMedicines/ucm107163.pdf

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United States, Intercontinental Marketing Services. (2006). Global pharmaceutical sales by region, 2005. Retrieved July 5, 2009, from http://www.imshealth.com/imshealth/Global/Content/StaticFile/Top_Line_Data/Global_Pharmaceutical_Sales_by_Region_2005.pdf

United States, Intercontinental Marketing Services. (2006). Global pharmaceutical sales by region, 2006. Retrieved July 5, 2009, from http://www.imshealth.com/imshealth/Global/Content/StaticFile/Top_Line_Data/Global%20Pharmaceutical%20Sales%20by%20Region%202006.pdf

United States, Intercontinental Marketing Services. (2006). Top therapeutic classes by U.S. sales. Retrieved July 5, 2009, from http://www.imshealth.com/deployedfiles/imshealth/Global/Content/StaticFile/Top_Line_Data/2008_Top_Therapy_Classes_by_U.S._Sales.pdf

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