[Pharmwaste] Fw: BNA on pharma mtg in vegas

greene.cynthia@epamail.epa.gov greene.cynthia@epamail.epa.gov
Mon, 29 Aug 2005 08:35:12 -0400


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Report on Los Vegas conference




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 No. 166                                                       Page B-1 
 Monday, August 29, 2005                                                
                                                                        
 ISSN 1521-9402                                                         
                                                                        
                                     Conference Report                  
                                                                        
 (Embedded image moved to file: pic09758.gif)                           
                                                                        
 Water Pollution                                                        
 New Approaches Urged to Limit Pollution                                
 From Pharmaceuticals, Other Compounds                                  
                                                                        


                  LAS VEGAS--Reducing pharmaceuticals and other
                  compounds that survive wastewater treatment and enter
                  the nation's streams, rivers, and surface waters will
                  likely require new regulatory approaches, including
                  changes to current hazardous waste laws, researchers
                  and regulators said at a conference Aug. 25.


                  An array of compounds, known as pharmaceuticals and
                  personal care products (PPCPs), are ubiquitous but
                  unregulated pollutants in U.S. waters, Environmental
                  Protection Agency officials said at the "Meeting on
                  Pharmaceuticals in the Environment." The three-day
                  meeting was sponsored by EPA at the agency's Las Vegas
                  laboratory.


                  The compounds began to draw wider interest from U.S.
                  researchers since the late 1990s, reflecting more
                  sensitive methods that detect trace levels of the
                  compounds in water at the parts-per-billion or even
                  parts-per-trillion level.


                  The regulatory and research challenges posed by PPCPs,
                  which include prescription and over-the-counter drugs
                  as well as fragrances, cosmetics, sunscreen,
                  veterinary drugs, and DEET insect repellent were the
                  focus of the conference.


                  Representatives from EPA, the Food and Drug
                  Administration, the Drug Enforcement Agency, the U.S.
                  Geological Survey, and the pharmaceutical industry
                  also outlined various regulatory challenges to
                  reducing the presence of pharmaceuticals and personal
                  care products in the environment.

                                 Recommendations Offered



                  They and other conference participants offered
                  recommendations at the closing session Aug. 25,
                  including:

                        (Embedded image moved to file: pic24221.gif)
                        Changes are needed to the Resource Conservation
                        and Recovery Act, which governs disposal of
                        industrial and bulk chemicals but has also been
                        applied to medical waste in health care
                        settings. Several speakers said Congress should
                        reconsider how provisions meant to ensure the
                        safe disposal of medical waste encourage the
                        flushing of pharmaceutical compounds in toilets
                        and drains for safety reasons. The RCRA
                        requirements, they said, hinder efforts by
                        consumers, hospitals, and other healthcare
                        operations to return unused drugs ultimately to
                        manufacturers or otherwise disposed away from
                        the wastewater stream.


                        (Embedded image moved to file: pic18588.gif)EPA
                        needs to develop regulatory guidance for
                        wastewater treatment plants on best treatment
                        technologies to attack many pharmaceuticals and
                        other compounds before the treated effluent is
                        returned to waterways. Researchers and EPA
                        officials agreed the agency needs to move
                        further along in developing accepted testing
                        methods for PPCPs. EPA's Office of Research and
                        Development has identified PPCPs as an emerging
                        issue and continues to support research on
                        detecting such compounds through its STAR grants
                        program, but agency officials said a coordinated
                        regulatory approach to such unregulated
                        compounds is probably years away, given strained
                        resources.


                        (Embedded image moved to file: pic06422.gif)The
                        Drug Enforcement Administration needs to change
                        current regulations, which bar the collection of
                        many controlled prescription drugs, including
                        painkillers. The "take-back" programs could
                        allow consumers to return unused, expired, or
                        poorly stored pharmaceuticals to manufacturers
                        for safe disposal, akin to the kinds of product
                        stewardship efforts already being run by
                        consumer electronics and other industries.


                        (Embedded image moved to file: pic24946.gif)Food
                        and Drug Administration regulations governing
                        the regulatory review of pharmaceuticals should
                        be revised to include a review of the
                        environmental effects of pharmaceuticals.
                        Currently, FDA does not typically require drug
                        manufacturers to conduct environmental
                        assessments when concentrations of the drug
                        entering the water are expected to fall below 1
                        part per billion.


                        (Embedded image moved to file: pic27506.gif)FDA
                        should also provide guidance that moves
                        consumers and health care professionals away
                        from the practice of flushing pharmaceuticals
                        and toward proper disposal, including
                        incineration, to take the products out of the
                        wastewater stream. The agency also should
                        consider whether certain regulations requiring
                        the safe disposal of pharmaceuticals in nursing
                        homes and other long-term care facilities
                        encourage the wide-scale flushing of such
                        medicines.


                                 Potential Health Effects

                  EPA officials and various researchers said human
                  health effects from a lifetime of consuming low levels
                  of PPCPs in drinking water are unlikely, but they
                  cautioned that such research is in its infancy. The
                  compounds can be pulled into intake systems for public
                  water systems that pull from rivers and other sources
                  that contain treated wastewater.


                  Failed septic tanks and "straight piping" residential
                  systems that pipe waste directly to rivers also
                  contribute to the levels of PPCPs in waters,
                  researchers said.


                  Researchers speaking at the three-day conference said
                  it is not well-understood how the trace levels of such
                  "micro-contaminants," or the interaction of the
                  various compounds, might affect humans or the
                  environment. Traditionally, the epidemiological
                  studies conducted on pollutants during the past few
                  decades have never accounted for potential effects
                  from the additional exposures from such
                  micro-contaminants.


                  Thousands of PPCPs are probably carried into rivers,
                  streams, and surface waters given the thousands of
                  distinct ingredients used in tens of thousands of
                  personal care products and pharmaceuticals, EPA
                  researchers said. Christian Daughton, chief of EPA's
                  environmental chemistry branch at EPA's National
                  Exposure Research Laboratory, said Aug. 23 that
                  detailed research on the effects of such compounds
                  downstream from wastewater plants remains in its
                  infancy.


                  "A lot of the research has grown exponentially in the
                  last five years," Daughton said. But detailed
                  literature is lacking on how trace levels of most of
                  the compounds might affect fish and other organisms.
                  There is "vast literature" on the effects of
                  antibiotics and steroidal hormones on such organisms
                  because those have long been studied, "but primarily
                  for everything else, there is very little that is
                  known," he said.


                  "To give you an idea of the scope of the chemicals
                  involved, we're not just talking about human and
                  veterinary drugs available by prescriptions or over
                  the counter," Daughton said. Other PPCPs of concern
                  include new classes of diagnostic agents used in
                  medicine, fragrances, and inert ingredients used in
                  the formulation of consumer products, Daughton said.

                             Risk From Unregulated Pollutants



                  Daughton said scientists and regulators have focused
                  for the past 40 years on the risks of traditional
                  "priority" pollutants that may be either acutely toxic
                  or carcinogenic. But it is becoming increasingly
                  obvious that those regulated pollutants make up only a
                  small portion of chemicals that may contribute to the
                  overall risks for humans and the environment, Daughton
                  said.


                  Carcinogens and other "archetypal" pollutants
                  currently regulated "are only one piece of the risk
                  puzzle," Daughton said.


                  "What portion of the overall risk is contributed by
                  unregulated pollutants and can that risk be assessed
                  in a truly holistic manner without knowing the actual
                  exposure universe" humans may in fact be exposed to,
                  he said.


                  The known chemical "universe" comprises some 26
                  million organic and inorganic chemicals, and of those,
                  9 million are commercially available worldwide,
                  Daughton said. Of those 9 million, about 250,000 "are
                  inventoried or regulated worldwide," meaning only
                  about 3 percent of commercially available chemicals
                  are substantially tracked or regulated around the
                  globe, he said.

                                   Reducing PPCP Levels



                  Others at the conference said more research was needed
                  to determine the cumulative ecological impacts of
                  PPCPs on fish and other aquatic organisms. Of
                  particular interest among the PPCP class of compounds
                  are chemicals known to disrupt or alter sexual
                  development in animals, as well as various plant and
                  animal steroids that can affect hormonal development.


                  Charlotte Smith, president of PharmEcology Associates,
                  which assists healthcare facilities in reducing and
                  managing pharmaceutical waste, said Aug. 24 that EPA
                  in particular needs to focus more attention on
                  encouraging the development of pharmaceutical
                  "take-back" programs that allow consumers to return
                  unused drugs to the manufacturer or other entity for
                  proper disposal.


                  Today, most consumers and even many health care
                  workers simply place such drugs in household trash,
                  where they are ultimately sent to landfills, Smith
                  said. Those compounds ultimately drain from the
                  landfills and join other compounds in the "leachate"
                  liquid that drains from trash to the bottom of
                  landfills, and some of the liquid goes either into
                  wastewater treatment or can leach into wells located
                  near the landfill, other researchers said.


                  Other consumers may dispose such pharmaceuticals in
                  sinks or toilets in an effort to protect them from
                  falling in the hands of children or harming others,
                  researchers said.


                  "The resources need to be committed for this effort
                  from all aspects of EPA," Smith said. "We need the
                  offices of water, solid waste; all these offices need
                  to be involved," she said.


                  The array of changes needed to clear the way for
                  large-scale take-back programs led much of the
                  discussion among researchers, industry
                  representatives, and other conference participants who
                  broke into small groups on Aug. 24 to recommend policy
                  changes.


                  Jan Baxter, an EPA Region 9 official, said at the
                  conclusion of the conference Aug. 25 that most
                  participants from her group "viewed take-back
                  [efforts] as the most promising approach" to reduce
                  levels of pharmaceuticals entering public sewers and
                  wastewater treatment plants.


                  The preferable approach would allow consumers to
                  return unused pharmaceuticals to pharmacies, Baxter
                  said.

                              Barriers to Take-Back Efforts



                  Vickie Seeger, of the Drug Enforcement
                  Administration's Office of Diversion Control, said
                  Aug. 24 that DEA regulations likely discourage such
                  take-back programs. Under the Controlled Substances
                  Act of 1970, DEA largely prevents the transfer and
                  thus potential misuse of many "controlled"
                  prescription drugs ranging from oxycontin and morphine
                  to steroids, Seeger said.


                  "The DEA can't allow you to take your drugs back just
                  anywhere," she said, and current DEA regulations would
                  prevent the collection and disposal of controlled
                  substances at community-sponsored collection sites
                  similar to those offered for hazardous waste, she
                  said. To comply with current law, such collections
                  would require the presence of law enforcement
                  officials to take possession and maintain precise
                  records of the volume and type of each controlled
                  substance returned, she said.


                  "It's not that we don't want take-back [efforts],
                  we're not completely against it," Seeger said. "But we
                  don't have a regulatory system" that allows for
                  consumers to participate in such efforts, she said.


                  Al Alwan, an EPA official from Region 5, also led a
                  small group of other participants in a discussion on
                  possible policy recommendations. He said Aug. 25 that
                  any policy changes at EPA, including more regulatory
                  interest in PPCPs, will take time, given that research
                  on the health effects from exposure to the trace
                  compounds is in its earliest stages.


                  The low levels of contaminants detected suggests EPA
                  should take a cautious approach on regulatory action
                  until more research is conducted and the agency and
                  other researchers develop agreed-upon monitoring and
                  detection methods, he said.


                  "This is a long-term [issue] not an emergency issue"
                  for EPA regulators, Alwan said. Researchers do not
                  currently have a range of tools for measuring the
                  impacts from exposure to such trace levels of
                  compounds over a lifetime for humans or for organisms
                  in the environment, he said.


                  Alwan, who also led a smaller group of participants in
                  a policy discussion Aug. 24, said his group agreed
                  that the lack of an EPA-approved chemistry method to
                  address such chemicals is a major obstacle to
                  conducting research that can be compared from lab to
                  lab.


                  Alwan said the agency also needs to work with
                  wastewater treatment operations, pharmaceutical
                  manufacturers, and other groups to begin conducting
                  monitoring of the compounds to determine the universe
                  of PCCPs that may exist in various downstream areas.


                  "For monitoring, we [at EPA] really don't monitor
                  these new chemicals. We basically monitor the
                  chemicals that are regulated and really the states are
                  doing most of that monitoring" of specific listed
                  contaminants that may affect water quality, he said.

                          Reducing Disposal Routes in Wastewater



                  Researchers at the conference said, however, that
                  there were several issues regarding the compounds
                  about which there is general agreement, including the
                  source of most of the pharmaceuticals.


                  The disposal of over-the-counter and prescription
                  drugs into drains and toilets is probably only a small
                  part of the problem, researchers said, because most
                  PPCPs enter the wastewater system because they are
                  washed off during bathing or excreted by the human
                  body into drains and collected by sewer systems.


                  "Patient use is still the primary pathway by which
                  pharmaceutical compounds enter the environment," Mary
                  Buzby, a representative from the Pharmaceutical
                  Research and Manufacturers of America, said at the
                  conference Aug. 24.


                  Many pharmaceuticals, researchers said, are only
                  partially metabolized by humans before the compounds
                  are swept into sewage systems. The compounds often
                  survive the biodegradation process of wastewater
                  treatment and thus are passed downstream, where they
                  could impact waterborne organisms and can be drawn
                  into water treatment intake pipes for drinking water.

                                Existing Research Detailed



                  Mike Myer, a researcher with the U.S. Geological
                  Survey, said researchers are in the earliest stages of
                  developing analytical methods for assessing the
                  environmental fate and transport of PPCPs. There are
                  still only a few such methods that can detect such
                  compounds at such low concentrations, he said,
                  including several approaches used for USGS research
                  that focus on such chemicals in water, soil and
                  sediment.


                  USGS researchers since 2002 have developed specific
                  analytical methods for measuring a total of 158
                  compounds that have traveled through wastewater
                  treatment and are found downstream, Myer said. The
                  compounds have a wide variety of uses and include
                  prescription and nonprescription drugs, the DEET
                  insecticide, and caffeine (86 DEN A-11, 5/5/05
                  (Embedded image moved to file: pic13030.gif)a0b0v4j2f5
                  ).


                  Other USGS methods have also been used to identify 83
                  compounds in sediment. Myer said he was finalizing an
                  extraction method for identifying antibiotics that
                  should be able to detect another 10 compounds in that
                  medium.


                  Sampling for PPCPs at such low levels is challenging
                  because many of the compounds sought by researchers
                  are the same as those consumed by researchers, such as
                  caffeine, or contained in personal or cosmetic
                  products the researchers may use, Myer said.


                  "You have to be extra careful when you collect samples
                  to make sure you're not contaminating" what is being
                  collected, he said.


                  One of the more complex research challenges on PPCPs
                  is that the types of compounds found in effluent
                  differ depending on the types and the overall mix of
                  industries found in different regions of the country,
                  according to Bobbye Smith, of EPA's Region 9 office
                  and the regional science liaison to EPA's Office of
                  Research and Development.


                  "The reason why pharmaceuticals and personal care
                  products are an issue and why we're talking about it
                  today is because of the experience of what is
                  happening out in the regions," Smith said. EPA's
                  regional offices believe the issue of PPCPs should be
                  a priority for researchers given how little is known
                  about the compounds and their effects, she said.


                  The issue has "bubbled up to the top" of priority
                  science needs compiled by EPA's regional offices in
                  recent years, Smith said.


                  Within EPA's Region 1 office in New England, for
                  example, researchers are working on analytical methods
                  for detecting steroid hormones in treated wastewater
                  from 40 wastewater treatment plants, Smith said. In
                  the Mid-Atlantic Region 3, the discovery of "intersex"
                  fish in the Potomac River has led to a coordinated
                  effort between EPA regional officials and Virginia
                  researchers to determine the potential source, she
                  said.


                  Such research is leading to the development of
                  genomic-based or molecular biology-based tools that
                  could have further utility in research on a wider
                  array of PPCPs, the EPA official said. Such tools are
                  aimed at examining gene expression in the fish to
                  determine whether it has been exposed to certain
                  endocrine disruptors that can augment the reproductive
                  organs of organisms.


                  Also within Region 3, researchers are focusing on the
                  effects of veterinary pharmaceuticals, particularly
                  those that have antimicrobial effects that may alter
                  antibiotic resistance in various organisms, Smith
                  said.

                               Endocrine Disruptor Research



                  Smith said EPA's Region 8 office, in conjunction with
                  the agency's water office, is funding a study on the
                  potential link between effluent from wastewater
                  treatment plants and any endocrine disrupting effects
                  in the white sucker fish.


                  In Region 9, researchers are participating in a study
                  of wastewater effluent focusing primarily on the
                  efficacy of a "new generation" of exposure assays
                  aimed at better understanding the measurable effects
                  such compounds might have on organisms, Smith said.


                  Region 10's focus has primarily been on the
                  application of veterinary pharmaceuticals, with a
                  particular focus on how those compounds may affect
                  various aquaculture farming operations. Researchers in
                  the region also have been studying the effects of
                  concentrated animal feeding operations and the effects
                  of their waste, on water in Idaho, she said.


                  For that region, "another area they've been trying to
                  evaluate is the potential impact of large cruise ships
                  on the local waters," Smith said. While there "is a
                  huge dilution factor" given the ships are discharging
                  waste into the Pacific Ocean, "the question is, is
                  this practice good or not," Smith said.


                  Taken together, research in the EPA regions should
                  help other researchers and policymakers get somewhat
                  closer to answering questions about PPCPs and their
                  effects on the environment, she said.


                  "We know we have detected pharmaceuticals in the
                  environment. But the question is, Does it matter? Is
                  it important?" Smith asked.


                  "Are the concentrations that are currently detectable
                  a problem, or not? That's the gorilla in the closet,
                  because we really don't know the answer to that
                  question."(Embedded image moved to file: pic16413.gif)
                  End of article graphic


                        By Dean Scott
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