[Pharmwaste] Pill Dump imperils water's quality - Colorado

[Tenace, Laurie]

Pill dump imperils water's quality

Reported in Colorado, but this practice is widespread - Laurie

http://www.coloradoan.com/apps/pbcs.dll/article?AID=3D/20050906/NEWS01/50=
906030
4/1002

Pill dump imperils water's quality
By KEVIN DARST=20
KevinDarst@coloradoan.com=20
=20
Package by package, nurses at long-term care facilities in Fort Collins =
are
spending hours a week flushing hundreds of unneeded pills, creams and =
fluids
down the drain.

The list of medications, which is logged by nurses as they dispose of =
the
drugs, includes blood thinners, anti-depressants, skin creams and =
bed-sore
creams, as well as pain narcotics such as Vicodin, Percoset and =
morphine.

It's a legal and inexpensive way to get rid of medication - far cheaper =
than
packaging unused medicine into biohazard bags and sending it out for
incineration. But it's a method some say might be no better than sewer
disposal. It's also the norm, according to nurses and pharmaceutical
distributors, and a practice one water quality researcher called "not
sustainable."

"There were garbage bags full of meds," said Debbie Conroy, a Loveland =
woman
who has worked as a nurse at long-term care facilities, including Centre
Avenue Health and Rehab Facility in Fort Collins, for the past seven =
years.
"It's a joke among nurses: Want to be happy? Just drink the water."

Drug doses can change often for patients in long-term care centers, =
Conroy
said. Like a typical prescription at a pharmacy, those centers get =
medicine
for patients in weeklong, monthlong or 90-day quantities. When a dose =
changes
or a patient leaves the facility or dies, the facility winds up with =
pills
and creams it can't use or, in most cases, can't return to the =
distributor.

Conroy and other nurses who talked to the Coloradoan said the facilities =
they
work at flush dozens, if not hundreds of pills and other medicines every
week.

Some medications are considered biohazards. Colorado regulations allow
tablets, capsules and liquids to be flushed down the toilet or sink. =
They
require ointments and creams to be put in the trash.

"I suspect that most of them flush them down the toilet," said Tim Mead, =
a
manager at PharMerica, a pharmaceutical distributor that sells primarily =
to
long-term care facilities in Denver and Northern Colorado.

PharMerica will take back unused drugs for incineration, but the program =
is
rarely used, Mead said.

And pharmacists, distributors and health-care professionals say current
regulations make it nearly impossible to return unused medicine or pass =
it on
to someone else who needs it.

Columbine Health Systems Coordinator Yvonne Myers questioned whether
incinerating drugs was any better for the environment than flushing =
pills
down the toilet. Columbine's system includes a half-dozen independent =
and
assisted-living facilities, including the Centre rehab facility.

"The pharmacy world's trying to figure out how best to dispose of =
these,"
Myers said.

Pharmaceuticals, personal-care products and other compounds in the water
supply have been a rising area of study by water-quality researchers in =
the
United States during the past decade, though the issue has only recently
garnered broader attention.

Last year, fish downstream of the Denver water treatment plant were
discovered to have both sex organs. Scientists linked the mutation to
estrogen levels in the water downstream of the treatment plant, =
presumably
the result of estrogen drugs that had been swallowed by Denver water
customers and flushed into the sewer system.

The human body can't completely break down most pharmaceuticals, leaving
unprocessed medication in the water supply that can't be removed at =
treatment
facilities.

One concern about pharmaceuticals persisting in waterways is that humans =
and
animals could build resistance to antibiotics. Another worry is that =
such
elements could disrupt endocrine systems.

Endocrine disrupters, as they're known, are human-made chemicals that
interfere with an organism's development. The double-sex fish are one
example.

Scientists are trying to learn what low, sustained levels of =
pharmaceuticals
and other organic compounds in the water can do - alone or in =
combination
with other compounds - to humans, animals and aquatic life.

"It's pretty well understood there are low levels of pharmaceuticals and
organic contaminants in surface waters in the United States," said Ed
Furlong, a leading researcher for the U.S. Geological Survey. "We're =
seeing
more interest in finding out what low levels mean."

That research could lead to regulation by the U.S Environmental =
Protection
Agency, which is investigating what it calls potential "hidden" =
environmental
problems caused by hormones, antibiotics and pharmaceuticals.

American research still lags behind European work on the same topic, =
though
some say the gap is closing quickly.

One expert said it would be nearly impossible to distinguish the effects =
of
mass pill-flushing by long-term care facilities from the broader =
introduction
of unprocessed medication by water users or hospitals. Most =
pharmaceuticals
are thought to enter the water supply after passing through humans.

"There's a lot of mixing and dilution," Furlong said.

Poudre Valley Hospital, for example, gives 1.4 million doses of =
medication to
its patients each year.

While it's difficult to tell who disposes of specific pharmaceuticals,
pouring pills down the drain is preventable, said Ken Carlson, a =
Colorado
State University associate professor who has studied pharmaceuticals and
water quality.

"It's something we can control," Carlson said.

Carlson's research has turned up antibiotics in the Poudre River, much =
of
which likely came from animal or veterinary operations that use the =
drugs to
enhance animal development, as well as antibiotic-resistant organisms in
those areas.

"The perception that we have pristine, first-use water is not true," =
Carlson
said.

Much of the research to date has been done on metro-area wastewater. In
Boulder, researchers are studying fish below that city's wastewater =
treatment
plant, looking for clues about how smaller sewer systems impact =
downstream
water and fish.

"If we can measure it, we can determine the biological impact of it," =
said
Allan Vadja, a researcher on the University of Colorado project.=20

Laurie J. Tenace
Environmental Specialist
Florida Department of Environmental Protection
2600 Blair Stone Road, MS 4555
Tallahassee, Florida 32399-2400
PH: (850) 245-8759
FAX: (850) 245-8811
Laurie.Tenace@dep.state.fl.us
=20
view our mercury web pages at:=20
http://www.dep.state.fl.us/waste/categories/mercury/default.htm
=20
=20