[Pharmwaste] Wash Post 3/27/06-Sewage Tested for Signs of Cocaine

[Stevan Gressitt]

Allen, I'll rise to the bait. There should be two GCCR's calculated. One
should be what the medical community has estimated for cocaine abuse in the
watershed area ( will take some work to shift from county/town/zip
code/state areas of assessment to watershed based geographic assessment) and
the other that of law enforcement.

If we as physicians have been so sure all our patients have been taking our
prescriptions and as directed, then the CATIE report should humble us all.
Patient adherence, or consumer compliance rates for prescriptions are a
national disaster compared with some of the controlled ARV treatment
adherence reported in Africa. Not clean neat comparisons by any means,
different diseases, different infrastructures, but comparing best practices,
or best outcomes around the world, simply on prescription drug adherence, we
are headed in the wrong direction. Medicare Part D will contribute far more
to waste medicine than has been written about now as states are no longer in
the business of asking for rebates on unused portions of prescriptions and
the new Prescription Drug Programs have no such mandate, program, nor
apparent interest. The state of Maine will loose 1 million dollars a year
this way, and it will all be trash. The state has decreed that it is all to
be destroyed. I have heard flushing is the recommendation.

Prescription drug abuse has increasing numbers virtually in all studies in
the US, but environmental metabolites specific for drugs is not my area of
expertise and I haven't yet seen a chart that identifies unique human
metabolites for many drugs at all. 

Bringing us to Cocaine. Most of the focus of law enforcement seems to me to
be focused on Opiates, Cocaine and Marijuana for interdiction and "market
disruption" efforts. So it is surprising that this effort to look for
cocaine has not been done long long ago. Perhaps when the results come in,
there will be more attention paid to one of the messages from Zucatto paper:
We need to do a better job. We need to get smarter about how we look for
drug abuse and it will be hard to argue against the numbers that are finally
presented. The only question is, how far off are our official estimates? And
what would the reason be for anyone to discount the data? The medical and
law enforcement communities will have to rethink their current data
collection efforts.

And perhaps we should include how much cocaine is collected by drug return
programs?

Actually Allen, I wonder if anyone will predict the numbers will be lower
than traditionally predicted?

Stevan Gressitt, M.D.
207-441-0291   

-----Original Message-----
From: pharmwaste-bounces at lists.dep.state.fl.us
[mailto:pharmwaste-bounces at lists.dep.state.fl.us] On Behalf Of Gilliam,
Allen
Sent: Monday, April 03, 2006 4:33 PM
To: pharmwaste at lists.dep.state.fl.us
Subject: RE: [Pharmwaste] Wash Post 3/27/06-Sewage Tested for Signs of
Cocaine

Anyone want to hazard a guess what Gressitt's "consumer compliance rate"
is on this one??? 

-----Original Message-----
From: pharmwaste-bounces at lists.dep.state.fl.us
[mailto:pharmwaste-bounces at lists.dep.state.fl.us] On Behalf Of
Pickrel.Jan at epamail.epa.gov
Sent: Monday, April 03, 2006 1:37 PM
To: pharmwaste at lists.dep.state.fl.us
Subject: [Pharmwaste] Wash Post 3/27/06-Sewage Tested for Signs of
Cocaine


Here is the link:
http://www.washingtonpost.com/wp-dyn/content/article/2006/03/26/AR200603
2600880.html

5 consecutive days of samples (from March 13-17, 2006) were taken from
the Noman Cole POTW in Fairfax County, VA, and tested for cocaine. The
sewage was analyzed for traces of benzoylecgonine, a urinary metabolite
of cocaine, by the Armed Forces Institute of Pathology in Rockville, MD.

~*^*~*^*~*^*~*^*~*^*~*^*~
Jan Pickrel
Water Permits Division, Industrial Branch
US Environmental Protection Agency
phone:  (202) 564-7904.
fax:  (202) 564-6431.
pickrel.jan at epa.gov

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