[Pharmwaste] Article: "What to do with unused medicine"

DeBiasi,Deborah dldebiasi at deq.virginia.gov
Fri Aug 18 11:51:35 EDT 2006


Consumer confusion...

http://www.goedwardsville.com/site/news.cfm?newsid=17056050&BRD=2291&PAG=461&dept_id=473648&rfi=6


08/15/2006
 
What to do with unused medicine 
 
Norma Mendoza , nmendoza at edwpub.net  

The answer isn't as simple as you might think
After throwing out all of the food in the refrigerator and freezer that sat without power for six days, I guess I was in the disposal mode and sought to also get rid of some unused and expired medications. 
 

I plead guilty to having flushed some down the tube before I heard that the Environmental Protection Agency frowns on this method of disposing of prescription drugs. 


Several of the leftovers were caused by a change in medication before they were completely consumed. So, I gathered up about five bottles of left-over pills and capsules and took them with me when I went to the pharmacy to pick up a prescription refill. 


"Do you take unused drugs to dispose of them safely?" was the query to the pharmacy technician. He said he'd check with the pharmacist and came back with the advice to flush them down the toilet. 


This turned out to be the advice I would get from several sources and yet the EPA warns us not to do this. According to the EPA: 


"If your throw your pharmaceuticals and personal care products (PPCPs) down the drain or flush them down the toilet, and if your home is connected to a municipal sewage system, some of the PPCPs would typically be discharged into lakes, rivers, or oceans, because most waste water treatment plants are not designed to remove or destroy PPCPs from waste water." 


Most septic systems don't destroy the PPCPs either. On the contrary, they may destroy the bacteria in the septic system that aid in breaking down the waste in the household waste water. These helpful bacteria are also a component used in sewage treatment plants to break down waste. 


An Internet search produced an article from the Harvard Heart Letter that warns against keeping unused medications because not only will you increase your chances of taking the wrong one, you could be taking an old one that has lost its potency. 


But, where do they end up when you get rid of them? 


"Scientists are finding everything from aspirin to Zoloft in our streams, rivers, and lakes," the article states. 


The article states that neither flushing or trashing the old medications is a good method for disposal. It warns that children or animals could get into drugs that are simply tossed into the trash and once they reach the landfill they can trickle down into the ground water. 


Harvard also backs up the advice of the EPA not to flush old meds. 


So, what do we do with these drugs? It is unlawful for pharmacies to take them back for redistribution. It is even unlawful to give them to an agency that could use them for its uninsured patients. It is also unlawful to pass them on to family members or friends, although this happens all too often. 


Toni Corona, public health administrator for the Madison County Health Department, said the county does not have a program for prescription drug disposal. 


"The question has never been posed to me before," Corona said. "This is the first time it has been brought to my attention." 


Corona did have some advice for a way to cut down on the amount of drugs to be disposed. She said her first advice would be to complete the dosage recommended by your physician. 


Not only would this eliminate the problem of leftover meds, but it could also help prevent the development of germs that are resistant to antibiotics. When the course of drug treatment is incomplete, the weaker germs are killed, but the stronger ones survive and become even more resistant to antibiotics. 


There is great concern in the medical community that this may be the reason for the development of a deadly strain of staph that threatens the health of hospital patients and those with weakened immune systems. 


According to a report on the U.S. EPA Web site, studies have confirmed that female hormones are in such abundance in our rivers and streams that the aquatic life is being affected. They report a feminization of male fish found in the United States, Europe, the United Kingdom and Japan. This is linked to the exposure to both natural and synthetic estrogens and chemicals that mimic estrogens in the water. 


According to U.S. EPA report, the majority of these endocrine-disrupting chemicals are believed to reach the aquatic environments via the effluent released into the streams and rivers by sewage treatment plants. 


Investigating the scarcity of fish in the Columbia River in Washington state near the Oregon border, scientists found only female fish, or at least what appeared to be female fish until their DNA was analyzed and many of them were found to actually be males. 


The same phenomenon was observed in England and both sites were said to be downstream from sewage treatment plants. Scientists have discovered that male alligators are similarly affected in Lake Apopka, Fla., and they also found many infertile male panthers. 


Dr. Leonard Sax said most of the chemicals under study did not exist before 1950. In his study, he found that many of them mimic the action of the female sex hormones called estrogens. Sax said a similar process to that affecting the aquatic animals and other wild life may also be affecting the human male. 


He reports that there has been a steady decline in the sperm count of the average American and European males over the last 50 years and today the average is less than 50 percent what it was 40 years ago. 


Another concern, he reports, is that girls are beginning to go through puberty at earlier and earlier ages. This is only happening to girls, not to boys. 


Sax also speculates that so much extra estrogen could lead to breast cancer in adult women. 


This is more serious than we thought at first. 


A query to the Illinois Department of Public Health brought a reply from Marlena Bordson, chief of the Division of Foods, Drugs and Dairies. 


She said the state of Illinois does not require anyone to provide a safe way to dispose of leftover or expired prescription drugs. One suggestion she made is to take them to the Hazardous Household Waste (HHW) Collection sites. Madison County sponsors such collections in the spring and fall. 


Bordson said the advice from the pharmacist to flush the drugs was the advice that was given for years. But, she said this is no longer considered the best option due to the concern expressed about it. Instead, the local HHW collection site is the new method of choice for disposal. 


Bordson advised checking with other states which may have adopted disposal programs. 


The state of Michigan's Department of Environmental Quality (DEQ) confirms that there is a major concern about increased resistance of germs to antibiotics and the disruption of endocrine systems by natural and synthetic sex steroids. 


Michigan's DEQ also recommends the HHW method of disposal. 


In Boulder County, Colo., the U.S. Geological Survey performed a study that confirmed that prescription and non-prescription drugs were not removed by the water treatment plant. 


According to the Boulder Web site: "Flushing PPCPs down the toilet is inconsistent with the 'First, do no harm' ethic for us or for the fish. Safe disposal of PPCPs falls into the gray area for which society has not yet developed a good enough solution." 




Boulder County suggests taking the unwanted drugs to a pharmacy for safe disposal, but admits that not all pharmacies are able to accept them. 


A pharmacist in a Granite City Walgreens suggested a safer way to dispose of them in the trash: fill the pill bottle with water to dissolve the medication and render it useless, glue the lid on using Elmer's Glue or the like, then dispose of the sealed container in the trash for waste disposal. Kitty litter or flour can be added to liquid medications to render them useless. 


One expert warns that land fills can be polluted this way and the drugs can pollute the ground water. But, Connie Letsky of the Collinsville office of the Illinois Environmental Protection Agency said land fills have leaching systems in place that would intercept the drug leakage and return it for water treatment. 


No matter which way you choose to dispose of them, It seems the onus is on the person taking the medication or in the case of leftover meds, not taking them. 


The Canadians have a much better solution. They put the onus on the pharmaceutical companies that produced the drugs. 


In most of the Canadian provinces, there is a Medications Return Program whereby people can take their outdated or unused medications to their local pharmacy where they will be held for the pharmaceutical companies. 


In 1997, British Columbia established Post-Consumer Residual Stewardship through its Waste Management Act. The Post-Consumer Pharmaceutical Stewardship Association was formed in 2000 to administer the Medications Return Program. 


In eight of Canada's provinces, consumers may return, at no charge, residual prescription and over-the-counter medications, vitamin and mineral supplements and natural health products. 


It is then up to the pharmaceutical and other manufacturers to dispose of the excess in ways that are acceptable to the Waste Management Act standards or find ways to safely recover the basic drugs for possible recycling. 


Until the United States or individual states are forward thinking enough to adopt a program such as the one in Canada or England or Australia, remember the advice "Don't flush" and check with your local public works department to find out when the next HHW (Hazardous Household Waste) collection will take place. 

 


Deborah L. DeBiasi
Email:   dldebiasi at deq.virginia.gov
WEB site address:  www.deq.virginia.gov
Virginia Department of Environmental Quality
Office of Water Permit Programs
Industrial Pretreatment/Toxics Management Program
Mail:          P.O. Box 10009, Richmond, VA  23240-0009 
Location:  629 E. Main Street, Richmond, VA  23219
PH:  	804-698-4028
FAX: 	804-698-4032



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