[Pharmwaste] Minnesota doctors want drug disposal research and guidelines

Tenace, Laurie Laurie.Tenace at dep.state.fl.us
Wed Jul 19 13:20:00 EDT 2006


http://minnesota.publicradio.org/display/web/2006/07/12/drugsdisposal/ 

Minnesota doctors want drug disposal research and guidelines
by Lorna Benson, Minnesota Public Radio
July 19, 2006 

 
Patients are often told to dispose of unused prescriptions by flushing them
down the toilet. But environmental officials say that's the wrong way to
dispose of them. (MPR Photo/Lorna Benson) 
 
Minnesota physicians are urging the Environmental Protection Agency to study
the public health consequences of flushing unused pharmaceuticals. Recently
the Minnesota Medical Association convinced its national counterpart, the
American Medical Association, to take its request to the EPA. The AMA also
plans to ask the agency to help develop guidelines for physicians and the
public on the proper disposal of these drugs.


St. Paul, Minn. - When her elderly mother died in May, Jeanie Picardi and her
siblings had to clean out her apartment.

Picardi expected to find a lot of unused medication because her mother had
been ill for a long time. But she was shocked when she filled up two garbage
bags with pain killers like Oxycontin and morphine, along with drugs for
depression, anxiety, and heart problems.
 
Unsure about what to do with the drugs, Picardi called a hospice nurse, a
social worker and a pharmacist for advice.

"When they said 'flush em,' I'm thinking now this is an environmental
hazard," says Picardi. "You know, the whole idea of putting morphine down the
toilet and then how well does it get cleaned out? I don't know those things,
but after you're told by three people you figure well it must get cleaned out
okay."

Actually, it doesn't get cleaned out. For several years now researchers have
been finding trace amounts of pharmaceuticals in many of the nation's water
bodies. Highly sensitive new tests have helped scientists detect dozens and
dozens of chemicals, from depression and cholesterol medications to ibuprofen
and caffeine.

Researchers suspect that many of these drugs are simply excreted in human
waste. But they also say many drugs are needlessly flushed into the system as
a method of disposing of unused or expired medication.

It's this latter practice that most concerns members of the Minnesota Medical
Association. Dr. Sam Hall, who serves on the MMA subcommittee that drew up
the EPA request, says so far there's no evidence the chemicals pose a major
health hazard for the public or the environment.
 
But he says no one has spent much time studying the matter either.

"There's enough to know that this is at least a theoretical problem," says
Hall. "Beyond that, we know that some studies have shown that for certain
classes of chemicals, one being endocrine active compounds, that those
chemicals can have adverse effects particularly in low concentrations on
aquatic life - frogs, fish and the like."

Endocrine active compounds include substances like birth control pills which
contain estrogen. These compounds, even in very low doses, have been shown to
feminize male fish.

The EPA has been studying endocrine disrupters for several years. Gary
Ankley, a toxicologist in the EPA's Office of Research and Development, works
on the project in Duluth.

Ankley says it's easy to duplicate the effect of endocrine disrupters in the
lab. But he says other types of pharmaceutical typically are not designed to
promote physical changes in people or animals. So if they have an effect, it
may be less obvious and it could take years to develop. Ankley says it seems
like an issue worth studying.

"The reality is that a lot of pharmaceuticals are designed to be potent, that
is, effective at very low concentrations," says Ankley. "And just because
they're at low concentrations in the environment, doesn't mean that they
don't have risk. And so yeah, probably we need to take a look at these."

  
 
  MMA wants policy  
 
For now the EPA isn't actively studying other types of pharmaceuticals in the
water. The American Medical Association will urge the EPA to ramp up its
pharmaceutical research and help develop guidelines for disposing of unused
drugs.

Until then, there's a range of advice depending on who's giving it, which
isn't very comforting to people like Jeanie Picardi.

"Nobody has a good answer. Nobody even has what you feel is the right
answer," says Picardi. "Sometimes I think back and I think I should have
worked harder. I should have done this. Or I should have done that. And then
I think I didn't have it in me. You know, neither did my siblings. None of us
had that energy to work harder on getting rid of them."

Picardi wishes some of the drugs could be re-used. But current regulations
across much of the U.S. prohibit that.

Many caretakers still recommend flushing to ensure that drugs don't fall into
the hands of small children. The Minnesota Office of Environmental Assistance
doesn't recommend flushing. Instead the state agency recommends destroying
the drugs with a liquid like water, wrapping them tightly in a plastic
container like a margarine tub and then throwing them in the trash.

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 at dep.state.fl.us  
 
view our mercury web pages at: 
http://www.dep.state.fl.us/waste/categories/mercury/default.htm 

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