[Pharmwaste] Measuring the amount of pharms reaching surface water

[gressitt]

The San Francisco report gave an estimate, though I think it is high (
estimate of family size was not included.) I don't recall a reference for
the 5-20% directly from sewering but I do know someone in PHARMA was
offering a 3% number that was not documented at all and would seem to fly in
the face of patient compliance rates that hover 20-80%. American Society of
Consulting Pharmacists estimated about 12-14% as I recall as wastage but
only in long term care facilities and that was about 2-3 years ago. And
unfortunately the information is proprietary and I had only limited access
to it at one point. I believe it might have been Anne Heil? Who exquisitely
took a list of the top 10 drugs and made a chart ( which I have lost but
love to have it again if anyone could forward it) showing rates of
metabolism and demonstrating a nice wide range. One of the purposes of the
various pilots is to simply collect benchmark data from all of our various
efforts and  address the exact question you have been asked as I think the
best answer is a cautious " I don't know." It is more than 1 pound, it is
more than 10, or a hundred, but I feel at this point many of our
measurements need to be accepted as labor intensive, unfunded efforts we all
have made that will likely pale when something does get up and running. At
this point, I fear at times that some of what we are doing is more akin to:
http://www.mousetrapcontraptions.com/rube-cartoons-2.html and in need of a
very healthy dose of self-humor. We are working in a particularly
frustration inducing area otherwise. And that contraption I keep in mind as
something we definitely do not want to have as a final solution/product. 

Stevan Gressitt, M.D.
207-441-0291
www.mainebenzo.org 

-----Original Message-----
From: pharmwaste-bounces at lists.dep.state.fl.us
[mailto:pharmwaste-bounces at lists.dep.state.fl.us] On Behalf Of Volkman,
Jennifer
Sent: Wednesday, February 21, 2007 1:41 PM
To: pharmwaste at lists.dep.state.fl.us
Cc: Jenna.Duwenhoegger at house.mn
Subject: [Pharmwaste] Measuring the amount of pharms reaching surface water

Hello list serv friends,
 
A MN legislator is possibly proposing some legislation related to
pharmaceutical collection.  She is very concerned about the impacts to fish,
etc.  
 
In attempting to provide information on the regulatory and other barriers to
collection of household pharms, I threw out a number, based on what I could
recall from several previous messages, that from 5 to 20% of pharms in
surface water are there due to direct sewering of waste pharms by households
and hospitals and that the rest is what passes through our bodies and so
can't be diverted (not easily anyway), from sewering.
 
The staff from her office would like to know what 5-20% would be in pounds
per year.  I said it was a pretty elusive number and that I have not seen
anything close to an actual estimate of pounds.  The more I think about it,
I wonder if the 5-20% numbers are even good.  We can certainly guess that
for households some percent is taken and expelled, some is in storage (for
years), some is disposed of through sewering and some is disposed of in the
trash.  For hospitals, it would be a similar mix of the same.  
 
I thought maybe the State Pharmacy Board might track the number of
prescriptions written or filled and from that we could extrapolate, but I
wouldn't have much confidence in the numbers.
 
Does anyone have any other ideas or has anyone tackled this question in
another state?
 
I thought it might make more sense to ban hospitals from sewereing any
pharms and/or require manufacturers and pharmacies to get involved in a
solution, rather than to try to establish a collection system that puts all
of the weight on the already overloaded HHW collection system.  I had a nice
discussion with the people from Washington State on their drop off system
which still isn't approved by DEA, but seems to be going well otherwise.
 
Please let me know your thoughts,
Thanks!
Jnifr

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