[Pharmwaste] Measuring the amount of pharms reaching surface water

Mon Feb 26 16:02:23 EST 2007

I hope that everyone is aware that there is no *one* answer for all pharmaceuticals regarding the relative amounts arriving the wastewater from human waste and direct disposal. Each pharmaceutical is different, particularly in terms of how they behave in the human body. Some are used up almost entirely in the body; some are passed through unchanged. There are also differences regarding disposal practices. One would not expect much vicodin to be disposed of directly, but we all know that people tend to not take all of their antibiotics. That said, I did a little exercise a few years ago to look at the amount of drugs metabolized and excreted in human waste. 

I started with the top ten drugs by sales for 2003 (latest year available when I did the analysis)from www.rxlist.com.  This site also has the top ten drugs by number of prescriptions.  The information on percent excreted I generally took from the patient package inserts, which can be found online using google searches. The percent excreted was usually listed as percent in urine.  There isn't much data on percent in feces.  In some cases an isotope study is done to determine overall percent excreted (unused drug and metabolites), but I was interested in actual amounts of drug excreted since we usually see actual drug amounts in water bodies.

Excretion Percentages - Top 10 US Pharmaceuticals in 2003 by Sales 
Lipitor  - cholesterol reduction - < 2% excreted 
Zocor - cholesterol reduction - < 0.5% excreted 
Prevacid - ulcers - < 1% excreted
Procrit - anemia - < 5% excreted
Zyprexa - antipsychotic - 7% excreted
Epogen - anemia -  < 5% excreted
Nexium - acid reflux - < 1% excreted
Zoloft - antidepressant - 14% excreted
Celebrex - anti-inflammatory - < 3% excreted
Neurontin - antiseizure - 100% excreted
Leading OTC drug: Ibuprofen - 10% excreted

Ann Heil, P.E.
Supervising Engineer
Sanitation Districts of Los Angeles County
1955 Workman Mill Road
Whittier, CA 90601
562/908-4288, x2803
fax 562/908-4293
aheil at lacsd.org

-----Original Message-----
From: pharmwaste-bounces at lists.dep.state.fl.us
[mailto:pharmwaste-bounces at lists.dep.state.fl.us]On Behalf Of gressitt
Sent: Saturday, February 24, 2007 1:28 PM
To: 'Volkman, Jennifer'; pharmwaste at lists.dep.state.fl.us
Cc: Jenna.Duwenhoegger at house.mn
Subject: RE: [Pharmwaste] Measuring the amount of pharms reaching
surface water

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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