[Pharmwaste] Sewered Pharms

Catherine Zimmer zimme053 at umn.edu
Tue Feb 27 11:12:36 EST 2007


Hi all,
As you know, in MN there has been a deliberate regulatory effort to 
ensure healthcare facilities properly manage their hazardous waste, 
including many pharmaceuticals.  According to summary data collected by 
the seven counties in the Mpls St Paul area, in 2005 close to 50,000 lbs 
of waste pharmaceuticals (not including chemotherapeutics) were 
collected and managed as hazardous waste.  This is data from 28 
hospitals.  Prior to the hazardous waste initiative, no pharmaceuticals 
were being reported to regulatory authorities as hazardous waste.  So, 
we assume these drugs were either being disposed of down the sewer--all 
the controlled substances of course, which in many cases still are, and 
to infectious waste--probably sewered with condensate.

Ann, thank you for the very interesting excretion data. 

Catherine Zimmer
Health Care Specialist

Minnesota Technical Assistance Program
University of Minnesota
612/624-4635, 800/247-0015
http://www.mntap.umn.edu

Helping Minnesota businesses maximize resource efficiency, prevent pollution and reduce costs.



Heil, Ann wrote:
> 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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