[Pharmwaste] Non-adherence

Gilliam, Allen GILLIAM at adeq.state.ar.us
Mon Jan 29 08:18:29 EST 2007


I was reminded that non-adherence also includes those scripts that are
not refilled.  I've been using 50% kind of as a national overall average
in my presentations since the numerous reports I've perused range from
20% to 80% (for psychotrophics).  Regardless of which study and what %,
our nations' waters are in deep doo.  The boulder/denver study REALLY
opened some eyes over here.  

Slap me if I'm wrong but, didn't Dr. Gressitt (or somebody "out there")
start a national registry to try and get some handle on this
non-adherence rate? If so, what's that website again please? The only
questionnaire I've got doesn't address "not refilled".

Allen Gilliam
ADEQ state pretreatment coordinator  

-----Original Message-----
From: pharmwaste-bounces at lists.dep.state.fl.us
[mailto:pharmwaste-bounces at lists.dep.state.fl.us] On Behalf Of Matthew
Mireles
Sent: Saturday, January 27, 2007 8:30 AM
To: 'Jackson, Jennifer'; pharmwaste at lists.dep.state.fl.us
Subject: RE: [Pharmwaste] RE: question on wastewater
characterizationofpharmaceuticals


Jen, thanks so much for your thoughtful and informative reply.  I agree
that prevention has to be the key.  Do you have an idea on what drugs
are most frequently showing up at your site?  If we can address the
issues of over-prescription, non-adherence of medications, and proper
disposal (this is the most challenging), then everyone should be happy.
Thanks for the reference.

Matthew Mireles

-----Original Message-----
From: pharmwaste-bounces at lists.dep.state.fl.us
[mailto:pharmwaste-bounces at lists.dep.state.fl.us] On Behalf Of Jackson,
Jennifer
Sent: Friday, January 26, 2007 5:01 PM
To: pharmwaste at lists.dep.state.fl.us
Subject: [Pharmwaste] RE: question on wastewater characterization
ofpharmaceuticals

Hi Matthew,

Your observation is a good one and there is a plethora of studies done
on what pharmaceuticals are entering waterways through wastewater
effluent. Check out the USGS 2002 Reconnaissance on Pharmaceuticals and
Personal Care Products. Boulder Creek, Potomac and San Francisco Bay
have some studies as well. Google Scholar will give you lots of hits. To
begin, look at: http://toxics.usgs.gov/highlights/DM_top100.html as well
as the archives of this listserv.

Lots of pharmaceuticals are coming to our treatment plants, and yes,
many wastewater agencies are concerned. Some pharms are broken down,
some adsorb to biosolids and some come out the end pipe. Every treatment
plant is different, with various kinds of technology. Reverse osmosis,
UV, ozonation, carbon filtration and now ultrasound are all possible
treatments that may break down or remove the pharmaceuticals.
Unfortunately, some pharms respond better to certain treatments than
others, meaning that a mix of treatments would be necessary to get 'em
all. Also unfortunately, the burden of bringing this technology to our
plants falls on our ratepayers -- real people, rather than the true
culprits: over-prescription, formulations that don't break down and a
lack of EPA and FDA collaboration in ensuring pharmaceuticals are tested
for their environmental impacts.

So pollution prevention is key for the portion of pharmaceuticals that
are unused by hospitals, hospice, or residents, because that's much less
expensive than, say reverse osmosis. Some people on this list are
working toward a solution for disposal that will comply with DEA
regulations as well as state and other federal law. The red tape is
unbelievable.

For pharms that we take and pass through our bodies, I believe some
folks are looking at whether reformulation may be possible.

Best,
Jen Jackson
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