[Pharmwaste] FW: 99.9% of drugs in water are from excretion

Thu Jul 8 02:24:39 EDT 2010

Pass! :)

________________________________
From: gressitt [gressitt at zoho.com]
Sent: Wednesday, July 07, 2010 8:05 PM
To: Volkman, Jennifer (MPCA)
Cc: Pamela Ortner; Tenace, Laurie; ,"pharmwaste at lists.dep.state.fl.us
Subject: RE: [Pharmwaste] FW: 99.9% of drugs in water are from excretion

HAving presented at a couple Patient Adherence and Compliance conferences over the past several years, I'd like to say that the manufacturers have a deep abiding interest in people taking their meds and not stopping. Much money has been spent commercially and in support of academicresearch to eke out small percentage gains in adherence. Almost any one of those programs would be more than all of us have spent in drug disposal. I really think that nobody in this whole process wants the waste.

Stevan Gressitt, M.D.
Faculty Associate, University of Maine Center on Aging
Founding Director
Maine Institute for Safe Medicine
University of New England, College of Pharmacy
Department of Pharmaceutical Sciences
Associate Professor of Clinical Psychiatry
University of New England, College of Osteopathic Medicine
716 Stevens Avenue
Portland, Maine 04103
gressitt at gmail.com<mailto:gressitt at gmail.com>
Cell: 207-441-0291

---- On Wed, 07 Jul 2010 20:39:48 -0400 Jennifer (MPCA) Volkman <Jennifer.Volkman at state.mn.us<mailto:Jennifer.Volkman at state.mn.us>> wrote ----

Regardless of PhRMA's assumptions, anyone who has sorted pharms from collection programs knows well that an incredible amount of drugs are completely wasted.  We have pharmatizing in every media and taking up more space each day, desperate patients looking for the magic pill, internet scam sales, the disconnect between insurance dollars and prescribing practices.  There are so many issues coming into better light as we generate more data.  It is just one more area where excess generates so many problems: pollution, abuse, poisoning, millions of dollars down the drain and up in smoke.  There is hope in this article?  I'm sure we can turn the ship while the interest is still building.

HEALTH   | July 06, 2010
In a World of Throwaways, Making a Dent in Medical Waste<http://www.nytimes.com/2010/07/06/health/06waste.html?emc=eta1>
By INGFEI CHEN
Untold numbers of unused, and reusable, health care supplies and equipment end up in millions of tons of health care industry trash.

________________________________
From: pharmwaste-bounces at lists.dep.state.fl.us<mailto:pharmwaste-bounces at lists.dep.state.fl.us> [pharmwaste-bounces at lists.dep.state.fl.us<mailto:pharmwaste-bounces at lists.dep.state.fl.us>] On Behalf Of Pamela Ortner [portner at angelahospice.net<mailto:portner at angelahospice.net>]
Sent: Wednesday, July 07, 2010 5:36 PM
To: gressitt; Tenace, Laurie
Cc: pharmwaste at lists.dep.state.fl.us<mailto:pharmwaste at lists.dep.state.fl.us>
Subject: Re: [Pharmwaste] FW: 99.9% of drugs in water are from excretion

I think one needs to be careful about quoting PhRMA. The EPA did not say 99.99% of APIs come from excretion; PhRMA (Pharmaceutical Research and Manufacturers of America) did. PhRMA accounts for 80% of drug sales in the US so it might be in their best interest to say the majority of the drug comes from excretion as it might lessen liability.

Pamela Ortner, MS, RN, CHPN, COHN-S
Quality Improvement/Education Coordinator
Angela Hospice
14100 Newburgh Rd.
Livonia, Michigan 48154
(734) 953-6040

"Willing is not enough, we must act.  Knowing is not enough, we must do."
                                                                                                     Goethe

From: gressitt at zoho.com<mailto:gressitt at zoho.com> href="mailto:gressitt at zoho.com" shape=rect target=_blank>gressitt
To: Laurie.Tenace at dep.state.fl.us<mailto:Laurie.Tenace at dep.state.fl.us> href="mailto:Laurie.Tenace at dep.state.fl.us" shape=rect target=_blank>Tenace, Laurie
Cc: pharmwaste at lists.dep.state.fl.us<mailto:pharmwaste at lists.dep.state.fl.us> href="mailto:pharmwaste at lists.dep.state.fl.us" shape=rect target=_blank>pharmwaste at lists.dep.state.fl.us
Sent: Wednesday, July 07, 2010 2:31 PM
Subject: Re: [Pharmwaste] FW: 99.9% of drugs in water are from excretion

One problem is much household waste in Maine is incinerated, not landfilled. I suspect likewise with WTE plants....

Stevan Gressitt, M.D.
Faculty Associate, University of Maine Center on Aging
Founding Director
Maine Institute for Safe Medicine
University of New England, College of Pharmacy
Department of Pharmaceutical Sciences
Associate Professor of Clinical Psychiatry
University of New England, College of Osteopathic Medicine
716 Stevens Avenue
Portland, Maine 04103
gressitt at gmail.com<mailto:gressitt at gmail.com>
Cell: 207-441-0291

---- On Wed, 07 Jul 2010 13:33:09 -0400 Laurie Tenace <Laurie.Tenace at dep.state.fl.us<mailto:Laurie.Tenace at dep.state.fl.us>> wrote ----

Several months ago a list serve member mentioned that 99.9% of active pharmaceutical ingredient surface water releases were from patient excretion. I stumbled across this reference to that number the other day:

page 69 of http://nepis.epa.gov/EPA/html/DLwait.htm?url=/Adobe/PDF/P1001AWF.PDF (or section 6.3)

EPA performed a literature search for studies or reports on pharmaceuticals disposed of in landfills. EPA found that in 2007, the Pharmaceutical Research and Manufacturers of America (PhRMA) evaluated the potential for 24 active pharmaceutical ingredients to leach from MSW landfills and their potential releases to surface water (Tischler, 2007). PhRMA compared the modeled landfill leachate releases to estimates of surface water releases from disposal of unused pharmaceuticals down the drain. PhRMA selected the 24 example pharmaceutical ingredients to represent a range of sales per year in the U.S. (i.e., high quantities and low quantities) and a range of physical-chemical properties. These pharmaceutical ingredients were also evaluated in the 2002 USGS study of pharmaceuticals in surface waters (Kolpin et al., 2002).

The PhRMA study calculated that the landfill disposal pathway to surface water accounted for an average of 0.03% to 0.10% of the estimated aggregate annual surface water releases for the 24 active pharmaceutical ingredients. Therefore, the study estimated that over 99.9% of active pharmaceutical ingredient surface water releases would be due to patient excretion, not landfill disposal of unused medicines, assuming that landfill disposal were used for all unused medicine disposal. The evaluation was based on the assumption that the efficiency of the pharmaceuticals partitioning to solids in the landfill is 50% of the efficiency of partitioning in a biological wastewater treatment unit (Tischler, 2007).

Laurie Tenace

Environmental Specialist

Waste Reduction Section

Florida Department of Environmental Protection

2600 Blair Stone Rd., MS 4555

Tallahassee FL 32399-2400

P: 850.245.8759

F: 850.245.8811

Laurie.Tenace at dep.state.fl.us<mailto:Laurie.Tenace at dep.state.fl.us>

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http://www.dep.state.fl.us/waste/categories/medications/default.htm

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http://www.dep.state.fl.us/waste/categories/hazardous/pages/household.htm

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