[Pharmwaste] NIOSH Update and groundwater

[Russell Mankes]

Regarding the potential of antineoplastics and RCRA drugs to enter ground or
surface waters, I completed a 2 year EPA funded study of pharmaceutical
wasting.

79 drugs are used in cancer treatment at an 650 bed academic medical center
hospital and an affiliated 23 hour, 20 bed surgical care center (AMCH and
SCC).   No drug used in cancer treatment appeared in the listing of the top
200 drugs for 2009 (http://www.drugs.com).  Of the 11 RCRA and 79 cytotoxic
drugs, three RCRA and 11 cytotoxic are not excreted as unchanged drug and
could not appear in "yellow water". Seven RCRA and 32 cytotoxic drugs do not
have pharmacologically active metabolites formed in vivo. (Data Tables are
available on request).

 

The average PBT (pesistence, bioaccumulating and toxicity value from
http://www.janusinfo.se) for the Chemo drugs was 5.0 (the same as the
average PBT for the top 200 drugs of 2009).  Four drugs (5%) were rated 7, 8
or 9/9 (docetaxel - 9/9, everolimus - 8/9, megstrol - 9/9, and tamoxifen -
9/9).   Seventeen drugs (22%) had a moderate PBT rating of 4, 5 or 6/9 while
7 (9%) had a rating of 1, 2 or 3 for PBT.  Fifty one (51) Chemo drugs (65%)
were not rated for PBT.  

 

The environmental risk ratio (based on the ratio between predicted
environmental concentration of the substance (PEC) and the highest
concentration of the substance that does not have a harmful effect in the
environment (PNEC)) for these 79 cytotoxic, antineoplastic drugs was minimal
with 12 (15%) rated as "Insignificant" (PEC/PNEC <0.1), and  27 drugs (34%)
rated as "Cannot be excluded" .  Thirty nine (49%) of these drugs were not
rated or had no data available for PEC/PNEC ratio. 

 

No cytotoxic, antineoplastic or Immunomodulatory (e.g., Chemo) drugs were
bedside wasted over the 2 year course of the study.  Between 200 and 300
pounds per year of antineoplastic drug waste is generated in the course of
cancer treatments.  These wastes include partially administered drug or
outdated materials returned to the pharmacy for disposal.  These wastes were
shipped for secure destruction at an EPA registered hazardous waste
incinerator (TSDF).  

 

 

Dr. Russell Mankes

141 Mohawk Dr

Schenectady, NY 12303-5732

518-355-1330

518-495-9775 (cellular)

Rmankes at nycap.rr.com

Tpathology at aim.com

 

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