[Pharmwaste] FW: Preventing Environmental Contamination by Drugs

Volkman, Jennifer (MPCA) jennifer.volkman at state.mn.us
Wed Jul 2 16:28:31 EDT 2014


FYI

From: Daughton, Christian [mailto:Daughton.Christian at epa.gov]
Sent: Wednesday, July 02, 2014 3:09 PM
To: Daughton, Christian
Subject: Preventing Environmental Contamination by Drugs

Subject: Preventing Environmental Contamination by Drugs

Our latest research at the US EPA on the role of pollution prevention for reducing the entry of pharmaceuticals to the environment is captured in a new publication:
            "Eco-directed sustainable prescribing: feasibility for reducing water contamination by drugs." Science of the Total Environment 2014, 493:392-404; http://dx.doi.org/10.1016/j.scitotenv.2014.06.013 [Open Access].

The entry to the environment of active pharmaceutical ingredients (APIs) from the use of therapeutic medications has been extensively documented. Considerable attention and effort has been expended over the last two decades on "downstream" approaches for reducing the potential of APIs to enter the environment. These approaches have almost exclusively relied on conventional, end-of-pipe pollution control measures - primarily sewage treatment and systematic collection of leftover medication waste.

Surprisingly, and in stark contrast, there has been little interest in "up-stream" measures to prevent the potential for API entry to the ambient environment - before any waste is ever generated. Such pollution prevention measures would serve to reduce the contributions from the three primary environmental sources of APIs - excretion, bathing, and the many factors responsible for the generation of leftover, unwanted medications. Pollution prevention measures are more sustainable - holding numerous advantages over pollution control - including increased effectiveness, reduced cost, conservation of resources, and often, many unforeseen collateral benefits.

Last year, we published the first of two pollution prevention concepts targeted at reducing API contamination of the environment. This first approach targeted a major up-stream process in the life cycle of pharmaceuticals - the clinical practice of prescribing. This new concept revealed that many drugs could be prescribed at lower doses than indicated on the label and still achieve therapeutic endpoints. Lower-dose prescribing is a viable means of reducing the ultimate excretion of APIs into sewage as well as reducing the incidence of leftover medications that might be disposed to sewers (partly as a result of lowering the occurrence of dose-related adverse events in patients). This first pollution-prevention concept has been published and is freely available for download:
            "Lower-Dose Prescribing: Minimizing 'Side Effects' of Pharmaceuticals on Society and the Environment," Science of the Total Environment, 2013, 443:324-337; http://dx.doi.org/10.1016/j.scitotenv.2012.10.092 [Open Access].

A summary is now provided here of the second paper on API pollution prevention, which builds upon the first approach on low-dose prescribing:
            "Eco-directed sustainable prescribing: feasibility for reducing water contamination by drugs." Science of the Total Environment 2014, 493:392-404; http://dx.doi.org/10.1016/j.scitotenv.2014.06.013 [Open Access].

Note that this paper includes three Supplementary Tables, which must be downloaded separately.

This paper evaluates a second approach for preventing API environmental contamination - by way of modifying and guiding clinical prescribing behavior and practices. This paper examines whether there is an easy way to categorize APIs according to their metabolic excretion profiles - delineated by the two extremes: those APIs that are extensively excreted unchanged versus those that are extensively metabolized. The latter could theoretically be prescribed with less concern for environmental impact (assuming the absence of effects from bioactive metabolites).

In the process of trying to determine the excretion potential for hundreds of APIs, this paper involved compiling an extensive database of environmental occurrence data. These data were mined from the published literature and were captured in two of three Supplementary tables. For the hundreds of APIs that were targeted in this investigation, the literature-derived occurrence data are among the most comprehensive set compiled to date.

For a significant number of APIs, the published occurrence data supported "evidence of absence" (that is, evidence that the levels of these APIs in the environment were negligible). The prescribing of these APIs could therefore possibly have comparatively minimal impact on the environment. For another set of APIs, little if any occurrence data has been published. Such "absence of data" is valuable in its own right, for reasons discussed in another recent STOTEN article:
            "The Matthew Effect and widely prescribed pharmaceuticals lacking environmental monitoring: Case study of an exposure-assessment vulnerability," Science of the Total Environment, 2014, 466-467:315-325;  http://dx.doi.org/10.1016/j.scitotenv.2013.06.111 [OpenAccess].

For example, absence of data can be used to better-inform future studies to ensure that potentially important chemical stressors are not being overlooked in environmental monitoring surveys or risk assessments.

Combined, the two pollution prevention approaches summarized here (the practice of clinical prescribing focused on reduced doses and that guided by the excretion potentials of APIs) are referred to here as Eco-Directed Sustainable Prescribing (EDSP). As an approach to pollution prevention, EDSP could also result in substantial collateral benefits for health care. These potential collateral benefits include: improving therapeutic outcomes; reducing patient expense; minimizing medication wastage and thereby the subsequent need for disposal; and reducing morbidity and mortality from accidental poisonings caused by improperly stored or disposed medications. Imprudent drug use (inappropriate, non-optimal selection of a specific medication and the use of unnecessarily excessive doses) is a major aspect of escalating national health care costs - which, overall, consumes an unsustainable 17% of GDP. EDSP could play a role in reducing a portion of this drain on the economy and at the same time protect the environment, improve healthcare, and prevent avoidable human poisonings.

This latest manuscript resulted from an EPA internal research grant awarded under the second year of ORD's Pathfinder Innovation Program: http://www2.epa.gov/innovation/pathfinder-innovation-projects-awardees-2012

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====================
Christian Daughton, Ph.D.
Environmental Chemistry Branch
Environmental Sciences Division
National Exposure Research Laboratory
U.S. Environmental Protection Agency
944 East Harmon
Las Vegas, NV 89119
702-798-2207
daughton.christian at epa.gov<mailto:daughton.christian at epa.gov>

CV:   http://www.epa.gov/esd/bios/daughton.htm#publications
PPCPs Literature Database:   http://epa.gov/ppcp/lit.html
Drug Disposal:   http://epa.gov/ppcp/projects/disposal.html

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