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</o:shapelayout></xml><![endif]--></head><body lang=EN-US link=blue vlink=purple><div class=WordSection1><p class=MsoNormal>The fact that no cytotoxic or antineoplastic drugs were “bedside wasted” over the course of Dr. Mankes’ study is positive testimony to the great work of the American Society of Health-Based Pharmacists (ASHP) who in 1990 recommended that all unused cytotoxic drugs be handled as RCRA waste. Their work can serve as a poster-child for Drug Take Back programs.<o:p></o:p></p><p class=MsoNormal><o:p> </o:p></p><p class=MsoNormal>It is not surprising that no cancer treatments appear in the top 200 drugs listings by either sales ($) or unit. In the US, most drugs are prescribed for chronic conditions – the patient will take the drug one or more times per day for the rest of his/her life. For the most part, cancer treatments are acute treatments – the patient is treated for a short period of time and then either enters remission or sadly dies. Cytotoxic chemotherapy drugs, by their nature, are overwhelming for the patients. The most common are low cost generics (i.e. cyclophosphamide, doxorubicin, 5-FU, etoposide); are not specific to cancer cells and instead attack ALL fast growing cells in the body by causing DNA/RNA damage. The aim is to poison as many fast growing cancer cells as possible while not overwhelming the patient’s healthy cells. For that reason, a chemotherapy protocol includes on average 2-6 infusions with several weeks between infusions to give the patient’s body a chance to recover. As the drugs are generics and are used less than 6 times in a patient’s life, they should never appear on the top 200 drug list. <span style='color:#1F497D'><o:p></o:p></span></p><p class=MsoNormal><o:p> </o:p></p><p class=MsoNormal>In the US, the National Comprehensive Cancer Network (<a href="http://www.nccn.org/professionals/drug_compendium/content/contents.asp">http://www.nccn.org/professionals/drug_compendium/content/contents.asp</a>) recommends 209 different medications for standard oncology treatment. Of these 103 are listed by NIOSH as hazardous. NIOSH also lists an additional 7 older drugs not in common usage. Only 24 hazardous cancer treatments (+1 no longer used) are well known to exit patients in large quantities of active drugs. The information about each of these drugs was known BEFORE the drugs were approved by the FDA. It can be found in the Pharmacokinetics/Pharmacodynamics sections of each Drug Insert (that tightly folded page that comes with every drug but nobody reads). For example, up to 25% of an infused dose of cyclophosphamide (U058, <a href="http://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=591d9955-3d9c-4cdc-a308-2f1288376b9f">http://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=591d9955-3d9c-4cdc-a308-2f1288376b9f</a>) is excreted in the urine as intact drug in the 24 hours after infusion. The danger to others of the excreted intact cytotoxic drugs is why OSHA (<a href="http://www.osha.gov/dts/osta/otm/otm_vi/otm_vi_2.html">http://www.osha.gov/dts/osta/otm/otm_vi/otm_vi_2.html</a>) has strict guidelines for handling not only the bodily fluids but also linens and dishes used by the patients during the period of active excretion. Cyclophosphamide is also notorious because greater than 98% of it exits wastewater treatment as the original chemical (<span class=MsoHyperlink><span style='color:windowtext;text-decoration:none'>Buerge et al. 2006 Envir Sci Tech). <o:p></o:p></span></span></p><p class=MsoNormal><span class=MsoHyperlink><span style='color:windowtext;text-decoration:none'><o:p> </o:p></span></span></p><p class=MsoNormal><span class=MsoHyperlink><span style='color:windowtext;text-decoration:none'>Because highly toxic cytotoxic drugs are used rarely in the US health care population when compared to the total prescription drug volume, their extreme danger is frequently overlooked. But just as we used to overlook the danger of mercury in our homes, a rare extreme danger can cause a huge amount of damage.<o:p></o:p></span></span></p><p class=MsoNormal><span class=MsoHyperlink><span style='color:windowtext;text-decoration:none'><o:p> </o:p></span></span></p><p class=MsoNormal>Theresa O'Keefe, Ph.D.<br>Chief Scientific Officer<br><b>Pharma-Cycle Inc.</b><br><i>Helping Cancer Patients Protect Their Families</i><o:p></o:p></p><p class=MsoNormal> <a href="http://www.pharma-cycle.com" target="_blank">www.pharma-cycle.com</a><br><br><span style='font-size:11.0pt;font-family:"Calibri","sans-serif"'><o:p></o:p></span></p></div></body></html>