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</o:shapelayout></xml><![endif]--></head><body lang=EN-US link=blue vlink=purple style='margin-left:3.0pt;margin-top:3.0pt;margin-right:3.0pt;margin-bottom:.75pt'><div class=WordSection1><p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D'>Hi Ed and Diane, <o:p></o:p></span></p><p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D'>I would like to add to Catherine’s List.<o:p></o:p></span></p><p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D'>In August The World Health Organization published a Handbook on health care waste management and highlighted a group of Pharmaceuticals called Genotoxic and stated<o:p></o:p></span></p><p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D'><o:p> </o:p></span></p><p class=MsoNormal style='text-indent:.5in'><span style='font-size:16.0pt;background:yellow;mso-highlight:yellow'>Any discharge of genotoxic waste into the environment could have disastrous ecological consequences</span><span style='font-size:16.0pt'>.</span><span style='font-size:16.0pt;color:red'><o:p></o:p></span></p><p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D'>Most Genotoxic drugs are used in cancer treatment and 27 of them are excreted heavily in the patients urine, feces and vomit for 48 hours after treatment. The WHO states that it is the responsibility of the Pharmacist to control Genotoxic waste including the human waste and it is the responsibility of those involved in paying for the treatment cover the cost. We are the United States of America, we put a car on the moon, we can collect pee in a cup.<o:p></o:p></span></p><p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D'>I am attaching a list of the 27 bad actors.<o:p></o:p></span></p><p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D'>Jim Mullowney<o:p></o:p></span></p><p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D'><a href="mailto:jmullowney@pharma-cycle.com">jmullowney@pharma-cycle.com</a> <o:p></o:p></span></p><p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D'><o:p> </o:p></span></p><div><div style='border:none;border-top:solid #B5C4DF 1.0pt;padding:3.0pt 0in 0in 0in'><p class=MsoNormal><b><span style='font-size:10.0pt;font-family:"Tahoma","sans-serif";color:windowtext'>From:</span></b><span style='font-size:10.0pt;font-family:"Tahoma","sans-serif";color:windowtext'> pharmwaste-bounces@lists.dep.state.fl.us [mailto:pharmwaste-bounces@lists.dep.state.fl.us] <b>On Behalf Of </b>Ed Gottlieb<br><b>Sent:</b> Friday, December 06, 2013 8:44 AM<br><b>To:</b> Buxbaum, Diane; DeBiasi, Deborah (DEQ); Zimmer, Catherine; pharmwaste@lists.dep.state.fl.us<br><b>Cc:</b> abuxbaum@downtownwomen.com; ATL-LEADERS@LISTS.SIERRACLUB.ORG; cbuxbaum@sandiaprep.org<br><b>Subject:</b> Re: [Pharmwaste] Concentrations of prioritized pharmaceuticals ineffluents from 50 large wastewater treatment plants in the US andimplications for risk estimation<o:p></o:p></span></p></div></div><p class=MsoNormal><o:p> </o:p></p><div><p class=MsoNormal><span style='font-size:10.0pt;font-family:"Tahoma","sans-serif";color:windowtext'>Hi Diane,<o:p></o:p></span></p></div><div><p class=MsoNormal><span style='font-size:10.0pt;font-family:"Tahoma","sans-serif";color:windowtext'> <o:p></o:p></span></p></div><div><p class=MsoNormal><span style='font-size:10.0pt;font-family:"Tahoma","sans-serif";color:windowtext'>I would add to Catherine's list: <o:p></o:p></span></p></div><div><p class=MsoNormal><span style='font-size:10.0pt;font-family:"Tahoma","sans-serif";color:windowtext'>Change prescribing guidelines (based on inventory data from take-back events) to help reduce the amount of waste medications generated.<o:p></o:p></span></p></div><div><p class=MsoNormal style='mso-margin-top-alt:5.0pt;margin-right:0in;margin-bottom:5.0pt;margin-left:0in'><span style='font-size:10.0pt;font-family:"Tahoma","sans-serif";color:black'>Ed Gottlieb<br>Chair, Coalition for Safe Medication Disposal <br>Industrial Pretreatment Coordinator <br>Ithaca Area Wastewater Treatment Facility<br>525 3<sup>rd</sup> Street<br>Ithaca, NY 14850<br>(607) 273-8381<br>fax: (607) 273-8433<o:p></o:p></span></p></div><div><p class=MsoNormal><span style='font-size:10.0pt;font-family:"Tahoma","sans-serif";color:windowtext'><br>>>> "Catherine Zimmer" <<a href="mailto:zenllc@usfamily.net">zenllc@usfamily.net</a>> 12/5/2013 4:03 PM >>><o:p></o:p></span></p></div><div><div><div><p class=MsoNormal><span style='font-size:10.0pt;font-family:"Calibri","sans-serif";color:black'>Hi Diane,<o:p></o:p></span></p></div><div><p class=MsoNormal><span style='font-size:10.0pt;font-family:"Calibri","sans-serif";color:black'> <o:p></o:p></span></p></div><div><p class=MsoNormal><span style='font-size:10.0pt;font-family:"Calibri","sans-serif";color:black'>From everything I’ve read it would take a multitude of treatment regimens to address the plethora of pharmaceuticals (and other contaminants) in our wastewater systems. And, if we got breakdown, what would those breakdown products look like? Would they be biologically active? What kind of pollutants would they be? <o:p></o:p></span></p></div><div><p class=MsoNormal><span style='font-size:10.0pt;font-family:"Calibri","sans-serif";color:black'> <o:p></o:p></span></p></div><div><p class=MsoNormal><span style='font-size:10.0pt;font-family:"Calibri","sans-serif";color:black'>I hate to sound like a broken record, but a better strategy is to reduce and eliminate these things at the source. First, we stop using our surface waters as dumps. Industry has to re-use their own water, they can’t dump into rivers, lakes, oceans. WWTP, also re-use water. Households get educated on health improvements that don’t use drugs and MD support alternative treatments and less toxic/persistent pharmaceuticals when necessary. Individual households treat their sewage to remove rx. While this is a large undertaking, it seems ultimately a better outcome than trying to treat everything being dumped into the water. <o:p></o:p></span></p></div><div><p class=MsoNormal><span style='font-size:10.0pt;font-family:"Calibri","sans-serif";color:black'> <o:p></o:p></span></p></div><div><p class=MsoNormal><span style='font-size:10.0pt;font-family:"Calibri","sans-serif";color:black'>Very truly yours,<br><br>Catherine Zimmer, MS, BSMT<br>Principal<br>Zimmer Environmental Improvement LLC<br>Ph: 651.645.7509<o:p></o:p></span></p></div><div><div><div><p class=MsoNormal><span style='font-size:10.0pt;font-family:"Tahoma","sans-serif";color:black'> <o:p></o:p></span></p></div><div><div><p class=MsoNormal style='background:whitesmoke'><b><span style='font-size:10.0pt;font-family:"Tahoma","sans-serif";color:black'>From:</span></b><span style='font-size:10.0pt;font-family:"Tahoma","sans-serif";color:black'> <a href="mailto:Buxbaum.Diane@epa.gov" title="Buxbaum.Diane@epa.gov">Buxbaum, Diane</a> <o:p></o:p></span></p></div><div><p class=MsoNormal style='background:whitesmoke'><b><span style='font-size:10.0pt;font-family:"Tahoma","sans-serif";color:black'>Sent:</span></b><span style='font-size:10.0pt;font-family:"Tahoma","sans-serif";color:black'> Tuesday, December 03, 2013 2:44 PM<o:p></o:p></span></p></div><div><p class=MsoNormal style='background:whitesmoke'><b><span style='font-size:10.0pt;font-family:"Tahoma","sans-serif";color:black'>To:</span></b><span style='font-size:10.0pt;font-family:"Tahoma","sans-serif";color:black'> <a href="mailto:Deborah.DeBiasi@deq.virginia.gov" title="Deborah.DeBiasi@deq.virginia.gov">DeBiasi, Deborah (DEQ)</a> ; <a href="mailto:pharmwaste@lists.dep.state.fl.us" title="pharmwaste@lists.dep.state.fl.us">pharmwaste@lists.dep.state.fl.us</a> <o:p></o:p></span></p></div><div><p class=MsoNormal style='background:whitesmoke'><b><span style='font-size:10.0pt;font-family:"Tahoma","sans-serif";color:black'>Cc:</span></b><span style='font-size:10.0pt;font-family:"Tahoma","sans-serif";color:black'> <a href="mailto:abuxbaum@downtownwomen.com" title="abuxbaum@downtownwomen.com">abuxbaum@downtownwomen.com</a> ; <a href="mailto:cbuxbaum@sandiaprep.org" title="cbuxbaum@sandiaprep.org">cbuxbaum@sandiaprep.org</a> ; <a href="mailto:ATL-LEADERS@LISTS.SIERRACLUB.ORG" title="ATL-LEADERS@LISTS.SIERRACLUB.ORG">ATL-LEADERS@LISTS.SIERRACLUB.ORG</a> <o:p></o:p></span></p></div><div><p class=MsoNormal style='background:whitesmoke'><b><span style='font-size:10.0pt;font-family:"Tahoma","sans-serif";color:black'>Subject:</span></b><span style='font-size:10.0pt;font-family:"Tahoma","sans-serif";color:black'> RE: [Pharmwaste] Concentrations of prioritized pharmaceuticals ineffluents from 50 large wastewater treatment plants in the US andimplications for risk estimation<o:p></o:p></span></p></div></div></div><div><p class=MsoNormal><span style='font-family:"Calibri","sans-serif";color:black'> <o:p></o:p></span></p></div></div><div><p class=MsoNormal><span style='font-family:"Calibri","sans-serif";color:#0F243E'>I am ccing some nongovernmental environmental activists on this email Wow, how depressing. Were most or all of these plants secondary plants? Were any tertiary? Are there any ideas of nonprohibitive methods for reducing or eliminating the discharge of these pharmaceuticals into the receiving bodies? Would, in areas where there is the land, exposure to sunlight and ponds allow for the breakdown of these drugs (and how dangerous might those products be)? Probably not possible in most urban areas and even where possible very costly. <o:p></o:p></span></p><p class=MsoNormal> <span style='font-family:"Calibri","sans-serif";color:#0F243E'><o:p></o:p></span></p><div><p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:#0F243E'>Diane D. Buxbaum, MPH<o:p></o:p></span></p><p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:#0F243E'>Environmental Scientist<o:p></o:p></span></p><p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:#0F243E'>U.S. Environmental Protection Agency,<o:p></o:p></span></p><p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:#0F243E'>Region 2<o:p></o:p></span></p><p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:#0F243E'>Division of Enforcement and Compliance Assistance<o:p></o:p></span></p><p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:#0F243E'>290 Broadway (21 East)<o:p></o:p></span></p><p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:#0F243E'>New York, NY 10007<o:p></o:p></span></p><p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:#0F243E'><a href="mailto:buxbaum.diane@epa.gov">buxbaum.diane@epa.gov</a><o:p></o:p></span></p><p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:#0F243E'>Phone 212-637-3919<o:p></o:p></span></p><p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:#0F243E'>Fax 212-637-4086<o:p></o:p></span></p></div><p class=MsoNormal> <span style='font-family:"Calibri","sans-serif";color:#0F243E'><o:p></o:p></span></p><div><div style='border:none;border-top:solid #B5C4DF 1.0pt;padding:3.0pt 0in 0in 0in'><p class=MsoNormal><b><span style='font-size:10.0pt;font-family:"Tahoma","sans-serif";color:windowtext'>From:</span></b><span style='font-size:10.0pt;font-family:"Tahoma","sans-serif";color:windowtext'> <a href="mailto:pharmwaste-bounces@lists.dep.state.fl.us">pharmwaste-bounces@lists.dep.state.fl.us</a> [<a href="mailto:pharmwaste-bounces@lists.dep.state.fl.us">mailto:pharmwaste-bounces@lists.dep.state.fl.us</a>] <b>On Behalf Of </b>DeBiasi, Deborah (DEQ)<br><b>Sent:</b> Tuesday, December 03, 2013 3:21 PM<br><b>To:</b> <a href="mailto:pharmwaste@lists.dep.state.fl.us">pharmwaste@lists.dep.state.fl.us</a><br><b>Subject:</b> [Pharmwaste] Concentrations of prioritized pharmaceuticals in effluents from 50 large wastewater treatment plants in the US and implications for risk estimation<o:p></o:p></span></p></div></div><p class=MsoNormal> <o:p></o:p></p><p class=MsoNormal> <o:p></o:p></p><table class=MsoNormalTable border=0 cellspacing=0 cellpadding=0 style='border-collapse:collapse'><tr style='height:95.6pt;mso-height-rule:exactly'><td width=615 valign=top style='width:461.3pt;padding:0in 0in 0in 0in;height:95.6pt;mso-height-rule:exactly'><p class=MsoNormal style='margin-right:12.6pt;line-height:16.7pt;mso-line-height-rule:exactly;vertical-align:baseline'><span style='font-size:15.5pt;color:black'>Concentrations of prioritized pharmaceuticals in ef</span><span style='font-size:14.5pt;font-family:"Arial","sans-serif";color:black'>fl</span><span style='font-size:15.5pt;color:black'>uents from 50 large wastewater treatment plants in the US and implications for risk estimation<o:p></o:p></span></p><p class=MsoNormal style='margin-top:9.2pt;line-height:12.8pt;mso-line-height-rule:exactly;vertical-align:baseline'><span style='color:black'>Mitchell S. Kostich</span><sup><span style='font-family:"Arial","sans-serif";color:black'>*</span></sup><span style='color:black'>, Angela L. Batt, James M. Lazorchak<o:p></o:p></span></p><p class=MsoNormal style='mso-margin-top-alt:5.45pt;margin-right:19.8pt;margin-bottom:.95pt;margin-left:0in;line-height:8.4pt;mso-line-height-rule:exactly;vertical-align:baseline'><b><i><span style='font-size:7.0pt;color:black'>Ecological Exposure Research Division, National Exposure Research Laboratory, U.S. Environmental Protection Agency, 26 W. Martin Luther King Drive, Cincinnati, OH 45268, USA<o:p></o:p></span></i></b></p></td><td width=83 valign=top style='width:62.15pt;padding:0in 0in 0in 0in;height:95.6pt;mso-height-rule:exactly'></td></tr></table><p class=MsoNormal> <o:p></o:p></p><p class=MsoNormal> <o:p></o:p></p><p class=MsoNormal style='mso-margin-top-alt:.2pt;margin-right:0in;margin-bottom:7.4pt;margin-left:0in;line-height:8.4pt;mso-line-height-rule:exactly;vertical-align:baseline'><b><span style='color:black;letter-spacing:3.0pt'>ABSTRACT<o:p></o:p></span></b></p><p class=MsoNormal style='text-align:justify;line-height:9.5pt;mso-line-height-rule:exactly;vertical-align:baseline'><img border=0 width=477 height=2 id="_x0000_i1025" src="cid:image001.png@01CEF270.40DC6E50"><span style='color:black;letter-spacing:-.3pt'>We measured concentrations of 56 active pharmaceutical ingredients (APIs) in effluent samples from 50 large wastewater treatment plants across the US. Hydrochlorothiazide was found in every sample. Metoprolol, atenolol, and carbamazepine were found in over 90% of the samples. Valsartan had the highest concentration (5300 ng/L), and also had the highest average concentration (1600 ng/L) across all 50 samples. Estimates of potential risks to healthy human adults were greatest for six anti-hypertensive APIs (lisinopril, hydrochlorothiazide, valsartan, atenolol, enalaprilat, and metoprolol), but nevertheless suggest risks of exposure to individual APIs as well as their mixtures are generally very low. Estimates of potential risks to aquatic life were also low for most APIs, but suggest more detailed study of potential ecological impacts from four analytes (sertraline, propranolol, desmethylsertraline, and valsartan).<o:p></o:p></span></p><p class=MsoNormal style='text-align:justify;line-height:9.5pt;mso-line-height-rule:exactly;vertical-align:baseline'> <span style='color:black;letter-spacing:-.3pt'><o:p></o:p></span></p><p class=MsoNormal><span style='color:black;letter-spacing:-.4pt'>Published by Elsevier Ltd.</span><o:p></o:p></p><p class=MsoNormal> <o:p></o:p></p><p class=MsoNormal> <o:p></o:p></p><p class=MsoNormal> <o:p></o:p></p><p class=MsoNormal> <o:p></o:p></p><p class=MsoNormal><span style='font-size:10.0pt;color:navy'>Deborah L. DeBiasi</span><span style='font-size:11.0pt;color:navy'><br></span><b><span style='font-size:10.0pt;color:navy'>Email: <a href="mailto:Deborah.DeBiasi@deq.virginia.gov">Deborah.DeBiasi@deq.virginia.gov</a></span></b><b><i><span style='font-size:10.0pt;color:red'><br></span></i></b><span style='font-size:10.0pt;color:navy'>WEB site address: <a href="http://www.deq.virginia.gov/">www.deq.virginia.gov</a></span><span style='font-size:11.0pt;color:navy'><br></span><span style='font-size:10.0pt;color:navy'>Virginia Department of Environmental Quality</span><span style='font-size:11.0pt;color:navy'><br></span><span style='font-size:10.0pt;color:navy'>Office of Water Permits </span><span style='font-size:11.0pt;color:navy'><br></span><span style='font-size:10.0pt;color:navy'>Industrial Pretreatment/Whole Effluent Toxicity (WET) Program</span><span style='font-size:11.0pt;color:navy'><br></span><span style='font-size:10.0pt;color:navy'>PPCPs, EDCs, and Microconstituents<o:p></o:p></span></p><p class=MsoNormal><span style='font-size:11.0pt;color:navy'><a href="http://www.deq.virginia.gov/Programs/Water/PermittingCompliance/PollutionDischargeElimination/Microconstituents.aspx">http://www.deq.virginia.gov/Programs/Water/PermittingCompliance/PollutionDischargeElimination/Microconstituents.aspx</a></span><span style='font-size:10.0pt;color:navy'><o:p></o:p></span></p><p class=MsoNormal><span style='font-size:10.0pt;color:navy'>Mail: P.O. Box 1105, Richmond, VA 23218</span><span style='font-size:11.0pt;color:navy'><br></span><span style='font-size:10.0pt;color:navy'>Location: 629 E. Main Street, Richmond, VA 23219</span><span style='font-size:11.0pt;color:navy'><br></span><span style='font-size:10.0pt;color:navy'>PH: 804-698-4028 FAX: 804-698-4032<o:p></o:p></span></p><p class=MsoNormal> <o:p></o:p></p><div class=MsoNormal align=center style='text-align:center'><span style='font-family:"Calibri","sans-serif";color:black'><hr size=2 width="100%" align=center></span></div><p class=MsoNormal><span style='font-family:"Calibri","sans-serif";color:black'>---<br>Note: As a courtesy to other listserv subscribers, please post messages to the listserv in plain text format to avoid the garbling of messages received by digest recipients.<br>---<br>TO SUBSCRIBE, go to: <a href="http://lists.dep.state.fl.us/cgi-bin/mailman/listinfo/pharmwaste">http://lists.dep.state.fl.us/cgi-bin/mailman/listinfo/pharmwaste</a> <br>TO UNSUBSCRIBE, DO NOT REPLY TO THE LISTSERV. 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