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<p class="MsoNormal"><span style="font-size:14.0pt;color:#1F497D">FYI<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:14.0pt;color:#1F497D"><o:p> </o:p></span></p>
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<p class="MsoNormal"><b><span style="font-size:10.0pt;font-family:"Tahoma","sans-serif"">From:</span></b><span style="font-size:10.0pt;font-family:"Tahoma","sans-serif""> Daughton, Christian [mailto:Daughton.Christian@epa.gov]
<br>
<b>Sent:</b> Wednesday, July 02, 2014 3:09 PM<br>
<b>To:</b> Daughton, Christian<br>
<b>Subject:</b> Preventing Environmental Contamination by Drugs<o:p></o:p></span></p>
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<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal" style="text-autospace:none"><span style="font-size:12.0pt;font-family:"Times New Roman","serif"">Subject: Preventing Environmental Contamination by Drugs<o:p></o:p></span></p>
<p class="MsoNormal" style="text-autospace:none"><span style="font-size:12.0pt;font-family:"Times New Roman","serif""><o:p> </o:p></span></p>
<p class="MsoNormal" style="text-autospace:none"><span style="font-size:12.0pt;font-family:"Times New Roman","serif"">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:<o:p></o:p></span></p>
<p class="MsoNormal" style="text-autospace:none"><span style="font-size:12.0pt;font-family:"Times New Roman","serif""> "Eco-directed sustainable prescribing: feasibility for reducing water contamination by drugs."<i> Science of the Total Environment
</i>2014, 493:392-404; <a href="http://dx.doi.org/10.1016/j.scitotenv.2014.06.013">
<span style="color:blue">http://dx.doi.org/10.1016/j.scitotenv.2014.06.013</span></a> [Open Access].<o:p></o:p></span></p>
<p class="MsoNormal" style="text-autospace:none"><span style="font-size:12.0pt;font-family:"Times New Roman","serif""><o:p> </o:p></span></p>
<p class="MsoNormal" style="text-autospace:none"><span style="font-size:12.0pt;font-family:"Times New Roman","serif"">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"<i>
</i>approaches for reducing the potential of APIs to enter the environment. These approaches have almost exclusively relied on conventional, end-of-pipe
<i>pollution control </i>measures - primarily sewage treatment and systematic collection of leftover medication waste.<o:p></o:p></span></p>
<p class="MsoNormal" style="text-autospace:none"><span style="font-size:12.0pt;font-family:"Times New Roman","serif""><o:p> </o:p></span></p>
<p class="MsoNormal" style="text-autospace:none"><span style="font-size:12.0pt;font-family:"Times New Roman","serif"">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 <i>pollution prevention </i>
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.<o:p></o:p></span></p>
<p class="MsoNormal" style="text-autospace:none"><span style="font-size:12.0pt;font-family:"Times New Roman","serif""><o:p> </o:p></span></p>
<p class="MsoNormal" style="text-autospace:none"><span style="font-size:12.0pt;font-family:"Times New Roman","serif"">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:<o:p></o:p></span></p>
<p class="MsoNormal" style="text-autospace:none"><span style="font-size:12.0pt;font-family:"Times New Roman","serif""> "Lower-Dose Prescribing: Minimizing 'Side Effects' of Pharmaceuticals on Society and the Environment,"
<i>Science of the Total Environment</i>, 2013, 443:324-337; <a href="http://dx.doi.org/10.1016/j.scitotenv.2012.10.092">
<span style="color:blue">http://dx.doi.org/10.1016/j.scitotenv.2012.10.092</span></a> [Open Access].<o:p></o:p></span></p>
<p class="MsoNormal" style="text-autospace:none"><span style="font-size:12.0pt;font-family:"Times New Roman","serif""><o:p> </o:p></span></p>
<p class="MsoNormal" style="text-autospace:none"><span style="font-size:12.0pt;font-family:"Times New Roman","serif"">A summary is now provided here of the second paper on API pollution prevention, which builds upon the first approach on low-dose prescribing:<o:p></o:p></span></p>
<p class="MsoNormal" style="text-autospace:none"><span style="font-size:12.0pt;font-family:"Times New Roman","serif""> "Eco-directed sustainable prescribing: feasibility for reducing water contamination by drugs."
<i>Science of the Total Environment </i>2014, 493:392-404; <a href="http://dx.doi.org/10.1016/j.scitotenv.2014.06.013">
<span style="color:blue">http://dx.doi.org/10.1016/j.scitotenv.2014.06.013</span></a> [Open Access].<o:p></o:p></span></p>
<p class="MsoNormal" style="text-autospace:none"><span style="font-size:12.0pt;font-family:"Times New Roman","serif""><o:p> </o:p></span></p>
<p class="MsoNormal" style="text-autospace:none"><span style="font-size:12.0pt;font-family:"Times New Roman","serif"">Note that this paper includes three Supplementary Tables, which must be downloaded separately.
<o:p></o:p></span></p>
<p class="MsoNormal" style="text-autospace:none"><span style="font-size:12.0pt;font-family:"Times New Roman","serif""> <o:p></o:p></span></p>
<p class="MsoNormal" style="text-autospace:none"><span style="font-size:12.0pt;font-family:"Times New Roman","serif"">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).<o:p></o:p></span></p>
<p class="MsoNormal" style="text-autospace:none"><span style="font-size:12.0pt;font-family:"Times New Roman","serif""><o:p> </o:p></span></p>
<p class="MsoNormal" style="text-autospace:none"><span style="font-size:12.0pt;font-family:"Times New Roman","serif"">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. <o:p></o:p></span></p>
<p class="MsoNormal" style="text-autospace:none"><span style="font-size:12.0pt;font-family:"Times New Roman","serif""><o:p> </o:p></span></p>
<p class="MsoNormal" style="text-autospace:none"><span style="font-size:12.0pt;font-family:"Times New Roman","serif"">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:<o:p></o:p></span></p>
<p class="MsoNormal" style="text-autospace:none"><span style="font-size:12.0pt;font-family:"Times New Roman","serif""> "The Matthew Effect and widely prescribed pharmaceuticals lacking environmental monitoring: Case study of an exposure-assessment
vulnerability," <i>Science of the Total Environment</i>, 2014, 466–467:315–325;
<a href="http://dx.doi.org/10.1016/j.scitotenv.2013.06.111"><span style="color:blue">http://dx.doi.org/10.1016/j.scitotenv.2013.06.111</span></a> [OpenAccess].
<o:p></o:p></span></p>
<p class="MsoNormal" style="text-autospace:none"><span style="font-size:12.0pt;font-family:"Times New Roman","serif""><o:p> </o:p></span></p>
<p class="MsoNormal" style="text-autospace:none"><span style="font-size:12.0pt;font-family:"Times New Roman","serif"">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.<o:p></o:p></span></p>
<p class="MsoNormal" style="text-autospace:none"><span style="font-size:12.0pt;font-family:"Times New Roman","serif""><o:p> </o:p></span></p>
<p class="MsoNormal" style="text-autospace:none"><span style="font-size:12.0pt;font-family:"Times New Roman","serif"">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.<o:p></o:p></span></p>
<p class="MsoNormal" style="text-autospace:none"><span style="font-size:12.0pt;font-family:"Times New Roman","serif""><o:p> </o:p></span></p>
<p class="MsoNormal" style="text-autospace:none"><span style="font-size:12.0pt;font-family:"Times New Roman","serif"">This latest manuscript resulted from an EPA internal research grant awarded under the second year of ORD's Pathfinder Innovation Program:
<a href="http://www2.epa.gov/innovation/pathfinder-innovation-projects-awardees-2012">
http://www2.epa.gov/innovation/pathfinder-innovation-projects-awardees-2012</a><o:p></o:p></span></p>
<p class="MsoNormal" style="text-autospace:none"><span style="font-size:12.0pt;font-family:"Times New Roman","serif""><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-size:12.0pt;font-family:"Times New Roman","serif"">Please note that you received this email as a member of a blind distribution list. If you would like to be removed from this distribution list, please let me know.</span><span style="font-size:12.0pt"><o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:12.0pt"><o:p> </o:p></span></p>
<p class="MsoNormal" style="margin-bottom:12.0pt"><span style="font-size:10.0pt;color:black">====================<br>
Christian Daughton, </span><span style="font-size:9.0pt;color:black">Ph.D.</span><span style="font-size:10.0pt;color:black"><br>
Environmental Chemistry Branch<br>
Environmental Sciences Division<br>
National Exposure Research Laboratory<br>
U.S. Environmental Protection Agency<br>
944 East Harmon<br>
Las Vegas, NV 89119<br>
702-798-2207<br>
<a href="mailto:daughton.christian@epa.gov"><span style="color:blue">daughton.christian@epa.gov</span></a><br>
<br>
</span><span style="font-size:9.0pt;color:black">CV: <a href="http://www.epa.gov/esd/bios/daughton.htm#publications">
<span style="color:blue">http://www.epa.gov/esd/bios/daughton.htm#publications</span></a><br>
PPCPs Literature Database: <a href="http://epa.gov/ppcp/lit.html"><span style="color:blue">http://epa.gov/ppcp/lit.html</span></a><br>
Drug Disposal: <a href="http://epa.gov/ppcp/projects/disposal.html"><span style="color:blue">http://epa.gov/ppcp/projects/disposal.html</span></a></span><span style="color:#1F497D"><o:p></o:p></span></p>
<p class="MsoNormal"><o:p> </o:p></p>
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