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</o:shapelayout></xml><![endif]--></head><body lang=EN-US link="#0563C1" vlink="#954F72"><div class=WordSection1><p class=MsoNormal><span style='color:#1F497D'>Thanks Laurie,<o:p></o:p></span></p><p class=MsoNormal><span style='color:#1F497D'><o:p> </o:p></span></p><p class=MsoNormal><span style='color:#1F497D'>Hope everyone’s back in the working mood for this new year (blech…, not me!),<o:p></o:p></span></p><p class=MsoNormal><span style='color:#1F497D'><o:p> </o:p></span></p><p class=MsoNormal><span style='color:#1F497D'>Just out of curiosity, I googled metformin and scanned its “FDA Approval History” from 3/95 up until 8/14. Although I didn’t check every date and “Applicant” (pharmaceutical co.?), I’m estimating there are 50+/- different companies who are making this drug now, if I’m understanding the “Approval History” chart correctly.<o:p></o:p></span></p><p class=MsoNormal><span style='color:#1F497D'><o:p> </o:p></span></p><p class=MsoNormal><span style='color:#1F497D'>Exponentially compound that number by the thousands of other drugs being manufacturing by a multitude of “big/little pharmas” and it’s no wonder why that humongous group can’t re-formulate their drugs to completely metabolize while in the patient. Even if forced to (at the consumer’s expense) which is highly unlikely in our lifetime, the generics are already eating up my paycheck the way it is. Food, electricity, etc. or high dollar BP, etc meds?<o:p></o:p></span></p><p class=MsoNormal><span style='color:#1F497D'><o:p> </o:p></span></p><p class=MsoNormal><span style='color:#1F497D'>I want to personally thank Ms. Tenace(ious) for giving us this platform to share stories, reports, etc to bring to the forefront this not-so-subtle environmental issue for the past…what?...almost a decade? Without this listserve and many of its very active members I don’t believe pharmaceutical laden waters of the U.S. would be at the level it has gained at EPA, DEA and the FDA. <o:p></o:p></span></p><p class=MsoNormal><span style='color:#1F497D'><o:p> </o:p></span></p><p class=MsoNormal><span style='color:#1F497D'>Kudos goes out to you Ms. Tenace!<o:p></o:p></span></p><p class=MsoNormal><span style='color:#1F497D'><o:p> </o:p></span></p><p class=MsoNormal><span style='color:#1F497D'>Let’s keep this wheel churning, <o:p></o:p></span></p><p class=MsoNormal><span style='color:#1F497D'><o:p> </o:p></span></p><p class=MsoNormal><span style='color:#1F497D'>Allen Gilliam<o:p></o:p></span></p><p class=MsoNormal><span style='color:#1F497D'>ADEQ State Pretreatment Coordinator<o:p></o:p></span></p><p class=MsoNormal><span style='color:#1F497D'>501.682.0625<o:p></o:p></span></p><p class=MsoNormal><span style='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"'>From:</span></b><span style='font-size:10.0pt;font-family:"Tahoma","sans-serif"'> pharmwaste-bounces@lists.dep.state.fl.us [mailto:pharmwaste-bounces@lists.dep.state.fl.us] <b>On Behalf Of </b>Tenace, Laurie<br><b>Sent:</b> Monday, January 05, 2015 7:27 AM<br><b>To:</b> 'pharmwaste@lists.dep.state.fl.us'<br><b>Subject:</b> [Pharmwaste] common diabetes medication among drugs found in lake Michigan<o:p></o:p></span></p></div></div><p class=MsoNormal><o:p> </o:p></p><p class=MsoNormal style='margin-bottom:9.0pt;background:white'><span lang=EN style='font-size:7.5pt;font-family:"Verdana","sans-serif";color:#444444'><a href="http://www.jsonline.com/news/health/common-diabetes-medication-among-drugs-found-in-lake-michigan-b99417112z1-287238651.html">http://www.jsonline.com/news/health/common-diabetes-medication-among-drugs-found-in-lake-michigan-b99417112z1-287238651.html</a><o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:9.0pt;background:white'><span lang=EN style='font-size:7.5pt;font-family:"Verdana","sans-serif";color:#444444'><o:p> </o:p></span></p><p class=MsoNormal style='margin-bottom:9.0pt;background:white'><span lang=EN style='font-size:7.5pt;font-family:"Verdana","sans-serif";color:#444444'>There is more than one way to measure prescription drug use in modern society.<o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:9.0pt;background:white'><span lang=EN style='font-size:7.5pt;font-family:"Verdana","sans-serif";color:#444444'>The most direct method is just to count up prescriptions filled by America's pharmacies. That would show, for instance, that more than 180 million prescriptions for diabetes drugs were dispensed in 2013.<o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:9.0pt;background:white'><span lang=EN style='font-size:7.5pt;font-family:"Verdana","sans-serif";color:#444444'>Or you could test the treated water coming out of sewage facilities such as the South Shore plant in Oak Creek.<o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:9.0pt;background:white'><span lang=EN style='font-size:7.5pt;font-family:"Verdana","sans-serif";color:#444444'>That approach reveals that in the Lake Michigan waters outside the plant, the diabetes drug metformin was the most common personal care product found by researchers with the <a href="http://uwm.edu/freshwater/" target="_blank"><span style='color:#002269;text-decoration:none'>School of Freshwater Sciences </span></a>at the University of Wisconsin-Milwaukee.<o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:9.0pt;background:white'><span lang=EN style='font-size:7.5pt;font-family:"Verdana","sans-serif";color:#444444'>More importantly, according to their latest research, the levels of metformin were so high that the drug could be disrupting the endocrine systems of fish.<o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:9.0pt;background:white'><span lang=EN style='font-size:7.5pt;font-family:"Verdana","sans-serif";color:#444444'>Last month, <a href="http://www.jsonline.com/watchdog/watchdogreports/effects-of-diabetes-drugs-dubious-b99398554z1-286482971.html"><span style='color:#002269;text-decoration:none'>a Journal Sentinel/MedPage Today investigation </span></a>found booming sales of diabetes drugs, which in 2013 had grown to more than $23 billion.<o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:9.0pt;background:white'><span lang=EN style='font-size:7.5pt;font-family:"Verdana","sans-serif";color:#444444'>Metformin is a first-line treatment for type 2 diabetes and is the most commonly prescribed medicine for the condition. In 2013, about 70 million prescriptions were dispensed, according to IMS Health, a drug market research firm.<o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:9.0pt;background:white'><span lang=EN style='font-size:7.5pt;font-family:"Verdana","sans-serif";color:#444444'>It is so ubiquitous it can easily be found in water samples taken two miles off the shore of Lake Michigan.<o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:9.0pt;background:white'><span lang=EN style='font-size:7.5pt;font-family:"Verdana","sans-serif";color:#444444'>"I was kind of a surprise," said Rebecca Klaper, a professor of freshwater science at UWM. "It was not even on our radar screen. I said, 'What is this drug?' "<o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:9.0pt;background:white'><span lang=EN style='font-size:7.5pt;font-family:"Verdana","sans-serif";color:#444444'>The drugs get into the sewage and eventually the lake because they are not broken down completely after they are consumed and then excreted.<o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:9.0pt;background:white'><span lang=EN style='font-size:7.5pt;font-family:"Verdana","sans-serif";color:#444444'>The metformin concentrations are low, compared with the amount taken by people.<o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:9.0pt;background:white'><span lang=EN style='font-size:7.5pt;font-family:"Verdana","sans-serif";color:#444444'>For instance, coming right out of the treatment plant the levels are about 40 parts per billion. About two miles away, they drop to 120 parts per trillion.<o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:9.0pt;background:white'><span lang=EN style='font-size:7.5pt;font-family:"Verdana","sans-serif";color:#444444'>Other commonly found substances include caffeine, sulfamethoxazole, an antibiotic, and triclosan, an antibacterial and antifungal found in soap and other consumer products.<o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:9.0pt;background:white'><span lang=EN style='font-size:7.5pt;font-family:"Verdana","sans-serif";color:#444444'>Klaper co-authored a 2013 science journal paper on the finding as well as another one this year.<o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:9.0pt;background:white'><span lang=EN style='font-size:7.5pt;font-family:"Verdana","sans-serif";color:#444444'>The more recent research suggests that metformin in lake water is not just a curious artifact of everyday life.<o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:9.0pt;background:white'><span lang=EN style='font-size:7.5pt;font-family:"Verdana","sans-serif";color:#444444'>The study looked at the effect of metformin on fathead minnows in the lab that were exposed to the drug at levels found in the lake for four weeks.<o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:9.0pt;background:white'><span lang=EN style='font-size:7.5pt;font-family:"Verdana","sans-serif";color:#444444'>It found gene expression suggesting disruption of the endocrine system of male fish, but not females. In essence, the males were producing biochemicals that are associated with female minnows. The biochemicals are precursors to the production of eggs.<o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:9.0pt;background:white'><span lang=EN style='font-size:7.5pt;font-family:"Verdana","sans-serif";color:#444444'>Klaper said that because the minnows are a stand-in for other fish, the changes also could be affecting other species such as perch, walleye and northern pike.<o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:9.0pt;background:white'><span lang=EN style='font-size:7.5pt;font-family:"Verdana","sans-serif";color:#444444'>The UWM research confirms what others have found regarding prescription drugs showing up in America's lakes, rivers and streams, said Melissa Lenczewski, an associate professor of geology and environmental geosciences at Northern Illinois University.<o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:9.0pt;background:white'><span lang=EN style='font-size:7.5pt;font-family:"Verdana","sans-serif";color:#444444'>For years, it was assumed that the volume of water in the Great Lakes was so enormous that any drugs that got through treatment facilities would be diluted to the point that they would not pose a problem, said Lenczewski, who was not a part of the UWM study.<o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:9.0pt;background:white'><span lang=EN style='font-size:7.5pt;font-family:"Verdana","sans-serif";color:#444444'>That theory itself now is being diluted.<o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:9.0pt;background:white'><span lang=EN style='font-size:7.5pt;font-family:"Verdana","sans-serif";color:#444444'>Even more concerning are the much higher levels of antibiotics that are being put into rivers and streams near pig farms where the drugs are used to produce larger animals, she said.<o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:9.0pt;background:white'><span lang=EN style='font-size:7.5pt;font-family:"Verdana","sans-serif";color:#444444'>In addition, strains of antibiotic-resistant bacteria also have been found in water near those farms, she said.<o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:9.0pt;background:white'><span lang=EN style='font-size:7.5pt;font-family:"Verdana","sans-serif";color:#444444'>"It is very alarming how much we are putting drugs out there in the environment," she said.<o:p></o:p></span></p><p class=MsoNormal><o:p> </o:p></p><p class=MsoNormal><o:p> </o:p></p><p class=MsoNormal>Laurie Tenace<o:p></o:p></p><p class=MsoNormal>Environmental Specialist<o:p></o:p></p><p class=MsoNormal>Waste Reduction Section<o:p></o:p></p><p class=MsoNormal>Florida Department of Environmental Protection<o:p></o:p></p><p class=MsoNormal>2600 Blair Stone Road, MS 4555<o:p></o:p></p><p class=MsoNormal>Tallahassee, FL 32399-2400<o:p></o:p></p><p class=MsoNormal>850.245.8759<o:p></o:p></p><p class=MsoNormal><a href="mailto:Laurie.Tenace@dep.state.fl.us">Laurie.Tenace@dep.state.fl.us</a><o:p></o:p></p><p class=MsoNormal><o:p> </o:p></p></div></body></html>