<html xmlns:v="urn:schemas-microsoft-com:vml" xmlns:o="urn:schemas-microsoft-com:office:office" xmlns:w="urn:schemas-microsoft-com:office:word" xmlns:m="http://schemas.microsoft.com/office/2004/12/omml" xmlns="http://www.w3.org/TR/REC-html40">
<head>
<meta http-equiv="Content-Type" content="text/html; charset=us-ascii">
<meta name="Generator" content="Microsoft Word 14 (filtered medium)">
<style><!--
/* Font Definitions */
@font-face
{font-family:Calibri;
panose-1:2 15 5 2 2 2 4 3 2 4;}
@font-face
{font-family:Tahoma;
panose-1:2 11 6 4 3 5 4 4 2 4;}
@font-face
{font-family:Verdana;
panose-1:2 11 6 4 3 5 4 4 2 4;}
/* Style Definitions */
p.MsoNormal, li.MsoNormal, div.MsoNormal
{margin:0in;
margin-bottom:.0001pt;
font-size:11.0pt;
font-family:"Calibri","sans-serif";}
a:link, span.MsoHyperlink
{mso-style-priority:99;
color:#0563C1;
text-decoration:underline;}
a:visited, span.MsoHyperlinkFollowed
{mso-style-priority:99;
color:#954F72;
text-decoration:underline;}
span.EmailStyle17
{mso-style-type:personal;
font-family:"Calibri","sans-serif";
color:windowtext;}
span.EmailStyle18
{mso-style-type:personal-reply;
font-family:"Calibri","sans-serif";
color:#1F497D;}
.MsoChpDefault
{mso-style-type:export-only;
font-size:10.0pt;}
@page WordSection1
{size:8.5in 11.0in;
margin:1.0in 1.0in 1.0in 1.0in;}
div.WordSection1
{page:WordSection1;}
--></style><!--[if gte mso 9]><xml>
<o:shapedefaults v:ext="edit" spidmax="1026" />
</xml><![endif]--><!--[if gte mso 9]><xml>
<o:shapelayout v:ext="edit">
<o:idmap v:ext="edit" data="1" />
</o:shapelayout></xml><![endif]-->
</head>
<body lang="EN-US" link="#0563C1" vlink="#954F72">
<div class="WordSection1">
<p class="MsoNormal"><span style="color:#1F497D"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="color:#1F497D"><o:p> </o:p></span></p>
<div>
<p class="MsoNormal"><span style="font-size:10.0pt;font-family:"Arial","sans-serif";color:#1F497D">Susan Hoertt, R.S., CPEA</span><span style="color:#1F497D"><o:p></o:p></span></p>
<p class="MsoNormal"><span style="color:#1F497D">S</span><span style="font-size:10.0pt;font-family:"Arial","sans-serif";color:#1F497D">enior Scientist |<b>
</b>Client Leader</span><span style="color:#1F497D"><o:p></o:p></span></p>
<p class="MsoNormal"><b><span style="font-size:10.0pt;font-family:"Arial","sans-serif";color:#1F497D"><o:p> </o:p></span></b></p>
<p class="MsoNormal"><b><i><span style="font-family:"Arial","sans-serif";color:#244061">Haley & Aldrich</span></i></b><i><span style="color:#244061"><o:p></o:p></span></i></p>
<p class="MsoNormal"><i><span style="font-size:10.0pt;font-family:"Arial","sans-serif";color:#1F497D">8899 Gander Creek Drive</span></i><i><span style="color:#1F497D"><o:p></o:p></span></i></p>
<p class="MsoNormal"><i><span style="font-size:10.0pt;font-family:"Arial","sans-serif";color:#1F497D">Miamisburg, OH 45342-5432</span></i><i><span style="color:#1F497D"><o:p></o:p></span></i></p>
<p class="MsoNormal"><i><span style="font-size:10.0pt;font-family:"Arial","sans-serif";color:#1F497D">+1 937.530.1408 Office</span></i><i><span style="color:#1F497D"><o:p></o:p></span></i></p>
<p class="MsoNormal"><i><span style="font-size:10.0pt;font-family:"Arial","sans-serif";color:#1F497D">+1 937.620.3799 Cellular</span></i><i><span style="color:#1F497D"><o:p></o:p></span></i></p>
<p class="MsoNormal"><i><span style="font-size:10.0pt;font-family:"Arial","sans-serif";color:#1F497D">+1 937.530.1458 Fax</span></i><i><span style="color:#1F497D"><o:p></o:p></span></i></p>
<p class="MsoNormal"><i><span style="color:#1F497D"><a href="mailto:SHoertt@HaleyAldrich.com" title="mailto:SHoertt@CoVeris-cpv.com"><span style="font-size:10.0pt;font-family:"Arial","sans-serif";color:blue">SHoertt@HaleyAldrich.com</span></a><o:p></o:p></span></i></p>
<p class="MsoNormal"><span style="color:#1F497D"><o:p> </o:p></span></p>
</div>
<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 8:27 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>