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<p class="MsoNormal" style="text-autospace:none">The topic of drug excretion efficiency is far more complex than generally recognized. And the rudimentary pharmacokinetic data on package inserts can be very misleading for the purposes of environmental risk
assessment.<o:p></o:p></p>
<p class="MsoNormal" style="text-autospace:none"><o:p> </o:p></p>
<p class="MsoNormal" style="text-autospace:none">There are numerous variables that dictate the extent to which an API is excreted unchanged. And even then, the portion of parent API that is excreted unchanged reveals only part of the story. Reversible metabolic
conjugates of the parent API, for example, can be highly excreted and serve as sizeable hidden reservoirs that can later release additional API. Excretion is a function not just of the API but also the genetics and health of the individual. Large portions
of some APIs are not even absorbed - passing directly through the gut (a reason for high doses of certain APIs). A wide range of excretion values often occurs across the general population for many APIs.<o:p></o:p></p>
<p class="MsoNormal" style="text-autospace:none"><o:p> </o:p></p>
<p class="MsoNormal" style="text-autospace:none">The role of pharmacokinetics in dictating the entry of APIs to the environment is rarely discussed in the literature. Here is the most comprehensive examination of this topic that I'm aware of:<o:p></o:p></p>
<p class="MsoNormal" style="text-autospace:none"><o:p> </o:p></p>
<p class="MsoNormal" style="text-autospace:none">Daughton CG "Eco-directed sustainable prescribing: feasibility for reducing water contamination by drugs." Science of the Total Environment 2014, 493:392-404;
<a href="http://dx.doi.org/10.1016/j.scitotenv.2014.06.013">http://dx.doi.org/10.1016/j.scitotenv.2014.06.013</a> [OpenAccess].<o:p></o:p></p>
<p class="MsoNormal" style="text-autospace:none"><o:p> </o:p></p>
<p class="MsoNormal" style="text-autospace:none">This paper can be directly downloaded from the link. I have also attached a reprint that contains some extensive supplementary data. The paper is not pleasant reading, but that reinforces the fact that this is
a tough subject that's not amenable to easy summary.<o:p></o:p></p>
<p class="MsoNormal" style="text-autospace:none"><o:p> </o:p></p>
<p class="MsoNormal" style="text-autospace:none">There is also a prior paper that shows how dose can be reduced for certain drugs - thereby reducing quantities excreted via sewage:<o:p></o:p></p>
<p class="MsoNormal" style="text-autospace:none"><o:p> </o:p></p>
<p class="MsoNormal" style="text-autospace:none">Daughton CG and Ruhoy IS "Lower-Dose Prescribing: Minimizing 'Side Effects' of Pharmaceuticals on Society and the Environment," Science of the Total Environment, 2013, 443:324-337; available:
<a href="http://dx.doi.org/10.1016/j.scitotenv.2012.10.092">http://dx.doi.org/10.1016/j.scitotenv.2012.10.092</a> (including supplementary data) [OpenAccess].<o:p></o:p></p>
<p class="MsoNormal" style="text-autospace:none"><o:p> </o:p></p>
<p class="MsoNormal" style="text-autospace:none">My apologies if this just confuses things.<o:p></o:p></p>
<p class="MsoNormal" style="text-autospace:none"><o:p> </o:p></p>
<p class="MsoNormal">christian daughton<span style="font-family:"Calibri","sans-serif";color:#1F497D"><o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-family:"Calibri","sans-serif";color:#1F497D"><o:p> </o:p></span></p>
<div>
<p class="MsoNormal" style="margin-bottom:12.0pt"><span style="font-size:10.0pt;font-family:"Calibri","sans-serif";color:black">====================<br>
Christian Daughton, </span><span style="font-size:9.0pt;font-family:"Calibri","sans-serif";color:black">Ph.D.</span><span style="font-size:10.0pt;font-family:"Calibri","sans-serif";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">daughton.christian@epa.gov</a><br>
<br>
</span><span style="font-size:9.0pt;font-family:"Calibri","sans-serif";color:black">CV:
<a href="http://www.epa.gov/esd/bios/daughton.htm#publications">http://www.epa.gov/esd/bios/daughton.htm#publications</a><br>
PPCPs Literature Database: <a href="http://epa.gov/ppcp/lit.html">http://epa.gov/ppcp/lit.html</a><br>
Drug Disposal: <a href="http://epa.gov/ppcp/projects/disposal.html">http://epa.gov/ppcp/projects/disposal.html</a></span><span style="font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D"><o:p></o:p></span></p>
</div>
<p class="MsoNormal"><span style="font-family:"Calibri","sans-serif";color:#1F497D"><o:p> </o:p></span></p>
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<p class="MsoNormal"><b><span style="font-size:11.0pt;font-family:"Calibri","sans-serif"">From:</span></b><span style="font-size:11.0pt;font-family:"Calibri","sans-serif""> pharmwaste-bounces@lists.dep.state.fl.us [mailto:pharmwaste-bounces@lists.dep.state.fl.us]
<b>On Behalf Of </b>Gilliam, Allen<br>
<b>Sent:</b> Wednesday, January 07, 2015 8:08 AM<br>
<b>To:</b> Heil, Ann; 'Catherine Zimmer'; 'jmullowney'; 'Bill Speenburgh'; pharmwaste@lists.dep.state.fl.us<br>
<b>Subject:</b> RE: [Pharmwaste] RE: Pharmwaste Digest, Vol 111, Issue 1 <o:p></o:p></span></p>
</div>
</div>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal"><span style="font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D">Thanks for the reminder and edification to all that responded. Laurie said it in the most simplest terms this mechanical engineer could understand, “That’s
how systemic drugs work. You take the pill and it has to go all over your body before it reaches the intended body part. We have to take a large dose to ensure a therapeutic amount of it reaches its target.”<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">I stand down to you experts out there and thank you for enlightening me (again?) on why there is so much un-metabolized meds leaving out body into the environment.
Jim’s chart was quite surprising. Don’t think I’ve seen anything like it before.
<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? What do you think the chances are that RI will pass legislation for passing on the cost to big Pharma to collect and destroy cytotoxic chemotherapy “leftovers”?<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">Allen Gilliam<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D">(Pharmwaste not in my job description, just continually passing thru)<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D">ADEQ State Pretreatment Coordinator<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D">501.682.0625<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>
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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""> Heil, Ann [<a href="mailto:AHeil@lacsd.org">mailto:AHeil@lacsd.org</a>]
<br>
<b>Sent:</b> Wednesday, January 07, 2015 9:34 AM<br>
<b>To:</b> 'Catherine Zimmer'; Gilliam, Allen; 'jmullowney'; 'Bill Speenburgh'; <a href="mailto:pharmwaste@lists.dep.state.fl.us">
pharmwaste@lists.dep.state.fl.us</a><br>
<b>Subject:</b> RE: [Pharmwaste] RE: Pharmwaste Digest, Vol 111, Issue 1<o:p></o:p></span></p>
</div>
</div>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal"><span style="font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D">Just to chime in here, just because a pharmaceutical passes through your body doesn’t NOT mean you are being overdosed or given unnecessary medication. Some
drugs work without being consumed. If you have any chemistry background, think of a catalyst – it causes certain reactions to occur, but is not consumed in the process. And yes, those little inserts in the drug packages have all sorts of good information on
them.<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">Ann Heil<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D">LACSD<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>
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<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"">
<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>Catherine Zimmer<br>
<b>Sent:</b> Wednesday, January 07, 2015 7:09 AM<br>
<b>To:</b> 'Gilliam, Allen'; 'jmullowney'; 'Bill Speenburgh'; <a href="mailto:pharmwaste@lists.dep.state.fl.us">
pharmwaste@lists.dep.state.fl.us</a><br>
<b>Subject:</b> RE: [Pharmwaste] RE: Pharmwaste Digest, Vol 111, Issue 1<o:p></o:p></span></p>
</div>
</div>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal"><span style="font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D">Hi Allen and all,<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">Yes, if you remember some years back, Ann Heil from I think its LA’s wastewater district compiled a list of metabolism vs. pass through of a number of common
rx. And a EPA, Region 3 scientist says, I paraphrase here, “the drug companies overdose us”. Pharmaceutical metabolism is less than an exact science, and Pharma is apparently not too interested in making it more so. Now, maybe with Almeda Co.’s take back
ordinance, or maybe if EPA demanded Pharma clean up the nation’s waters—that would be incentive to develop more site specific and directed drugs.
<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">Following up on Jim’s comments—I have done exactly that with my physician. When she prescribes a drug—for which there is no rx-free alternative treatment, we’ll
get out the package insert to identify the amount that passes through. A good education for both you and your MD.
<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>
<p class="MsoNormal"><span style="font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D">Very truly yours,<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">Catherine Zimmer, MS, BSMT<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D">Zimmer Environmental Improvement, LLC<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D">St. Paul, MN
<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D">Ph: 651.645.7509<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:zenllc@usfamily.net">zenllc@usfamily.net</a><o:p></o:p></span></p>
</div>
<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"">From:</span></b><span style="font-size:10.0pt;font-family:"Tahoma","sans-serif"">
<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>Gilliam, Allen<br>
<b>Sent:</b> Wednesday, January 07, 2015 8:39 AM<br>
<b>To:</b> jmullowney; Bill Speenburgh; <a href="mailto:pharmwaste@lists.dep.state.fl.us">
pharmwaste@lists.dep.state.fl.us</a><br>
<b>Subject:</b> RE: [Pharmwaste] RE: Pharmwaste Digest, Vol 111, Issue 1<o:p></o:p></span></p>
</div>
</div>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal"><span style="font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D">So the general public would not realize they’re paying for perhaps 25% of the (almost prohibitively) expensive drug they’ve been prescribed; the rest being
wasted to the environment? Sumpthin just doesn’t pass the smell test on this scenario.<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">Allen g<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"">From:</span></b><span style="font-size:10.0pt;font-family:"Tahoma","sans-serif"">
<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>jmullowney<br>
<b>Sent:</b> Wednesday, January 07, 2015 5:38 AM<br>
<b>To:</b> Bill Speenburgh; <a href="mailto:pharmwaste@lists.dep.state.fl.us">pharmwaste@lists.dep.state.fl.us</a><br>
<b>Subject:</b> RE: [Pharmwaste] RE: Pharmwaste Digest, Vol 111, Issue 1<o:p></o:p></span></p>
</div>
</div>
<p class="MsoNormal"><o:p> </o:p></p>
<div>
<p class="MsoNormal">Bill<o:p></o:p></p>
</div>
<div>
<p class="MsoNormal">You do not need to have your urine tested you can just read the drug insert,that pice of paper that comes with your prescription with all the fine print. It will tell you how much passes in the urine and feces and how quickly. This is
all information from the FDA.<o:p></o:p></p>
</div>
<div>
<p class="MsoNormal">A patient on a chemotherapy drug called cyclophosphamide will urinate 1000 ppm in 24 hours, enough to kill a child nevermind the fact it is a US Epa hazardous waste and a known carcinogen as well as known to cause birtdefects. <o:p></o:p></p>
</div>
<div>
<p class="MsoNormal">Not all drugs are hazardous to humans in small quantities but the ones that are need to be controlled such as cytotoxic chemotherapy drugs.<o:p></o:p></p>
</div>
<div>
<p class="MsoNormal">Pee in a cup for two days after treatment if you are on chemo as recommended by the World Health Organization. Check out
<a href="http://www.cytotoxicsafety.org">www.cytotoxicsafety.org</a> <o:p></o:p></p>
</div>
<div>
<p class="MsoNormal"><o:p> </o:p></p>
</div>
<div>
<p class="MsoNormal"><o:p> </o:p></p>
</div>
<div>
<div>
<p class="MsoNormal"><span style="font-size:7.0pt;color:#575757">Sent from my T-Mobile 4G LTE Device<o:p></o:p></span></p>
</div>
</div>
<p class="MsoNormal" style="margin-bottom:12.0pt"><o:p> </o:p></p>
<div>
<p class="MsoNormal">-------- Original message --------<o:p></o:p></p>
</div>
<div>
<p class="MsoNormal">From: Bill Speenburgh <<a href="mailto:wcermail@gmail.com">wcermail@gmail.com</a>>
<o:p></o:p></p>
</div>
<div>
<p class="MsoNormal">Date:01/06/2015 8:15 PM (GMT-05:00) <o:p></o:p></p>
</div>
<div>
<p class="MsoNormal">To: <a href="mailto:pharmwaste@lists.dep.state.fl.us">pharmwaste@lists.dep.state.fl.us</a>
<o:p></o:p></p>
</div>
<div>
<p class="MsoNormal">Cc: <o:p></o:p></p>
</div>
<div>
<p class="MsoNormal">Subject: [Pharmwaste] RE: Pharmwaste Digest, Vol 111, Issue 1
<o:p></o:p></p>
</div>
<div>
<p class="MsoNormal"><o:p> </o:p></p>
</div>
<p class="MsoNormal" style="margin-bottom:12.0pt">As a person with Type II diabetes, I am prescribed by the VA with 2 x 1000<br>
mg tablets of Metformin per day. Maybe I will get my urine tested to see<br>
what passes thru? <br>
<br>
William G. Speenburgh<br>
World Class Environmental Resources, LLC<br>
<br>
(973) 770-2275 (Phone)<br>
(973) 219-5720 (cell)<br>
<br>
-----Original Message-----<br>
From: <a href="mailto:pharmwaste-bounces@lists.dep.state.fl.us">pharmwaste-bounces@lists.dep.state.fl.us</a><br>
[<a href="mailto:pharmwaste-bounces@lists.dep.state.fl.us">mailto:pharmwaste-bounces@lists.dep.state.fl.us</a>] On Behalf Of<br>
<a href="mailto:pharmwaste-request@lists.dep.state.fl.us">pharmwaste-request@lists.dep.state.fl.us</a><br>
Sent: Tuesday, January 6, 2015 3:54 AM<br>
To: <a href="mailto:pharmwaste@lists.dep.state.fl.us">pharmwaste@lists.dep.state.fl.us</a><br>
Subject: Pharmwaste Digest, Vol 111, Issue 1<br>
<br>
Send Pharmwaste mailing list submissions to<br>
<a href="mailto:pharmwaste@lists.dep.state.fl.us">pharmwaste@lists.dep.state.fl.us</a><br>
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To subscribe or unsubscribe via the World Wide Web, visit<br>
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or, via email, send a message with subject or body 'help' to<br>
<a href="mailto:pharmwaste-request@lists.dep.state.fl.us">pharmwaste-request@lists.dep.state.fl.us</a><br>
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You can reach the person managing the list at<br>
<a href="mailto:pharmwaste-owner@lists.dep.state.fl.us">pharmwaste-owner@lists.dep.state.fl.us</a><br>
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When replying, please edit your Subject line so it is more specific than<br>
"Re: Contents of Pharmwaste digest..."<br>
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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>
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TO SUBSCRIBE, go to: <a href="http://lists.dep.state.fl.us/cgi-bin/mailman/listinfo/pharmwaste">
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TO UNSUBSCRIBE, DO NOT REPLY TO THE LISTSERV. Please send an e-mail to <a href="mailto:pharmwaste-unsubscribe@lists.dep.state.fl.us">
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If you believe you may be subscribed with a different email address, please visit the subscriber listing at
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FOR PROBLEMS: Contact List Administrator <a href="mailto:Laurie.Tenace@dep.state.fl.us">
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SEND MAIL to the list server at: <a href="mailto:pharmwaste@lists.dep.state.fl.us">
pharmwaste@lists.dep.state.fl.us</a><o:p></o:p></p>
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