Once a medication expires or is no longer needed, healthcare facilities and patients have to decide what to do with the unused portion. Some people may flush the unwanted pills down the toilet, while others may toss them in the trash. However, disposing of drugs in this manner can be hazardous. Improperly disposed drugs may be snapped up by an addict or accidentally ingested by a child or animal. Drugs in a landfill can leach into the public water supply, as can medications that are flushed down the toilet. American healthcare facilities flush an estimated 250 million pounds of medication per year, the Associated Press estimates. That figure doesn’t include the drugs that are flushed by community pharmacies and consumers.
An investigation by the AP found minute concentrations of drugs in the drinking water supplies of two dozen major American cities. The majority of drugs that make their way into the water supply are actually not the result of improper disposal, but of metabolism. Just as they do with food and drink, our bodies metabolize the drugs we take, excreting what is not used. Pharmaceutical companies could theoretically help reduce the drug concentration in the water supply by formulating medications that are metabolized more efficiently. But improper drug disposal is a controllable factor in pharmaceutical pollution, an environmental problem that may have consequences for human health. The federal government does not have any regulations regarding acceptable levels of pharmaceuticals in drinking water or bottled water. Some preliminary studies have linked drugs in the water supply to health hazards in humans, the AP reports. An Italian researcher found that exposing developing human kidney cells to a mixture of small amounts of drugs slowed the cells’ growth by up to a third. A German research team found that low levels of a common pain reliever were associated with an inflammatory response in human cells. Although the effect on humans has not been determined, AP reports that pharmaceuticals in the water have been shown to cause reproductive problems in fish and mussels, kidney failure in vultures, and inhibited growth in algae.
Consumers and medical facilities can help by disposing properly of unused drugs. The Office of National Drug Control Policy advises patients not to flush unused drugs down the toilet or drain unless the label says to do so, or in cases where the drug has high abuse potential. Some communities may have drug take-back programs or household hazardous waste collection events. Companies such as Stericycle (which acquired disposal company Medserve in March 2009), Clean Harbors and Sharps Compliance offer pharmaceutical disposal programs for communities, retail pharmacies and medical facilities. For communities that do not have drug take-back programs, the Office of National Drug Control Policy offers guidelines for proper drug disposal here.
Many pharmacies and medical facilities send expired or unwanted drugs back to the manufacturer for incineration. Sharps Compliance operates in a similar fashion, explains Claude Dance, senior vice president of the Texas-based company. Drugs are mailed to their facility by pharmacies or consumers. Patient information is kept secure, and the pharmacy is notified when the drugs are received. The medications are scanned in by police and subjected to a police-witnessed incineration. Any leftover ash is combined with a substance used in the making of industrial products. The resulting mixture is used to manufacture cement.
Sharps Compliance is collaborating with the National Community Pharmacists Association on the Dispose My Meds program, which rolled out this week. The program assists consumers in finding medication disposal programs at their local community pharmacies. Dance says that medication disposal programs can improve patient health outcomes as well as the environment. The interaction between the patient, the pharmacist, and the physician has been a key component in the waste disposal company’s work with the state of Iowa. A patient might bring a bottle of unexpired blood pressure medication back to his or her pharmacy for disposal. If the pharmacist discovers that the medication was rejected due to an undesirable side effect, the pharmacist can call the patient’s doctor and get the scrip changed to a medication that doesn’t produce that side effect. “Hopefully, we’ll have less of these drugs in the environment in the future because the patients will be more adherent,” says Dance.
The subject of medication in the water supply is a matter of fierce debate. Is it truly dangerous to humans, or are the drugs present in such small amounts their effect is negligible? Post your opinion in comments.