5.1. Introduction (Batz)
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This document discusses proper disposal of pharmaceutical products by pharmacists. It begins with background information on where pharmaceutical contaminants come from, including manufacturing residues, hospitals, human and veterinary drug use, and agribusiness. Pharmaceutical and personal care products (PPCPs) are discussed as emerging pollutants, comprising thousands of substances like prescription drugs, over-the-counter medications, fragrances, and cosmetics. The document outlines federal and state regulations regarding pharmaceutical disposal and urges pharmacists to do their part in addressing this issue.
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2) The most common types of inquiries related to use, dosage, drug interactions, and contraindications, especially regarding cardiovascular diseases and pain/inflammation.
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The document summarizes the results of a study that examined pharmaceutical waste collected at take-back sites in the San Francisco Bay Area in 2009. It found that a total of 65,676 pounds of pharmaceutical waste was collected from 126 sites across the region, at a total cost of $119,133. Manual counts of medications returned found that the most common were analgesics, bronchodilators, and dermatological agents, and that the majority of medications were in pill or capsule form and were prescription drugs, with many being expired.
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The document discusses various forms of non-compliance with medication regimens, including forgetting to take medications, taking less than the recommended dose, and failing to fill prescriptions. It notes that non-compliance is a major cause of wasted medication and occurs in about 50% of patients. Reasons for non-compliance include medication costs, fear of side effects, distrust of doctors, and reluctance to acknowledge illness. Having multiple prescriptions can also increase non-compliance rates.
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The document summarizes the life cycle of pharmaceutical manufacturing and its environmental impacts. It discusses how the industry uses significant amounts of energy, water, and emits air pollutants and greenhouse gases through its operations. Transportation of pharmaceuticals also contributes significantly to its carbon footprint. The industry is taking steps to improve efficiency and reduce waste, such as increasing reuse of solvents, installing pollution controls, and examining supply chains and models of care to lower emissions. Major companies have sustainability initiatives underway to address these issues across their operations.
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This document outlines the life cycle of prescription pharmaceuticals from development through disposal. It discusses how current drug development and prescribing patterns relate to unused medications. The focus is on reducing leftover drugs through better understanding of prescribing, patient compliance, and accumulation in homes. The learning objectives are to review the pharmaceutical life cycle, patterns of prescribing that lead to unused drugs, current disposal policies and options, and six action steps to minimize waste.
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This document discusses current federal and state activities around minimizing pharmaceutical waste. It outlines research being done on occurrence and treatment options for pharmaceuticals in the environment. It also discusses federal legislation like the Safe Drug Disposal Act and various state legislation regarding take-back programs. The document notes that 54% of people throw medicines in the trash and 35% flush them, contributing to pharmaceuticals in waterways. It provides strategies to minimize waste at the prescribing, dispensing, and patient levels, and encourages proper disposal and take-back programs.
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Evidence shows that APIs in aquatic environments can have negative effects on organisms. Long term, multi-generational exposure to low levels of APIs may disrupt endocrine systems and cause alterations to sexual differentiation, as seen in studies on Boulder Creek and Potomac River. While APIs have been detected in most US streams sampled, questions remain about their potential low-dose, interactive, and chronic effects. More research is needed to understand risks to both environmental and human health from exposure to multiple APIs at low concentrations over long time periods.
5.5. State Regulations and Guidance (Batz)
State regulations and guidance on prescription drug take-back programs vary. Examples of innovative state programs discussed include those in Arizona, California, Maine, Washington, and Washington D.C. Arizona's TakeAway program uses pharmacies as take-back sites. California's program allows anonymous drug surrender. Maine's mail-back program has disposed of over 2,300 pounds of drugs. Washington's program allows drop-off at pharmacies and police stations. Washington D.C.'s program allows veterans to mail back unused drugs.
5.4. Federal Regulations (Batz)
The document discusses federal regulations regarding the disposal of medicines from the FDA, DEA, and USPS. The FDA recommends mixing most medicines with unpalatable substances and throwing them in the trash or using drug take-back programs. However, some controlled substances should not be thrown in the trash due to the risk of accidental ingestion; these may require approval from the DEA for disposal. The USPS allows returning prescription drugs by mail for recalls, withdrawals, or errors when sent to the manufacturer.
5.6. Conclusion (Batz)
Practitioners can help address the issue of improper medication disposal by including special instructions on disposal with prescriptions, supporting take-back programs in their local area, and displaying informational posters in and around pharmacies. Additional resources for practitioners and the public include the Groundwater Foundation, Drug Take-Back Network, and Teleosis Institute websites, which provide information on drug take-back and disposal issues and how to get involved.
2.6. Reducing Unused Pharmaceuticals: Conclusion (Ruhoy)
This document discusses ways to reduce unused pharmaceuticals entering the environment. It argues that usage control through prudent healthcare practices that minimize unnecessary prescribing and dispensing can significantly reduce pharmaceutical residues more than disposal practices alone. Usage control can eliminate the need for disposal and also reduce residues released through excretion and bathing. The document also notes several collateral benefits to pollution prevention and usage control, such as reduced healthcare costs, improved treatment outcomes, and fewer poisonings from unused drugs.
2.4. Environmental Impact of Disposal (Ruhoy)
The document discusses the environmental impacts of disposing of unused and leftover medications. It notes that APIs (active pharmaceutical ingredients) enter the environment through excretion, bathing, and disposal. Disposal represents acute but transient pollution from fewer people, compared to the continual low-level contributions from excretion by many people. Indirect entry can occur when drugs are disposed of in trash. Proper disposal is complicated by the need to protect safety and minimize environmental exposure. The document also discusses concerns about potential ecological and human health effects of APIs in the environment.
2.2. Significance of Long-Term Exposure to Multiple APIs (Ruhoy)
Long-term exposure to low levels of multiple active pharmaceutical ingredients (APIs) present in the environment is a concern, even though individual levels are below known effect thresholds. While human exposure is limited, questions remain about potential health effects of fetal or other vulnerable exposures. Comparisons to therapeutic levels are irrelevant at ultra-low levels, which may act through different mechanisms. Key issues include understanding accumulation of leftover drugs in society, environmental transport and fate, potential risks to humans and wildlife, and minimizing unwanted drug disposal to reduce environmental impacts and benefits beyond. Identifying adverse effects in real-world settings is challenging due to masking by natural variability and unknown mechanisms of action for many APIs.
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5.1. Introduction (Batz)
- 1. PharmaceuticalDisposalWhat Pharmacists Need to Know Victoria Henderson Forrest Batz, PharmD
- 3. Outline Background Information Methods of Disposal Federal Regulations State Regulations and Guidance Doing Your Part
- 4. Background Information Origination of: Pharmaceutical contaminates Personal care products (PPCP) Pathways
- 5. Pharmaceutical &Personal Care Products (PPCP) Pharmaceutical and personal care products (PPCPs) refers, in general, to any product used by individuals for personal health or cosmetic reasons or used by agribusiness to enhance growth or health of livestock. PPCPs comprise a diverse collection of thousands of chemical substances, including prescription and over-the-counter therapeutic drugs, veterinary drugs, fragrances, and cosmetics.
- 6. Pharmaceutical &Personal Care Products (PPCP) PPCPs as environmental pollutants is a subject that has received exponentially growing attention since the late 1990s. Over the next few topics you will learn why this is the case and how you can play a part in the green pharmacy revolution.
- 7. PPCPs include… Prescription and over-the counter therapeutic drugs Veterinary drugs Fragrances Cosmetics Sun-screen products Diagnostic agents Nutraceuticals (e.g. vitamins)
- 8. Sources of PPCPs Human activity Residues from pharmaceutical manufacturing (well defined and controlled) Residues from hospitals Illicit drugs Veterinary drug use, especially antibiotics and steroids Agribusiness
- 9. Origins of pharmaceuticalsinto our environment & possible ramifications http://www.epa.gov/esd/bios/daughton/drug-lifecycle.pdf
- 10. Why we should care… According to the EPA, studies have shown that pharmaceuticals are present in our nation's waterbodies. Further research suggests that certain drugs may cause ecological harm. More research is needed to determine the extent of ecological harm and any role it may have in potential human health effects. To date, scientists have found no evidence of adverse human health effects from PPCPs in the environment.