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Drugs and the Environment: Stewardship and Sustainability
Citation:
DAUGHTON, C. G. Drugs and the Environment: Stewardship and Sustainability. U.S. Environmental Protection Agency, Washington, DC, EPA/600/R-10/106, 2010.
Impact/Purpose:
From this simple beginning stems the vast, inter-related complexities that surround the controversies and consequences involved with the pharmaceuticals we use - and those we fail to use. But Asher's quip omits some of the other, less-obvious detours along a pill's journey. These include: refusing to take the pill, ignoring its usage instructions, giving it to someone else, failing to store it safely (resulting in its theft or deterioration), or simply forgetting about it (until it expires). All of these contribute to the innumerable issues involved with drug ingredients as environmental contaminants and with the unintended problems resulting from their use, non-use, misuse, and abuse. The unintended problems and their possible solutions are the subject of this report. The focus of this report is on the many issues surrounding the disposal of consumer-generated drug waste. Parallel problems derive from the use of pharmaceuticals by healthcare facilities, as well as by veterinary practices and other professions using pharmaceuticals, such as agriculture. But the issues facing healthcare facilities regarding drug wastage often differ from those for consumer drug waste in a number of ways. For example, the types of drugs used most frequently can differ dramatically; a complex array of regulations govern how drug waste should be handled; and the geographic distribution of healthcare facilities is more limited (making their contributions of drug ingredients to the environment less ubiquitous but also less disperse). Despite the differences with consumer-generated waste, this report discusses some of the aspects of healthcare waste when they are pertinent to consumer use.
Description:
This report represents the first-ever comprehensive examination of the broad scope of issues surrounding the topic of disposal of unwanted, unneeded, leftover medications from consumer use and the countless ways in which the introduction of active pharmaceutical ingredients (APIs) to the environment can be reduced. The report presents a synthesis of thought resulting from the body of work performed on this topic over the last decade by the US Environmental Protection Agency’s Office of Research and Development (ORD) at the National Exposure Research Laboratory in Las Vegas, Nevada. After distilling and synthesizing the published literature, it becomes clear that a holistic solution to the problem of consumer drug disposal will require the coordinated efforts of numerous stakeholders,agencies, and disciplines. A truly sustainable solution has the potential to not just reduce the entry of APIs to the environment via direct disposal of drugs to sewers (by flushing down drains) and landfills (by discarding in trash). More significant outcomes are possible from a holistic, sustainable approach that targets the many factors that contribute to the incidence of leftover drugs. Instead of limiting the focus to mechanisms for disposing of leftover drugs, a sustainable approach could also reduce: environmental loadings of APIs as a result of actions that also minimize their excretion; the incidence of drug diversion and abuse; the incidence of morbidity and mortality resulting from unintended poisonings (for humans, companion animals, and wildlife); and healthcare costs. Perhaps most importantly, a system that minimizes drug wastage may lead to improved therapeutic outcomes and general health, as well as to improvements in other aspects of the system of healthcare such as the way in which drug donations are handled. It is clear that the most practical and effective potential solutions to the related issues of leftover medications and pharmaceutical residues in the environment reside with the prescribing and dispensing communities and allied industries such as manufacturers and insurers. Countless improvements to these practices could be made, resulting in lower drug usage, fewer leftovers, improved therapeutic outcomes, and lower healthcare costs. This is where efforts need to be focused in changing the behaviors and practices of those involved with medical care. While patient expectations play a large role as well (such as with non-compliance to medication regimens, or with misguided expectations that a successful visit to a doctor is measured in part by whether a prescription is obtained), these expectations need to be changed by the medical care community. The responsibility of manufacturers not only can target issues such as patient non-compliance and excessive or unnecessary drug usage, but it can extend beyond the point of drug usage to deal with leftover medications. A fully integrated, sustainable approach to optimal drug use and generation and disposition of wastes can only be achieved by the close and integrated collaboration of healthcare professionals, environmental scientists, regulators, and numerous other organizations and stakeholders. This report seeks to summarize the many facets and nuances surrounding the drug disposal issue in a way suited for informing development of future guidance or regulation. A comprehensive examination of the many dimensions of drug wastage is critically important because policy or regulation not sufficiently grounded with a holistic, systems-level understanding of the overall issue could result in: increased healthcare costs (e.g., increased dispensing costs), poor therapeutic outcomes (e.g., from degraded patient compliance), increased costs to society from policies that exacerbate drug diversion and accidental poisonings, and at best nominal improvement for the environment (if disposal proves to be of little consequence to overall environmental residues of APIs).
URLs/Downloads:
DAUGHTON 10-081-FINAL REPORT DAUGHTON-DRUGS AND THE ENVIRONMENT.PDF (PDF, NA pp, 4907 KB, about PDF)APM200-2010.pdf