Today’s pharmaceuticals play a major role in helping consumers keep chronic conditions under control, manage pain, promote healing or fight disease. According to a 2010 report by the IMS Institute for Healthcare Informatics on the use of medicine in the United States, almost 4 billion prescriptions were filled in 2010. However, an estimated one-third of these—1.3 billion—are not taken, generating some 200 million pounds of unused pharmaceuticals. Some fear that the way in which these medications are disposed, in addition to portions excreted by humans and animals, could represent a mounting problem for water supplies and the environment. A common sense solution is being promoted by government agencies and organizations such as the National Community Pharmacists Association: consumer should be informed about how to dispose of unused drugs, including taking them to a local drug store or other collection point.
Flushing: Not Always the Answer
As government agencies have instructed for years, consumers often flush unused and unneeded pharmaceuticals down the toilet. Although wastewater treatment plants remove some of these drugs, a 2002 U.S. Geological Survey study found trace levels of pharmaceuticals in 139 public waterways in 30 states. It is important to keep in mind that with increasingly sensitive laboratory analytical methods, it is now possible to detect substances at extremely low levels: the USGS report notes detected levels were generally less than one part per billion (equivalent to less than one inch in 16,000 miles). At what levels might we be exposed to these substances in treated drinking water, and does that exposure present a risk? These are important questions. In the absence of complete answers, it is worth considering immediate options that can help us avoid future problems.
FDA recommends medicine take-back programs as a good way to remove expired, unwanted or unused medicines from the home. According to the Agency, these programs may be managed by community pharmacies or municipal trash and recycling services. The National Community Pharmacists Association, for example, has developed an online resource to help consumers locate medication disposal programs at local independent community pharmacies.
When a take-back program is unavailable, flushing certain medicines (FDA list) is still promoted by FDA to help prevent potential accidental ingestion that could be especially harmful to a child, pet or adult. For the majority of medications, however, if take-back programs are unavailable and flushing is not recommended by FDA, medicines can be disposed of in household trash (providing there are no local ordinances to the contrary). Prescriptions should first be mixed with unpalatable matter such as kitty litter or coffee grounds in preparation for the journey to a landfill. This includes over-the-counter medications as well as prescription.
An Ounce of Prevention
A new Government Accountability Office report notes a serious lack of agreement and coordination among federal regulators on a plan to tackle the issue of pharmaceuticals that may end up in drinking water. Last spring, the Environmental Protection Agency’s Office of Ground Water and Drinking Water announced a list of 32 contaminants for potential regulation. Among these were seven pharmaceuticals (all hormones). By mid-2012, EPA will announce its intentions to regulate or not regulate at least five of the list of 32. Final regulatory decisions are due in the summer of 2013.
Given the long timeline of developing a government strategy to address pharmaceuticals in water systems, it makes sense to support and promote consumer education on pharmaceutical disposal options, and smart take-back programs.
In this case, an ounce of prevention—reducing pharmaceuticals’ entry into water systems in the first place–could be worth a pound of cure—costly remediation.
Linda Golodner is President Emeritus of the National Consumers League and Vice Chair of the Water Quality & Health Council.