Transcript Pharmaceuticals and Personal Care Products

A program of
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Drugs and their impact on:
• Rivers
• Kids
• Law Enforcement Agencies
Pharmaceuticals and Personal Care
Products (PPCPs)
 Includes prescription and over-the-counter (OTC)
medications, cleaning agents, cosmetics, nutritional
supplements, & skin care products
 Produced and used in larger volumes yearly
 Released via small quantity generators
 Biologically active
1999-2002
1988-1994
65 years and
over
all ages
Percent of persons reporting prescription drug use in the past month
by age
1999-2002
45-64 years
1999-2002
18-44 years
1999-2002
under 18
years
1988-1994
1999-2002
1988-1994
1988-1994
1988-1994
0
10
20
30
40
50
one or two prescribed drugs
60
70
80
90
three or more prescribed drugs
Source: U.S. Center for Disease Control and Prevention. National Center for Health
Statistics. National Health and Nutrition Examination Survey.
100
Disposal of Unwanted Medicines
In some cases, medicines are not entirely
consumed due to:





Change in prescription
Patient’s health improves
Patient death
Patient doesn’t want to take the medicine
Bulk “economy size” containers
of over-the-counter medicines
contain more than is used
before expiration date
Expired Medication Disposal
Habits
500 patients surveyed:
 54% disposed of
medications in the trash
Used All Prior
to Expiration
Returned to
Pharmacy
Did Not
Dispose
 35.4% flushed drugs down
the toilet or sink
 7.2% did not dispose of
medications
Flushed
Trashed
 2% used all medication prior
to expiration
 1.4% returned medications
to the pharmacy
Boehringer, S. “What’s the Best Way to Dispose of Medications?” (2004)
Improper Disposal Practices
More than half the 301
patients surveyed at a
military base pharmacy
in 2006 said they had
flushed medications
down a toilet; fewer than
20% said they had ever
been given advice about
proper disposal by a
health care provider.
Main Risks of Improper Disposal
Practices
 Environmental impact
- Accumulation in waterways  potentially harmful effects on
wildlife
 Accidental ingestion (children & elderly)
- 78,000 children under 5 treated for unintentional medication
poisoning each year in the U.S.
 Illegal use or theft
- Appropriation of pharmaceuticals by family and friends, workers
in homes, and burglars
Medicines in the Environment
U.S. Geological Survey monitoring study
• 139 streams analyzed in 30 states
• Contaminants identified in 80% of these streams
• 82 contaminants identified (many were
pharmaceuticals)
• Co-occurrence common; average 7 distinct
contaminants identified per stream
Kolpin, D.W. et al. 2002. “Pharmaceuticals, hormones, & other organic
wastewater contaminants in U.S. streams, 1999-2000: A national
reconnaissance.” Environmental Science & Technology. 36(6):1202-1211.
Medicines in the Environment
USGS/CDCP study of drinking water facility
 Analyzed for 106 contaminants in 24 water samples
from locations within a drinking-water- treatment facility
and the 2 streams serving the facility
 40 contaminants detected in 1 or more samples of
stream water or raw-water supplies in the plant
 34 contaminants detected in >10% of these samples
 Some prescription and non-prescription drugs and their
metabolites were detected in finished water
Stackleberg, P.E. et al. 2004. “Persistence of pharmaceutical compounds and other
organic wastewater contaminants in a conventional drinking-water-treatment plant.”
Science of the Total Environment. 329:99-113.
Effects on Aquatic Organisms:
Cause for Concern
 Aquatic exposure – chemicals in the aquatic environment
can result in continuous, multigeneration exposure.
 Feminization of fish - link to estrogen exposure?
Ex: Boulder Creek, CO: female white suckers outnumber males by > 5
to 1; 50% of males have female sex tissue
(David Norris, Univ.
of Colorado at Boulder)
 Effects of antidepressants on fish and frog development?
Ex: Lab studies show low levels of common anti-depressants, including
Prozac, Zoloft, Paxil and Celexa, cause development problems
in fish, and metamorphosis delays in frogs
(Marsha Black, Univ. of Georgia)
Entry Pathways of Medicines into
the Environment
 Outflow from wastewater
treatment plants
 Surface application of
manure and biosolids
 Commercial animal
feeding operations and
aquaculture
 Landfill leachate sent to
wastewater treatment
plants
 Septic tanks
Source: www.york.ac.uk/.../ gsp/esm/images/pharma1.jpg
Prescription Drug Abuse
 A study in Florida found that deaths caused
by prescription drugs were three times the
number caused by illegal drugs in that state.
• Among young people ages 12-17, prescription
drugs have become the second most abused
illegal drug, behind marijuana.
• In the past year 9.3% of 12th graders used
vicodin and 5% used OxyCotin (without a
prescription)
Extent of Prescription Drug Abuse
• 48 million Americans have used prescription
drugs recreationally
• 6.4 million Americans are abusing prescription
drugs – more than the number of Americans
abusing cocaine, heroin, hallucinogens, and
inhalants combined
• In 2008 Wilkes County had the 3rd
highest overdose rate in the nation
Where are Teens Getting
Prescription Drugs?
What Can Be Done?
 Education and awareness
 Pharmacies, Public Utilities, Health
Providers and Law Enforcement
 Collections
 One day drop-off events
 Long-term take-back program
Initial Partners 2009
• Watauga Riverkeeper/Appalachian Voices, Co-operative Extension, Watauga
County Solid Waste, NCNR, WRCP, Boone Drug, Mountainkeepers & more:
– Project Coordination
– Volunteer Support
– Graphic Design, web site
– Media Outreach
• Watauga County Sheriff’s Dept. Lead Law Enforcement with support from
Boone, Blowing Rock and Seven Devils Police Departments and the SBI
– Law Enforcement Personnel
– Transport to Incinerator and Disposal
• Watauga County, Cities of Boone, Blowing Rock and Seven Devils
– Publicity (signage)
– Funding
– Resolutions of Support
A huge success in 2009
40,000 pills, 12 gallons of liquid medication,
2000 sharps‐needles, syringes and lancets, and a
glucose meter.
Drugs collected included:
Hydrocodone, oxycodone, blood
thinners, anti-allergens, iodine, insulin,
antibiotics, steroids, hormones, antidepressants, cough syrup, topical
creams, over the counter medications,
flu vaccinations, heart, blood pressure,
cancer and heartburn medicine and
even some pet medications.
Potential Partners May 22, 2010
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Avery County Sheriff’s Department
Civic Organizations
Safe Kids
Drug Awareness Programs
High Schools
Local Churches
Watauga Medical Center
Medical Community
Assisted Living Center
Retirement Centers
Ways to get involved with the
Watauga Riverkeeper program:
1. Report pollution by calling our toll-free pollution
hotline 1-877-277-8642
2.Become a member of Appalachian Voices
3.Volunteer for Big Sweep, Operation Medicine
Cabinet or Muddy Water Watch
4.Read and share our Appalachian Voices newsletter
with others.
Thanks to all Appalachian Voices members of the
Watauga Riverkeeper Program and the Helen M.
Clabough Charitable Foundation for their ongoing
commitment and financial support.
They make presentations like this possible!
Questions?