Keystone Pharmacy is committed to patient safety. Part of the safety is not only what we do inside of our store, but includes the safe disposal of medication once it has left our, or another, pharmacy. We do our best to be good corporate citizens and community partners. Further, we drink the same water that our patients do, so clean water is very important to us.
Medication disposal used to be fairly simple: flush the medication down your toilet and let the municipal waste water system or your own septic system take care of it. However, we realized that, despite the best efforts of our municipal systems or septic tanks, drugs were still leaching into our water supply. Then we evolved. We recommended mixing unused drugs with kitty litter or coffee grounds and thawing out with the trash. The thought behind this is that, once in the landfills, the drugs would be prevented from leaching into the ground water because the landfills were lined with heavy plastic to prevent such leaching.
Each year large amounts of pharmaceutical chemicals are exposed to the environment as evidenced by an AP investigation that found US drug companies and other manufacturers dump 271 million pounds of pharmaceutical waste into water sources each year. This same investigation revealed that hospitals and long-term care facilities create an additional 250 million pounds of pharmaceutical waste. The general public is also contributing to this problem by letting 200 million pounds of unused medications enter the country’s sewer systems. There is increasing evidence that these chemicals can be found in many zones of our environment, and that these chemicals are having an effect on wildlife. In addition, these chemicals are also making contact with human populations in the United States.
A USGS study of Boulder Creek in Colorado revealed detectable levels of the antibiotic, sulfamethoxazole, caffeine, and triclosan, an antimicrobial found in soaps. Waterways near drug manufacturers in Michigan and Delaware have also shown higher levels of antibiotics and codeine. In the Western areas of the country, where the summer months often present drought conditions, farmers must use treated wastewater to irrigate their fields. Samples taken from Colorado farms are showing that common household medications are being deposited in the soil and remaining there for several months. Some of the medications detected were antidepressants, anticonvulsants, and anticoagulants. More common medications were also found including Tylenol, caffeine, nicotine, and Benadryl. This evidence shows that medications are reaching the environment both in water and on land.
The next concern is whether the amounts of pharmaceutical chemicals found in the environment are capable of impacting wildlife. Even though contaminants were found at “safe” levels, the Boulder Creek study found that fish are displaying both male and female sex organs, and there is a disproportionate number of female fish for every male. Increased amounts of sex hormones in aquatic ecosystems have led to hormonal changes in fish species that lead to reproductive dysfunction. This occurrence has been seen nationwide, most significantly in Lake Mead, Nevada and the Potomac River of Maryland. Another study conducted by the USGS in Fourmile Creek, Iowa detected levels of commonly used antidepressants in stream water, stream bottom sediment, and in fish tissue. The medications Effexor, Wellbutrin, and Celexa were detected at the highest level in stream water, with Effexor and Prozac found at the highest levels in bottom sediment. White suckers are a native fish species to Fourmile Creek that displayed a measurable amount of Zoloft and Prozac embedded in brain tissue of the fish. Scientists have also found that frogs and other species can be harmed by low concentrations of certain medications. These findings provide insight that the amounts of pharmaceutical compounds found in the environment is high enough to impact wildlife.
The implications of these findings on the human population are largely unknown. Pharmaceutical chemicals have been found in the drinking water of 51 million people in the United States, but all of these were detected at very low levels that are considered safe for human consumption. However, many chemicals do not have a determined safe upper limit, and it is unknown at what level many chemicals begin to cause damage. Further research is needed to determine the safety of the many different chemicals being found in the country’s water ways.
Due to the detection of pharmaceutical chemicals in the environment and their known harm to aquatic wildlife, it is important for the general public to utilize medication disposal programs to minimize the amount of harmful chemicals released into the environment. The uncertainty of how pharmaceutical contaminants impact human health only adds to the importance of reducing pharmaceutical waste.