The afterlife of drugs and the role of pharmEcovigilance

Pharmaceutical Pollutants: Ecotoxicological Impacts and the Use of Agro-Industrial Waste for Their Removal from Aquatic Environments

Medicines are pharmaceutical substances used to treat, prevent, or relieve symptoms of different diseases in animals and humans. However, their large-scale production and use worldwide cause their release to the environment. Pharmaceutical molecules are currently considered emerging pollutants that enter water bodies due to inadequate management, affecting water quality and generating adverse effects on aquatic organisms. Hence, different alternatives for pharmaceuticals removal from water have been sought; among them, the use of agro-industrial wastes has been proposed, mainly because of its high availability and low cost. This review highlights the adverse ecotoxicological effects related to the presence of different pharmaceuticals on aquatic environments and analyzes 94 investigations, from 2012 to 2024, on the removal of 17 antibiotics, highlighting sulfamethoxazole as the most reported, as well as 6 non-steroidal anti-inflammatory drugs (NSAIDs) such as diclofenac and ibuprofen, and 27 pharmaceutical drugs with different pharmacological activities. The removal of these drugs was evaluated using agro-industrial wastes such as wheat straw, mung bean husk, bagasse, bamboo, olive stones, rice straw, pinewood, rice husk, among others. On average, 60% of the agro-industrial wastes were transformed into biochar to be used as a biosorbents for pharmaceuticals removal. The diversity in experimental conditions among the removal studies makes it difficult to stablish which agro-industrial waste has the greatest removal capacity; therefore, in this review, the drug mass removal rate (DMRR) was calculated, a parameter used with comparative purposes. Almond shell-activated biochar showed the highest removal rate for antibiotics (1940 mg/g·h), while cork powder (CP) (10,420 mg/g·h) showed the highest for NSAIDs. Therefore, scientific evidence demonstrates that agro-industrial waste is a promising alternative for the removal of emerging pollutants such as pharmaceuticals substances.

Future Healthcare Workers and Ecopharmacovigilance: Where Do We Stand?

With the rapid development of the pharmaceutical industry and constant growth of drug usage, ecopharmacovigilance (EPV) has emerged as a way of coping with and minimizing the effects that drugs have on the environment. EPV concerns and describes unwanted effects that the use of a specific drug could have on the environment. The US, EU and Cananda are the improving position of EPV, both in legislation and practice. EPV requires further development as previous studies have shown that neither the general population nor healthcare professionals have enough knowledge about the subject. Improving awareness and knowledge about this topic is a key task for the future of EPV. The main objective was to determine students' level of knowledge about ecopharmacovigilance and to examine ways of storing and disposing of unused and expired drugs. Students' knowledge and habits were examined by a previously published survey. The survey contains twenty questions divided into three parts and the possibility of writing an additional note. There was no difference in the level of knowledge between the students of different studies. Also, students who had a family member working as healthcare professional did not show a higher level of knowledge compared to the others. Pharmacy students had a greater intention to educate their environment about EPV when compared to students of the other studies. This is in the line with a previous study which showed that the general public expects that pharmacists and physicians educate them about EPV. Medicine and dental medicine students will become prescribers after finishing their studies, and as such, they should be informed about eco-directed sustainable prescribing (EDSP) as part of an EPV strategy. More than half of the participants reported good adherence to prescribers' instruction, which decreased the amount of unused drugs. Most of the students found that the drug expiration date was legible, but they did not check it often. In comparison with similar studies, Croatian students had more knowledge and better practices concerning EPV and drug disposal. Structured learning strategies and curriculum implementation for EPV are much needed for further raising awareness about the subject among healthcare professionals and the public.

Effective adsorption of amoxicillin by using UIO-66@ Cr-MIL-101 nanohybrid: isotherm, kinetic, thermodynamic, and optimization by central composite design

In this research, the amoxicillin (AMX) removal was studied on a prepared nanosorbent from MOFs. The aim of this research work is to prepare nanohybrids based on metal-organic frameworks (MOFs) as an efficient nanosorbent for the absorption of amoxicillin drug. In this study, UIO-66 nanoparticles (UIO-66 NPs) were prepared from Zirconium (Zr) metal and 1,4-benzene dicarboxylic acid (BDC). Then UIO-66@Cr-MIL-101 nanohybrid was synthesized by hydrothermal method. Structural and physicochemical properties of nanohybrid UIO-66@Cr-MIL-101 were characterized by different analyses such as X-ray diffraction analysis (XRD), fourier transform infrared spectrometer (FT-IR), scanning electron microscopy (SEM), energy dispersive X-ray (EDX), transmission electron microscopy (TEM), therapeutic goods administration (TGA), and Brunauer-Emmett-Teller (BET). The effect of four fundamental variables effective on adsorption was optimized by the central composite response surface methodology (CCRSM). This parameters including loading percentage of Cr-MIL-101 NPs (10-30%), initial concentration of AMX (20-140 mg L-1), contact time (20-60 min), and pH (20-10). The removal percentage (Re%) of AMX equal to 99.50% was obtained under the following conditions: The loading value of 20% Wt%, the initial concentration of AMX 80 mg L-1, contact time 20 min, and pH = 6. Also, the experimental data were investigated with famous kinetic models and isotherms, and it was observed that AMX removal by nanohybrid is correlated with the PSO kinetic model and Langmuir isotherm.

Public knowledge of antibiotics, self-medication, and household disposal practices in Jordan

BACKGROUND

This study aimed to assess public understanding of antibiotics, self-medication, and drug disposal practices.

METHODS

A cross-sectional self-administered online survey was undertaken in Jordan.

RESULTS

The study was completed by 1,105 participants. When asked about their knowledge of antibiotics, rational antibiotic use, and disposal practices, 16% percent believed they should discontinue antibiotics once they felt better, and 12% agreed to take the same antibiotics prescribed to others for the same illness. Self-medication with antibiotics was practiced by 44% of the participants. Prior experience, healthcare costs, and pharmacy location were all major determinants of self-medication. Only 6.4% of unneeded antibiotics were returned to the pharmacy, 60% were kept at home, and 26.6% were disposed of at home. Almost half of those who kept the antibiotics said they would use them again, and one-third said they would give them to friends and family. Respondents who had used antibiotics within the previous 6 months (p = 0.052) and relied on medication leaflets (p = 0.031) and physician recommendations (p = 0.001) were less likely to self-medicate with antibiotics.

CONCLUSIONS

The study highlighted areas of inappropriate use of antibiotics, self-medication and the improper antibiotic disposal that can inform antimicrobial stewardship.

Design of experiments (DoE) to develop and to optimize extraction of psychoactive substances

The design of experiments (DoE) method was employed to optimize the adsorption processes of seven psychoactive substances in magnetic solid phase extraction. Fe₃O₄/GO/ZIF-8 was utilized as an adsorbent for the efficient extraction of psychoactive substances from environmental water samples. The analytes were ephedrine, methylephedrine, amphetamine, methamphetamine, morphine, papaverine, and thebaine, which were determined by ultrahigh performance liquid chromatography-tandem mass spectrometry. Plackett-Burman design was employed to identify the significant factors responsible for adsorption, and Box-Behnken design was used for further optimization to obtain the optimum values for each variable. The predicted and experimental values were found to be in good agreement. The coefficient of determination (R²) values of 0.9500-0.9976 indicated that the model was significant. The linear ranges were 1-100 ng mL^-1, and the correlation coefficient was good (r² ≥ 0.995). The EF with values of about 2.5 was obtained with recoveries in the range of 74.92-94.47%. The limits of detection (LOD) and limits of quantification (LOQ) were 0.086-0.353 ng mL^-1 and 0.286-1.175 ng mL^-1, respectively. The intra-day and inter-day RSDs were in the range of 0.17-1.87% and 0.06-2.21%, respectively. By using the DoE method, the errors associated with inferring the influence and interaction between various factors can be reduced. The combination of MSPE and DoE improves the recovery, precision, and simultaneous detectability of the target analytes. It has a high potential for psychoactive substance analysis in environmental water.

Household Pharmaceutical Waste Management Practices in the Johannesburg Area, South Africa

Pharmaceutical wastes are expected to increase given the increasing population growth rates and rapidly rising economic burden of human diseases. This challenge calls for appropriate measures for the management of such hazardous wastes. The purpose of this survey was to document and investigate existing practices for the handling, storage, and disposal of household pharmaceutical wastes (HPWs) in the Johannesburg area. Primary data were collected via online surveys with self-administered questionnaires completed by respondents. The research found that 77% (n = 286) of respondents claimed some knowledge about HPWs. Types of medicines that contributed to HPWs included painkillers or analgesics (73%, n = 270) and drugs for treating colds and flu-related illnesses (52%; n = 193). Although there were a few exceptions, the respondents generally exhibited strong disagreements with environmentally unfriendly and health-threatening disposal practices. Moreover, most participants were willing to return expired medicines to pharmacies (40.7%, n = 151), whereas only 8.6% (n = 32) opposed this solution. Awareness levels tended to vary with employment status, educational qualifications, and place of residence. However, place of residence and household size did not correlate with types of pharmaceutical waste. Additionally, the study found that education attainments significantly influenced the willingness of respondents to return pharmaceutical wastes. Finally, there were no significant differences amongst respondents in terms of waste disposal practices. Altogether, the findings suggest the need for targeted efforts to bring about sustainable waste management at a household level.

Management of pharmaceutical micropollutants discharged in urban waters: 30 years of systematic review looking at opportunities for developing countries

Pharmaceutical micropollutants' contamination of urban waters has been studied globally for decades, but the concentration of innovations in management initiatives is still in developed economies. The gap between the locus of innovations in pharmaceuticals and the relative stagnation in less developed economies to manage waste originating in this activity seems fruitful for investigations on innovation in integrated micropollutant management strategies. These tensions allow for advances in current knowledge for environmental management and, particularly, finding solutions for the contamination by pharmaceutical micropollutants of urban water bodies in developing countries. We aim to list the main strategies for managing pharmaceutical micropollutants discussed to point out opportunities for developing countries to advance in this direction. Methodologically, we conducted a systematic literature review from 1990 to 2020, covering 3027 documents on "pharmaceutical micropollutants management." The framework formed by the macro-approach to integrated management operationalized by the dimensional micro-approaches: technical, organizational, community, and governmental allowed us to understand that (1) the management of pharmaceutical micropollutants tends to occur through a technical approach centered on the removal of aquatic matrices, green chemistry, and urine diversion; (2) management with an organizational approach has enabled removing drugs from water bodies by drug take-back program, collaborative projects, drug use reduction, and better organizational practices; (3) the community approach have helped minimize this type of pollution by reducing the consumption of medicines and the proper destination for medicines that are no longer in use. Finally, the government management approach emerges as a source of legal, economic, and informational instruments to reduce pollution by pharmaceutical micropollutants. Furthermore, these management approaches allowed us to identify 15 opportunities for possible adjustments for developing societies. These opportunities can be promising for practices and research and, in the medium term, contribute to minimizing pollution by pharmaceutical micropollutants in urban waters.

Assessing the scale of adoption of sustainability practices by community pharmacies in Spain in the time of COVID-19

Community pharmacies play a critical societal role and are well placed to enable the progress of national health systems towards sustainability. Nevertheless, there is a dearth of research which has been set up to understand sustainability practices adopted by community pharmacies and evaluate the drivers behind their adoption. This study undertook an exploratory analysis of 95 community pharmacies in Spain, measured their engagement with sustainability practices and assessed these practices in light of the COVID-19 pandemic. The results demonstrated the room for improvement in the adoption of green procurement practices in pharmacies and in their engagement with the community. Moreover, the study showcased that, during the COVID-19 crisis, the pharmacies with the largest extent of adoption of sustainability practices implemented preventative measures against the pandemic in a more diverse number during the first weeks of the lockdown, compared to their less sustainable counterparts. This indicates that, to build resilience to future (health) crises, the implementation of sustainable practices in community pharmacies should be encouraged by both policy makers and pharmaceutical firms.

Medicine storage, wastage, and associated determinants among urban households: a systematic review and meta-analysis of household surveys

Background

Irrational household storage of medicines is a world-wide problem, which triggers medicine wastage as well as its associated harms. This study aimed to include all available evidences from literature to perform a focused examination of the prevalence and factors associated with medicine storage and wastage among urban households. This systematic review and meta-analysis mapped the existing literature on the burden, outcomes, and affective socio-economic factors of medicine storage among urban households. In addition, this study estimated pooled effect sizes for storage and wastage rates.

Methods

Household surveys evaluating modality, size, costs, and affective factors of medicines storage at home were searched in PubMed, EMBASE, OVID, SCOPUS, ProQuest, and Google scholar databases in 2019. Random effect meta-analysis and subgroup analysis were used to pool effect sizes for medicine storage and wastage prevalence among different geographical regions.

Results

From the 2604 initial records, 20 studies were selected for systematic review and 16 articles were selected for meta-analysis. An overall pooled-prevalence of medicine storage and real wastage rate was 77 and 15%, respectively. In this regard, some significant differences were observed between geographical regions. Southwest Asia region had the highest storage and wastage rates. The most common classes of medicines found in households belonged to the Infective agents for systemic (17.4%) and the Nervous system (16.4%). Moreover, income, education, age, the presence of chronic illness, female gender, and insurance coverage were found to be associated with higher home storage. The most commonly used method of disposal was throwing them in the garbage.

Conclusions

Factors beyond medical needs were also found to be associated with medicine storage, which urges effective strategies in the supply and demand side of the medicine consumption chain. The first necessary step to mitigate home storage is establishing an adequate legislation and strict enforcement of regulations on dispensing, prescription, and marketing of medicines. Patient’s pressure on excessive prescription, irrational storage, and use of medicines deserve efficient community-centered programs, in order to increase awareness on these issues. So, hazardous consequences of inappropriate disposal should be mitigated by different take back programs, particularly in low and middle income countries.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-11100-4.

Pharmaceuticals, herbicides, and disinfectants in agricultural water sources

Agricultural water withdrawals account for the largest proportion of global freshwater use. Increasing municipal water demands and droughts are straining agricultural water supplies. Therefore, alternative solutions to agricultural water crises are urgently needed, including the use of nontraditional water sources such as advanced treated wastewater or reclaimed water, brackish water, return flows, and effluent from produce processing facilities. However, it is critical to ensure that such usage does not compromise soil, crop, and public health. Here, we characterized five different nontraditional water types (n = 357 samples) for the presence of pharmaceuticals, herbicides, and disinfectants using ultra-high-pressure liquid chromatography tandem mass spectrometry based method (UPLC-MS/MS). We then evaluated whether the levels of these contaminants were influenced by season. The highest level of herbicides (atrazine) was detected in untreated pond water (median concentration 135.9 ng/L). Reclaimed water had the highest levels of antibiotics and stimulants including azithromycin (215 ng/L), sulfamethoxazole (232.1 ng/L), and caffeine (89.4 ng/L). Produce processing plant water also tended to have high levels of atrazine (102.7 ng/L) and ciprofloxacin (80.1 ng/L). In addition, we observed seasonal variability across water types, with the highest atrazine concentrations observed during summer months, while the highest median azithromycin concentrations were observed in reclaimed water during the winter season. Further studies are needed to evaluate if economically feasible on-farm water treatment technologies can effectively remove such contaminants from nontraditional irrigation water sources.

Environmental pharmacology: source, impact and solution

Environmental pharmacology is the knowledge, study and the methods implemented for amalgamating the presence of pharmaceutical products and their metabolites in the environment. Pharmaceutical and house care products and their metabolites gain access to the environment through various means and affect the flora and fauna and modulate the ecosystem. The effect on wildlife, biofilms and human are being studied to gain knowledge of sources and causations. Potential risks of development of acute and chronic toxicity, carcinogenicity, interference with hormone and immune systems and drug resistance are of major concern. They may alter the genome and can affect future generations leaving them vulnerable to disease. There are regulations in good manufacturing practices and disposal which take into account the environmental risks but the knowledge for stakeholders and their implementation is very restricted. Ecopharmacology and ecopharmacovigilance are propagators of green healthcare. A strategy towards human health risk assessment and ecotoxicological hazard evaluation must be developed and risk minimization measures to be sought for and applied.

Pharmaceuticals in the aquatic environments: Evidence of emerged threat and future challenges for marine organisms

Pharmaceuticals are nowadays recognized as a threat for aquatic ecosystems. The growing consumption of these compounds and the enhancement of human health in the past two decades have been paralleled by the continuous input of such biologically active molecules in natural environments. Waste water treatment plants (WWTPs) have been identified as a major route for release of pharmaceuticals in aquatic bodies where concentrations ranging from ng/L to μg/L are ubiquitously detected. Since medicines principles are designed to be effective at very low concentrations, they have the potential to interfere with biochemical and physiological processes of aquatic species over their entire life cycle. Investigations on occurrence, bioaccumulation and effects in non target organisms are fragmentary, particularly for marine ecosystems, and related to only a limited number over the 4000 substances classified as pharmaceuticals: hence, there is a urgent need to prioritize the environmental sustainability of the most relevant compounds. The aim of this review is to summarize the main adverse effects documented for marine species exposed in both field and laboratory conditions to different classes of pharmaceuticals including non-steroidal anti-inflammatory drugs, psychiatric, cardiovascular, hypocholesterolaemic drugs, steroid hormones and antibiotics. Despite a great scientific advancement has been achieved, our knowledge is still limited on pharmaceuticals behavior in chemical mixtures, as well as their interactions with other environmental stressors. Complex ecotoxicological effects are increasingly documented and multidisciplinary, integrated approaches will be helpful to clarify the environmental hazard of these "emerged" pollutants in marine environment.

'You don't throw these things out:' an exploration of medicines retention and disposal practices in Australian homes

BACKGROUND

Consumers most commonly discard unwanted medicines in household rubbish or drains, however, there are global concerns over the extent, environmental impact and health risks. When consumers procure or store medicines for future use, this can impact negatively on quality use of medicines and consumer safety. We sought greater insight into the extent of these practices by exploring the volume and types of medicines in Australian homes, and self-reported practices related to medicine accumulation, use and disposal. This qualitative study formed part of a larger project that included a general population survey on household medicine disposal practices.

METHODS

Semi-structured telephone interviews were undertaken with a subset of respondents (n = 166) from the survey. Participants were eligible if they were experienced medicine users, i.e. used five or more prescribed, over the counter, and/or complementary and alternative medicines. Participants were asked to collect and name all medicines in their household; further detail was obtained about medicines used only when required or no longer used, such as expiry dates and quantity remaining. The quantitative data on the number and type of medicines stored at home were analysed descriptively. All interviews were transcribed verbatim and thematically analysed.

RESULTS

A total of 2301 medicines were identified as 1424 medicines not in everyday use (unused, unwanted, expired or when required) in 166 households, and 877 regularly used medicines by 119 participants. Medicines were often stored in multiple locations, particularly kitchens. Although accidental ingestion in children and pets and decreased efficacy were recognised health risks, this did not always translate to appropriate storage, usage or disposal practices. Individual risk-benefit assessments were applied to decisions to retain, use or dispose of medicines, including expired medicines.

CONCLUSIONS

Inappropriate medicine storage, use, and/or disposal practices raises public health concerns, particularly as there is a free returned medicines scheme available, and that this particular participant group were considered experienced medicine users. Healthcare professionals must act to address consumer misconceptions around the quality use of medicines, including medicine retention, storage and disposal. Future research is warranted to explore consumer practices in this context and confirm these findings in a younger, or healthier population.

Implementing ecopharmacovigilance (EPV) from a pharmacy perspective: A focus on non-steroidal anti-inflammatory drugs

Environmental experts have made great efforts to control pharmaceutical pollution. However, the control of emerged environmental problems caused by medicines should draw more attention of pharmacy and pharmacovigilance researchers. Ecopharmacovigilance (EPV) as a kind of pharmacovigilance for the environment is recognized worldwide as crucial to minimize the environmental risk of pharmaceutical pollutants. But continuing to treat the pollution of pharmaceuticals as a group of substances instead of targeting individual pharmaceuticals on a prioritized basis will lead to a significant waste of resources. Considering vulture population decline caused by non-steroidal anti-inflammatory drugs (NSAIDs) residues, we presented a global-scale analysis of 139 reports of NSAIDs occurrence across 29 countries, in order to provide a specific context for implementing EPV. We found a heavy regional bias toward research in Europe, Asia and America. The top 5 most frequently studied NSAIDs included ibuprofen, diclofenac, naproxen, acetaminophen and ketoprofen. The profile of NSAIDs was dominated by acetaminophen in wastewater influents and effluents. Ibuprofen was the most abundant NSAID in surface water. Only 9 NSAIDs were reported in groundwater samples. And majority of NSAIDs were detected in solid matrices at below 1μg/g except for ketoprofen, diclofenac and ibuprofen. From a pharmacy perspective, we get some implication and propose some management practice options for EPV implementation. These include: Further popularizing and applying the concept of EPV, together with developing relevant regulatory guidance, is necessary; More attention should be paid to how to implement EPV for the pollution control of older established drugs; Triggering "a dynamic watch-list mechanism" in conjunction with "source control"; Implementing targeted sewage treatment technologies and strengthening multidisciplinary collaboration; Pharmaceutical levels in aquatic organisms as biological indicators for monitoring pharmaceutical pollution within the water environment; Upgrading drinking water treatment plants with the aim of removing pharmaceutical residues; Paying more attention to EPV for pharmaceuticals in solid matrices.

Assessment of the association between drug disposal practices and drug use and storage behaviors

Objective

Keeping unnecessary drugs at home is a situation showing both causes and consequences of irrational use of medicine. This study aimed to evaluate the approaches of a company's employees regarding drug storage, use, and disposal.

Method

This online-based descriptive study was held in a multi-centered private-sector company in a voluntary basis. The survey assessing participants' drug handling and storage behaviors was answered by 1121 employees from across eight provinces of Turkey in 2016. Main outcome measures were storage and disposal of unused/unwanted drugs at home in a rational way.

Results

The percentage of participants who declared that they keep unused/unwanted drugs at home was 28.0%. About one-third of participants disposed their unused/unwanted drugs via the "garbage, sink, toilet, etc.". Participants ≥30 years old and living with <4 household members significantly tended to bring their unused/unwanted drugs to the company's drug-box. Nearly half of all participants (46.5%) stated a recent change in their disposal behavior. The vast majority of participants (94.6%) who previously took drugs back to the company's drug-box stated that they either had, or would, help their contacts adopt such behaviors. These participants were also significantly less likely to dispose of drugs inappropriately, practice self-medication, be unaware of expired drugs at home, or fail to store drugs according to the labelling.

Conclusion

While our findings showed that a substantial number of participants still had unused drugs at home and disposed of them inappropriately, it is understood that they started to exhibit more favorable behaviors in recent years.

Waiter, there is a drug in my soup - using Leximancer® to explore antecedents to pro-environmental behaviours in the hospital pharmacy workplace

OBJECTIVE/S

The aim of this study was to explore Queensland hospital pharmacists' and pharmacy technicians' knowledge and understanding of the impact of pharmaceuticals on the environment and the handling of pharmaceutical waste.

METHODS

This study followed a mixed methods research design. Purposive sampling techniques were used to recruit 64 hospital pharmacists and pharmacy technicians working in five public and private hospitals, in metropolitan and regional Queensland, Australia. Both quantitative and qualitative data were collected. Qualitative data were analysed using both the text analytics using descriptive statistics.

KEY FINDINGS

Lack of environmental knowledge regarding the impact of pharmaceuticals on the environment and lack of understanding of systems thinking concepts (that all living things are part of the one environment or system, and therefore any negative impacts on the environment will ultimately have negative impacts on human health) were the key findings of this research. Interviewees expressed concern, but most expressed minimal personal concern, about the impact of pharmaceuticals entering the environment. Most interviewees were unsure as to best practice methods for the disposal of pharmaceutical waste, and by complying with hospital policy assumed appropriate disposal occurred.

CONCLUSION

Before the pharmacy profession can take up a leadership role in the more sustainable use of pharmaceuticals, pharmacists and pharmacy technicians require environmental information regarding the negative impacts of pharmaceuticals on the environment, and education on systems thinking to enable them to understand that any negative impacts on the environment will ultimately have negative impacts on human health.

Investigating sources of pharmaceutical pollution: Survey of over-the-counter and prescription medication purchasing, use, and disposal practices among university students

Pharmaceutical pollution in surface waters poses a range of risks to public health and aquatic ecosystems. Consumers contribute to pharmaceutical pollution via use and disposal of medications, though data on such behaviors is limited. This paper investigates the purchasing, use, and disposal practices among a population that has been researched only minimally to date, yet will determine pharmaceutical pollution for decades to come: young adults represented by a university student population. We employed an online, 21-question survey to examine behaviors related to pharmaceuticals among students at the University of Vermont (n = 358). Results indicate that the majority of respondents had purchased medications in the previous 12 months (94%), and had leftover drugs (61%). Contrary to previous studies of older populations, only a small proportion of students had disposed of drugs (18%); municipal trash was the primary route of drug disposal (25%), and very few students disposed drugs via flushing (1%). Less than a quarter of students were aware of drug take-back programs (24%), and only 4% had ever used take-back services. These findings indicate that the university student population may be storing a large volume of unused drugs that will require future disposal. Increasing awareness of, access to, and participation in pro-environment pharmaceutical behaviors, such as purchasing over-the-counter medication in smaller quantities and utilizing drug take-back programs, could minimize future pharmaceutical pollution from this population.

Pharmaceuticals and Personal Care Products as Emerging Water Contaminants

With the advent of better detection, more micro-contaminants are being found in water. Many of these micro-contaminants come from medical therapies and personal care products. These chemicals are comprised of a wide-range of substances including pharmaceuticals, dietary supplements, veterinary drugs, fragrances, hair care products, body lotions, oral care, and cosmetics. Many of these products enhance our quality of life and in some cases, provide life-saving therapies. But, they come with an environmental cost. Scientific research has found sub-therapeutic levels of many of these chemicals in our waterways and in our finished drinking water, causing concern about the potential environmental and public health impacts associated with very low, chronic exposure. As tailored therapies and personal care products are developed, it is crucial to consider how to control emerging contaminants from medical therapies and personal care products. Specific actions and policies can be implemented now by adopting upstream approaches to prevent waste and decrease environmental exposures.

Investigating dynamic sources of pharmaceuticals: Demographic and seasonal use are more important than down-the-drain disposal in wastewater effluent in a University City setting

Pharmaceutical pollution in surface waters poses risks to human and ecosystem health. Wastewater treatment facilities are primary sources of pharmaceutical pollutants, but little is known about the factors that affect drugs entering the wastewater stream. This paper investigates the effects of student pharmaceutical use and disposal behaviors and an annual demographic shift on pharmaceutical pollution in a university town. We sampled wastewater effluent during a ten-day annual spring student move-out period at the University of Vermont. We then interpreted these data in light of survey results that investigated pharmaceutical purchasing, use, and disposal practices among the university student population. Surveys indicated that the majority of student respondents purchased pharmaceuticals in the previous year. Many students reported having leftover drugs, though only a small portion disposed of them, mainly in the trash. We detected 51 pharmaceuticals in 80% or more of the wastewater effluent samples collected over the ten-day sampling period. Several increased in concentration after students left the area. Concentrations of caffeine and nicotine decreased weakly. Drug disposal among this university student population does not appear to be a major source of pharmaceuticals in wastewater. Increases in pharmaceutical concentration after the students left campus can be tied to an increase in the seasonal use of allergy medications directly related to pollen, as well as a demographic shift to a year-round older population, which supports national data that older people use larger volumes and different types of pharmaceuticals than the younger student population.

Pharmaceuticals and the Environment (PiE): Evolution and impact of the published literature revealed by bibliometric analysis

The evolution and impact of the published literature surrounding the transdisciplinary, multifaceted topic of pharmaceuticals as contaminants in the environment is examined for the first time in an historical context. The preponderance of literature cited in this examination represents the earlier works. As an historical chronology, the focus is on the emergence of key, specific aspects of the overall topic (often termed PiE) in the published literature and on the most highly cited works. This examination is not a conventional, technical review of the literature; as such, little attention was devoted to the more recent literature. The many dimensions involved with PiE span over 70years of published literature. Some articles began to appear in published works in the 1940s and earlier, while others only began to receive attention in the 1990s and later. Decades of early research on what at the time seemed to be disconnected topics eventually coalesced in the mid-to-late 1990s around a number of interconnected concerns and issues that now comprise PiE. Major objectives are to provide a new perspective to the topic, to facilitate more efficient and effective review of the literature by others, and to recognize the more significant, seminal contributions to the advancement of PiE as a field of research. Some of the most highly cited articles in all of environmental science now involve PiE. As of April 2015, a core group of 385 PiE articles had each received at least 200 citations; one had received 5424 citations. But hundreds of additional articles also played important roles in the evolution and advancement of the field.

Fate of Antibiotics and Antibiotic Resistance during Digestion and Composting: A Review

Antibiotics and antibiotic-resistant bacteria (ARB) enter the environment through municipal and agricultural waste streams and pose a potential risk to human and livestock health through either direct exposure to antibiotic-resistant pathogens or selective pressure on the soil microbial community. This review summarizes current literature on the fate of antibiotics, ARB, and antibiotic resistance genes (ARGs) during anaerobic digestion and composting of manure and wastewater residuals. Studies have shown that removal of antibiotics varies widely during mesophilic anaerobic digestion, even within the same class of antibiotics. Research on ARB shows a wide range of removal under mesophilic conditions, with nearly complete removal under thermophilic conditions. Research on 16 antibiotics in 11 different studies using both bench-scale and farm-scale composting systems demonstrates that composting significantly reduces levels of extractable antibiotics in livestock manure in nearly all cases. Calculated half-lives ranged from 0.9 to 16 d for most antibiotics. There is more limited evidence that levels of ARB are also reduced by composting. Studies of the fate of ARGs show mixed evidence for removal during both mesophilic and thermophilic anaerobic digestion and during thermophilic composting. Antibiotic resistance genes are DNA structures, so they may persist until the DNA structure is degraded, yet the bacterium may have been rendered nonviable long before the DNA is completely degraded. Additional research would be of value to determine optimum anaerobic digestion and composting conditions for removal of ARB and to increase understanding of the fate of ARGs during anaerobic digestion and composting.

[Patients' knowledge and practices about unconsumed drugs disposal. An Approach to Ecopharmacovigilance]

Objective To describe knowledge, attitudes and practices about remaining drugs (RD) and expired drugs (ED) disposal. Method Descriptive study in 392 patients at a hospital in Bogotá, Colombia. Results Participants were 17 to 86 years old. 66.1% of them had RD, 31.4 % were nervous system drugs (according to Anatomical Therapeutic Chemical classification of WHO). 25.8 % of people dispose of RD in common waste (CW) and 64.0 % dispose of ED in CW. 17.4 % think RD, and 62.5 % think ED should be thrown away like CW. 4.9% of people think RD, and 6.6 % think ED should be thrown away in specialized places. 92.4 % people don't know about DRP nor 86.7 % about "Puntos Azules"; 94.6 % would like more information. 79.1 % think that throwing away drugs can affect health and, 88.8 %, the environment. Conclusions Most participants dispose of drugs inappropriately. They think that it is wrong and this can damage the environment and health. There is an interest in being informed. This reveals an area of possible work in awareness, information and education from pharmacovigilance about this subject for the benefit of the population.

Ciprofloxacin residues in municipal biosolid compost do not selectively enrich populations of resistant bacteria

Biosolids and livestock manure are valuable high-carbon soil amendments, but they commonly contain antibiotic residues that might persist after land application. While composting reduces the concentration of extractable antibiotics in these materials, if the starting concentration is sufficiently high then remaining residues could impact microbial communities in the compost and soil to which these materials are applied. To examine this issue, ciprofloxacin was added to biosolid compost feedstock to achieve a total concentration of 19 ppm, approximately 5-fold higher than that normally detected by liquid chromatography-tandem mass spectrometry (LC-MS/MS) (1 to 3.5 ppm). This feedstock was placed into mesh bags that were buried in aerated compost bays. Once a week, a set of bags was removed and analyzed (treated and untreated, three replicates of each; 4 weeks). Addition of ciprofloxacin had no effect on the recovery of resistant bacteria at any time point (P = 0.86), and a separate bioassay showed that aqueous extractions from materials with an estimated 59 ppm ciprofloxacin had no effect on the growth of a susceptible strain of Escherichia coli (P = 0.28). Regression analysis showed that growth of the susceptible strain of E. coli can be reduced given a sufficiently high concentration of ciprofloxacin (P < 0.007), a result that is consistent with adsorption being the primary mechanism of sequestration. While analytical methods detected biologically significant concentrations of ciprofloxacin in the materials tested here, the culture-based methods were consistent with the materials having sufficient adsorptive capacity to prevent typical concentrations of ciprofloxacin residues from selectively enriching populations of resistant bacteria.

Drugs of abuse and benzodiazepines in the Madrid Region (Central Spain): seasonal variation in river waters, occurrence in tap water and potential environmental and human risk

This work analyzes the seasonal variation (winter and summer) of ten drugs of abuse, six metabolites and three benzodiazepines in surface waters from the Jarama and Manzanares Rivers in the Madrid Region, the most densely populated area in Spain. The occurrence of these compounds in tap water in this region is also investigated and a preliminary human health risk characterization performed for those substances found in tap water. Finally, a screening level risk assessment that combines the measured environmental concentrations (MECs) with dose-response data to estimate Hazard Quotients (HQs) for the compounds studied is also presented. The results of this study show the presence of fourteen out of the nineteen compounds analyzed in winter and twelve of them in summer. The most ubiquitous compounds, with a frequency of detection of 100% in both seasons, were the cocaine metabolite benzoylecgonine (BE), the amphetamine-type stimulant (ATS) ephedrine (EPH), the opioid methadone (METH), the METH metabolite 2-ethylene-1,5-dimethyl-3,3-diphenylpyrrolidine (EDDP), and the three benzodiazepines investigated, namely alprazolam (ALP), diazepam (DIA) and lorazepam (LOR). The highest concentrations observed corresponded to EPH (1020ngL(-1) in winter and 250ngL(-1) in summer). The only compounds not detected in both seasons were heroin (HER) and its metabolite 6-acetylmorphine (6ACM), lysergic acid diethylamide (LSD) and its metabolite 2-oxo-3-hydroxy-LSD (O-H-LSD), and Δ(9)-tetrahydrocannabinol (THC). In terms of overall concentration, all sampling points presented higher concentrations in winter than in summer. Statistical analyses performed to gather evidence concerning occasional seasonal differences in the concentrations of individual substances between summer and winter showed statistically significantly higher concentrations (p<0.05) of BE, EPH and the opioid morphine (MOR) in winter than in summer. Two out of the nineteen compounds studied, namely cocaine (CO) and EPH, were detected in tap water from one sampling point at concentrations of 1.61 and 0.29ngL(-1), respectively. The preliminary human health risk characterization showed that no toxic effects could be expected at the detected concentration level in tap water. The screening level risk assessment showed that MOR, EDDP and the THC metabolite 11-nor-9-carboxy-Δ(9)-tetrahydrocannabinol (THC-COOH) were present in at least one of the sampling sites in a concentration leading to a Hazard Quotient (HQ) value between 1.0 and 10.0, thus indicating some possible adverse effects. The cumulative HQ or Toxic units (TUs) calculated for each of the groups studied showed that opioids and cannabinoids were present at concentrations high enough to potentially generate some adverse effects on at least one sampling point.

Reducing PEC uncertainty in coastal zones: a case study on carbamazepine, oxcarbazepine and their metabolites

Concentrations of the antiepileptic drugs carbamazepine (Cbz), oxcarbazepine (OxCz) and their main metabolites were predicted in a wastewater treatment plant (WTP) and in the vicinity of its submarine outfall located in a Mediterranean coastal zone. Refined predicted environmental concentrations (PECs) were calculated in effluents based on consumption data and human excretion rates. PECs were estimated in the sea using the hydrodynamic MARS 3D model integrating meteorological data, oceanic conditions (wind, tide, atmospheric pressure), freshwater and sewage inputs. Measured environmental concentrations (MECs) were compared to PECs to assess the estimation relevance. In the coastal zone, PEC and MEC were in the same magnitude range. Modeling of Cbz diffusion and advection just above the submarine outfall showed the influence of the thermocline during summer, with low diffusion of Cbz from the bottom to the surface. This work allowed understanding the dispersion of target compounds and deserved further development for a better acknowledgement of vulnerability at local scales.

Nissen L, Barter N, McIntosh M. The global public health issue of pharmaceutical waste: what role for pharmacists?

Purpose

– Pharmaceuticals have played an important role in improving the quality of life of the human population in modern times. However, it must also be acknowledged that both the production and use of pharmaceuticals have a significant, negative impact on the environment and consequently, a negative impact on the health of humans and wildlife. This negative impact is due to the embedded carbon in pharmaceuticals' manufacture and distribution and the waste generated in their manufacture, consumption and disposal. Pharmaceutical waste is comprised of contaminated waste (unwanted pharmaceuticals and their original containers) and non-contaminated waste (non-hazardous packaging waste). The paper aims to discuss these issues.

Design/methodology/approach

– The article is a literature review.

Findings

– The article identified a gap in the literature around pharmacist attitudes and behaviour toward the environmentally responsible handling of pharmaceutical waste.

Originality/value

– Pharmacists, with their professional commitment to the quality use of medicines and their active participation in the medicines management pathway, already play an important role in the more sustainable use of pharmaceuticals. Even so, they have the potential to play an even greater role with the environmentally responsible disposal of pharmaceutical waste (including packaging waste) and the education of other health professionals and the general public on this topic.

Implementing ecopharmacovigilance in practice: challenges and potential opportunities

Ecopharmacovigilance (EPV) is a developing science and it is currently very unclear what it might mean in practice. We have performed a comparison between pharmacovigilance (PV) and EPV and have identified that there are similarities, but also some important differences that must be considered before any practical implementation of EPV. The biggest difference and greatest challenge concerns signal detection in the environment and the difficulty of identifying cause and effect. We reflect on the dramatic vulture decline in Asia, which was caused by the veterinary use of diclofenac, versus the relative difficulty in identifying the specific causes of intersex fish in European rivers. We explore what EPV might mean in practice and have identified that there are some practical measures that can be taken to assess environmental risks across product life cycle, particularly after launch of a new drug, to ensure that our risk assessments and scientific understanding of pharmaceuticals in the environment remain scientifically and ecologically relevant. These include:

Tracking environmental risks after launch of the product, via literature monitoring for emerging data on exposure and effects

Using Environmental Risk Management Plans (ERMPs) as a centralized resource to assess and manage the risks of a drug throughout its life cycle

Further research, testing or monitoring in the environment when a risk is identified

Keeping a global EPV perspective

Increasing transparency and availability of environmental data for medicinal products.

These measures will help to ensure that any significant environmental issues associated with pharmaceuticals in the environment (PIE) are identified in a timely way, and can be managed appropriately.

Behind closed doors: medication storage and disposal in the home

BACKGROUND

More than half of all medications are inappropriately prescribed, dispensed, or sold and only 50% of patients take their medications correctly. Oftentimes, unwanted or expired medications are saved for later use, stored indefinitely, or disposed via the sink, toilet, or garbage.

OBJECTIVE

To determine how residents in Cook County, Illinois, use, store, and dispose of their medications to assess the possible impact of these medications on health care and the environment.

METHODS

Researchers at the University of Illinois conducted a survey of Cook County residents over a 13-week period. Residents were surveyed regarding their use, storage, and disposal of prescription and nonprescription medications.

RESULTS

From 3954 telephone numbers generated through random-digit dialing, 445 telephone interviews were completed. Eighty-one and a half percent of respondents had prescription medications and 92.4% had nonprescription medications in their homes. On average, respondents possessed 4.4 distinct prescription and 5.5 distinct nonprescription medications. Despite possessing a number of medications, approximately 30% of respondents stated that they took no medication on a regular basis; 59% of respondents reported disposing medications in the household gar bage and 31% flushed them down the toilet or sink. Over 80% of respondents stated that they had never received information about proper medication disposal. Thirty-seven percent reported having leftover unexpired medications from a previous illness. Of these, 63% stopped taking their medications because they believed that they no longer needed them or because they felt better. Thirty-two percent of respondents expected to have leftover prescription medications within the next 6 months.

CONCLUSIONS

Almost all respondents had excess and leftover medications in their homes. This may be a result of both overprescribing and poor medication adherence. In addition to the potential human health risk of nonadherence, disposal of excess medication raises concerns about their environmental impact and safety.

Disposal of unwanted medications: throw, bury, burn or just ignore?

OBJECTIVES

The aim of this article is to highlight the relevance of proper disposal of unwanted medications.

KEY FINDINGS

Proper disposal of unwanted medications is a global issue. The consequences of improper disposal are a major concern, as it has negative consequences on both human health and the environment. Pharmacists are in a key position to ensure proper disposal and reduce the generation of unwanted medications.

CONCLUSION

There is urgent need for awareness on a global scale, among the public and healthcare professionals, of the importance of proper disposal of unwanted medications. Research is required to assess pharmacists' attitudes and methods used for disposal from pharmacies.

Selective serotonin re-uptake inhibitors (SSRIs) in the aquatic environment: an ecopharmacovigilance approach

Selective serotonin re-uptake inhibitors (SSRIs) antidepressants are among the most prescribed pharmaceutical active substances throughout the world. The occurrence of these widely used compounds in different environmental compartments (wastewaters, surface, ground and drinking waters, and sediments), justify the growing concern about these emerging environmental pollutants. Viewing an ecopharmacovigilance approach, a comprehensive discussion of the state of the art regarding different contamination sources, fate, degradation and occurrence is presented. Information on the current distribution levels and fate in different environmental matrices continues to be sparse and measures are imperative to improve awareness and encourage precautionary actions to minimize SSRIs' environmental impact.

Green pharmacy and pharmEcovigilance: prescribing and the planet

Active pharmaceutical ingredients (APIs) are ubiquitous environmental contaminants, resulting primarily from excretion and bathing and from disposal of leftover drugs by consumers and healthcare facilities. Although prudent disposal of leftover drugs has attracted the most attention for reducing API levels in the aquatic environment, a more effective approach would prevent the generation of leftover drugs in the first place. Many aspects of the practice of medicine and pharmacy can be targeted for reducing environmental contamination by APIs. These same modifications--focused on treating humans and the environment as a single, integral patient--could also have collateral outcomes with improved therapeutic outcomes, and with a reduced incidence of unintended poisonings, drug interactions and drug diversion, and lower consumer costs.

Nursing role in the pharmaceutical life cycle

Biologically active, nontherapeutic levels of pharmaceuticals have been detected in waterways and effluent. Although the vast majority of releases stem from human or animal excretion and production effluent, some come from disposal practices. Studies have demonstrated numerous links between environmental exposures from pharmaceutical compounds and their impact upon aquatic life. Nurses need to be aware of this issue since their roles in health care are expanding and considered among the most trusted. Throughout the life cycle of pharmaceuticals (design, approval/regulation, production, use, and discharge/disposal), nursing can play pivotal roles in reducing and eliminating pharmaceutical waste as well as improving public safety through decreasing poisoning and drug abuse. This article discusses the environmental impact of the pharmaceutical life cycle and what roles nurses have as clinicians, educators, advocates, and researchers.

Illicit drugs: contaminants in the environment and utility in forensic epidemiology

The published literature that addresses the many facets of pharmaceutical ingredients as environmental contaminants has grown exponentially since the 1990s. Although there are several thousand active ingredients used in medical pharmaceuticals worldwide, illicit drug ingredients (IDIs) have generally been excluded from consideration. Medicinal and illicit drugs have been treated separately in environmental research even though they pose many of the same concerns regarding the potential for both human and ecological exposure. The overview presented here covers the state of knowledge up until mid-2010 regarding the origin, occurrence, fate, and potential for biological effects of IDIs in the environment. Similarities exist with medical pharmaceuticals, particularly with regard to the basic processes by which these ingredients enter the environment--excretion of unmetabolized residues (including via sweat), bathing, disposal, and manufacturing. The features of illicit drugs that distinguish them from medical pharmaceuticals are discussed. Demarcations between the two are not always clear, and a certain degree of overlap adds additional confusion as to what exactly defines an illicit drug; indeed, medical pharmaceuticals diverted from the legal market or used for non-medicinal purposes ar also captured in discussions of illicit drugs. Also needing consideration as par tof the universe of IDIs are the numerous adulterants and synthesis impurities often encountered in these very impure preparations. many of these extraneous chemicals have high biological activity themselves. In contract to medical pharmaceuticals, comparatively little is know about the fate and effects of IDIs in the environment. Environmental surveys for IDIs have revealed their presence in sewage wastewaters, raw sewage sludge and processed sludge (biosolids), and drinking water. Nearly nothing is known, however, regarding wildlife exposure to IDIs, especially aquatic exposure such as indicated by bioconcentration i tissues. In contrast to pharmaceuticals, chemical monitoring surveys have revealed the presence of certain IDIs in air and monetary currencies--the latter being of interest for the forensic tracking of money used in drug trafficking. Another unknown with regard to IDIs is the accuracy of current knowledge regarding the complete scope of chemical identities of the numerous types of IDIs in actual use (particularly some of the continually evolving designer drugs new to forensic chemistry) as well as the total quantities being trafficked, consumed, or disposed. The major aspect unique to the study of IDI's in the environment is making use of their presence in the environment as a tool to obtain better estimates of the collective usage of illicit drugs across entire communities. First proposed in 2001, but under investigation with field applications only since 2005, this new modeling approach for estimating drug usage by monitoring the concentrations of IDIs (or certain unique metabolites) in untreated sewage has potential as an additional source of data to augment or corroborate the information-collection ability of conventional written and oral surveys of drug-user populations. This still evolving monitoring tool has been called "sewer epidemiology" but is referred to in this chapter by a more descriptive proposed term "FEUDS" (Forensic Epidemiology Using Drugs in Sewage). The major limitation of FEUDS surrounds the variables involved at various steps performed in FEUDS calculations. These variables are summarized and span sampling and chemical analysis to the final numeric calculations, which particularly require a better understanding of IDI pharmacokinetics than currently exists. Although little examined in the literature, the potential for abuse of FEUDS as a tool in law enforcement is briefly discussed. Finally, the growing interest in FEUDS as a methodological approach for estimating collective public usage of illicit drugs points to the feasibility of mining other types of chemical information from sewage. On the horizon is the potential for "sewage information mining" (SIM) as a general approach for measuring a nearly limitless array of biochemical markers that could serve as collective indicators of the specific or general status of public health or disease at the community-wide level. SIM may create the opportunity to view communities from a new perspective--"communities as the patient." This could potentially lead to the paradigm of combining human and ecological communities as a single patient--as an interconnected whole.

Environmental and food analysis by desorption atmospheric pressure photoionization-mass spectrometry

Desorption atmospheric pressure photoionization-mass spectrometry (DAPPI-MS) is a versatile surface analysis technique for a wide range of analytes, especially for neutral and non-polar analytes. Here, a set of analytes typically found in environmental or food samples was analyzed by DAPPI-MS. The set included five polyaromatic hydrocarbons (PAHs), one N-PAH, one brominated flame retardant, and nine pesticides, which were studied with three different spray solvents: acetone and toluene in positive ion mode, and anisole in negative ion mode. The analytes showed [M + H](+), M(+*), and [M-H](-) ions as well as fragmentation and substitution products. Detection limits for the studied compounds ranged from 30 pg to 1 ng (from 0.14 to 5.6 pmol). To demonstrate the feasibility of the use of DAPPI-MS two authentic samples - a circuit board and orange peel - and a spiked soil sample were analyzed. Tetrabromobisphenol A, imazalil, and PAHs were observed from the three above-mentioned samples, respectively. The method is best suited for rapid screening analysis of environmental or food samples.

Don’t Rush to Flush: Safer Pharmaceutical Practices for Hospice Home Care and Home Health Nurses

Hospice home care and home health nurses are essential providers in efforts to improve the care and quality of life with families who have someone living with advanced or life-limiting conditions. Because these nursing professionals are part of end-of-life care, their duties include education about and disposal of unused medications. But drug disposal has broader implications, especially for the environment, aquatic life, and ultimately for human health. The purpose of this article is to (a) introduce the topic of drug disposal within an environmental and health context, (b) identify current recommendations for drug disposal, and (c) provide suggestions for hospice home care and home health care nurses for safer drug disposal.

Do biological medicinal products pose a risk to the environment?: a current view on ecopharmacovigilance

The occurrence of active pharmaceutical substances in the environment is of growing concern. The vast majority of the compounds in question are of low molecular weight, intended for oral use and designed to tolerate, for example, the digestive enzymes in the upper alimentary tract, the harsh milieus found in the acidic stomach, or the microbe rich intestine. Accordingly, these xenobiotic compounds may, due to their inherent biological activity, constitute a risk to the environment. Biological medicinal products, for example recombinant human insulin or monoclonal antibodies, however, are different. They are primarily made up of oligomers or polymers of amino acids, sugars or nucleotides and are thus readily metabolized. They are therefore generally not considered to pose any risk to the environment. Certain classes of biological medicinal products, however, are associated with specific safety issues. Genetically modified organisms as vectors in vaccines or in gene therapy products have attracted much attention in this regard. Issues include the degree of attenuation of the live recombinant vaccine, replication restrictions of the vaccine vector, alteration of the host and tissue tropism of the vector, the possibility of reversion to virulence, and risk to the ecosystem. In this review we discuss the fate and the potential environmental impact of biological medicinal products following clinical use from an ecopharmacovigilance point of view, and review relevant policy documents and regulatory statements.

Disposal practices for unwanted residential medications in the United States

The occurrence of trace levels of prescription and over-the-counter pharmaceuticals in the environment began to receive concerted attention nearly two decades ago. The public's growing awareness and concern over the presence of these chemicals, especially in drinking water, has served to catalyze considerable discussion and debate regarding the best practices for disposal of unused or unwanted medications. In the United States, the first federal guidance for consumers was issued in 2007. It recommends discarding unused pharmaceuticals to household trash, after taking precautions to mix the pharmaceuticals with an inert substance and conceal the contents from view. Providing the consumer with additional options for conscientious disposal are various community, city, and state collection events, ongoing programs, and government-funded pilot projects. These strategies include the opportunity to mail or bring unused medications to various collection points, such as pharmacies, for eventual destruction. All of these approaches to medication disposal play roles in reducing the introduction of pharmaceuticals to the environment.