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Contribution to the existing page: Environmental impact of pharmaceuticals and personal care products

Contribution to the Human subheading under Effects
There have been recent studies conducted aimed to investigate the link between household disposal and risk perception. A survey carried out by Jonathan P. Bound from the Centre for Environmental Policy in London further examines this issue. Four hundred householders from the area of South-East of England, were interviewed on topics based on how they disposed unfinished pharmaceuticals. These responses were in turn analyzed in regards to personal information and attitudes in order to determine the factors affecting the chosen methods of disposal. Bound’s findings reveal that one’s level of environmental awareness has an impact on the method of disposal chosen.

The relationship between risk perception and behavior is multifaceted. Risk management is most effective once the motivation behind the behavior of disposing unused pharmaceuticals is understood. There was little correlation found between the perception of risk and knowledge regarding pharmaceutical waste according to a study conducted by Cook and Bellis in 2001. This study cautioned against the effectiveness of attempting to change the public’s behavior on these health issues by warning them of the risks associated with their actions. It is advised to take careful measures to inform the public in a way that does not impart guilt but rather public awareness. For example, a study carried out by Norlund and Garvill in Sweden (2003) that found that some people may make a personal sacrifice in terms of comfort because they feel that it would be helpful to reduce further environmental damage caused by the use of cars. Awareness of air pollution problems was a factor in their decision to take action on a more environmentally favorable choice of transportation. Thus, the goal of Bound’s project encapsulates whether the perception of risk associated with pharmaceuticals has an effect on the way in which medication is commonly disposed.

In order to conduct this study, the pharmaceuticals were grouped by their therapeutic action in order to help participants identify them. The eight therapeutic groups are listed below: antibacterials, antidepressants, antihistamines, antiepileptics, hormone treatments, and lipid regulators. Next, a survey was created to examine the disposal patterns of the participants and their perception of the existing risk or threat against the environment. Respondents were asked the following questions in part one of the survey: 1. When and how they disposed of pharmaceuticals. 2. How they perceive the risk to the environment posed by pharmaceuticals. 3. To differentiate between the risks associated with different classed of pharmaceuticals. Part two of the survey involved each of the eight pharmaceutical groups described above individually. Finally, the third part asked information about the age, sex, profession, postcode, and education of participants. The sample size of participants was precise in comparison to the actual distribution of males and females in the UK: Sample- 54.8% were female and 45.2% male vs. Actual- the UK of 51.3% female to 48.7% male. Results showed that when a medication must be discarded, 63.2% of participants throw them in a bin, 21.8% return them to a pharmacist, 11.5% and 11.5% dispose of them via the toilet/sink, while the remaining 3.5% keep them. Only half of the respondents felt like pharmaceuticals could potentially be harmful to the environment. Upon examination of factors relevant to risk perception, there was no definite link found between perception and education or income.

Dr. Bound noted that participation in altruistic activities such as Environmental Conservation groups may provide members with the ability to better grasp the effects of their actions in the environment. In regards to the aquatic environment, it is hard for one to perceive the favorable impacts of properly disposing medication. There also exists the plausibility that a person’s behavior will only be affected if there is a severe risk to themselves or humans as opposed to an environmental threat. Even though there are serious threats of pharmaceutical pollution resulting in the feminization of certain fish, they have a lower priority because they are not easily understood or experienced by the general public. In Jonathan P. Bound’s opinion, the provision of information about exactly how to go about disposing unused medication properly in conjunction with risk education may have a more positive and forceful effect.



Contribution to the Environmental subheading under Effects
There are various concerns about the effects of pharmaceuticals found in surface waters and specifically the threats against rainbow trout exposed to treated sewage effluents. Analysis of these pharmaceuticals in the blood plasma of fish compared to human therapeutic plasma levels have yielded vital information providing a means of assessing risk associated with medication waste in water. In a study by Dr. Jerker Fick from Umea University rainbow trout were exposed to undiluted, treated sewage water at three different sits in Sweden. They were exposed for a total of 14 days while 25 pharmaceuticals were measured in the blood plasma at different levels for analysis. The progestin Levonorgestrel was detected in fish blood plasma at concentrations between 8.5 and 12 ng mL-1 which exceed the human therapeutic plasma level. Studies show that the measured effluent level of Levonorgestrel in the three areas was shown to reduce the fertility of the rainbow trout.

The three sites chosen for field exposures were in located in Stockholm, Gothenburg, and Umea. They were chosen according to their varying degrees of treatment technologies, geographic locations, and size. The effluent treatment includes active sludge treatment, nitrogen and phosphorous removal (except in Umea), primary clarification, and secondary clarification. Juvenile rainbow trout were procured from Antens fiskodling AB, Sweden and Umlax AB, Sweden. The fish were exposed to aerated, undiluted, treated effluent. Since all of the sites underwent sludge treatment, it can be inferred that they are not representative of the low end of treatment efficacy. Of the 21 pharmaceuticals that were detected in the water samples, 18 were identified in the effluent, 17 in the plasma portion, and 14 pharmaceuticals were found in both effluent and plasma.

There have been studies conducted that examine concentrations of the drug Diclofenac in rainbow trout as well. This particular pharmaceutical has been found to cause damage to the kidney such as degeneration of the tubular epithelial cells and the cause of interstitial nephritis. Diclofenac is a common antiheumatic and antiphologistic drug. The drug may be improperly disposed or not fully degraded and then excreted after consumption. In surface waters, the maximum concentrations are in the range or 2 g/L (Lehmann, 2000 ). It has been determined by J. Schwaiger and his lab that rainbow trout exposed to Diclofenac for a four week time period leads to distinct alterations in both the kidney and gills.

The result of these lethal pharmaceutical concentrations in fish is that renal lesions and damage to the gills are due to a threshold concentration of 5 g/L. As a consequence of therapeutical doses of Diclofenac there have been comparable changes in the kidney in some mammals and humans. In short term treatment of rats and dogs, alterations such as necrosis and dilation have occurred (Manocha and Venkataraman 2000). Commonly reported kidney related complications in humans such as necrosis have been reported as well.

Chemical analysis of Diclofenac residues in different organs was also examined. Even though remarkable concentrations of the drug were detected in the gills and kidney of the rainbow trout, the highest concentration was found in the liver. As opposed to Diclofenac treated humans and rats in which there was notable necrosis and inflammation in the liver, there were no detrimental histopathological alterations observed in the liver; yet, at the ultrastuctural level, Diclofenac induced cellular reactions in the liver became visible in rainbow trout after 1 g/L of exposure.

Contribution to the Proper Disposal section
A significant proportion of the pharmaceuticals found in sewage treated effluent have been due to human secretion; however, here are ways to properly dispose of unused medication to decrease the amount of pharmaceuticals found in sewage effluent. Some common medications are in fact flushable such as morphine sulfate, Percocet, and Percodan. More flushable drugs have been listed by the FDA and can be found online.

Separate Page on the National Take Back Initiative
The annual National Take Back Initiative in the United States occurs October 29. This program is coordinated by the Drug Enforcement Administration (DEA). Drug Take Back Programs are a common and environmentally supportive venue for avoiding the improper disposal of unused pharmaceuticals.

In 2010, according to the Centers for Disease Control and Prevention, enough pharmaceuticals were prescribed to medicate every American adult around-the-clock for one month. Some of these prescriptions and over the counter drugs decay in the home and are highly susceptible to diversion, misuse, and abuse. Often, more Americans currently abuse prescription drugs than the number of those using cocaine, hallucinogens, heroin, and inhalants combined, according to the 2010 National Survey on Drug Use and Health. Studies show that the majority of teens who abuse prescription drugs obtain them from family or friends for free, including from the home medicine cabinet. Improper disposal methods can pose both safety and environmental hazards.

Four days following the DEA’s first Take-Back Day on September 25, 2010, Congress approved legislation that amended the Controlled Substances Act. This action provided the DEA with the option to develop a permanent process for people to safely and conveniently dispose of their prescription drugs. After October 12,President Obama signed the Safe and Secure Drug Disposal Act of 2010, and the DEA immediately began installing regulations for a more permanent solution.

The DEA’s Take-Back events are also a reflection of the President's prescription drug abuse prevention strategy entitled Epidemic: Responding to America’s Prescription Drug Abuse Crisis developed and promoted by the Office of National Drug Control Policy. Ridding medicine cabinets of unused or expired medications in American homes is one of the four main items addressed the strategy for reducing diversion prescription drug abuse. The other action items include educating the public as well as health care providers. In turn, this system establishes prescription drug monitoring programs in all the states.