The new evidence suggests that discarding unused drugs in the trashis a better option to limit the risk of poisoning and at the sametime curb pollution of both water and air. To arrive at this conclusion, the researchers compared the totalemissions created by take-back, trash and toilet disposal methods.This included emissions of pharmaceutical active ingredients aswell as releases of other water and air pollutants. "National policy seems to be changing to support take-backprograms, and we don't know if that's justified," said SherriCook, a doctoral student in the U-M Department of Civil andEnvironmental Engineering. Cook is first author of a paper on thefindings published in the May 16 edition of Environmental Science& Technology. |
U.S. households accumulate an estimated 200 million pounds ofunused pharmaceuticals every year, the researchers say. In mostcases today, the FDA recommends throwing them away, but only if youdon't have access to a take-back program. Cities, states and evensome stores have initiated them. From collection sites, thereturned drugs are transferred to another facility where they'reincinerated as hazardous waste.
Health officials caution that unused pills should be out of thehouse as soon as possible to prevent poisoning and drug abuse byother family members. But that need must be balanced with pollutioncontrol, both for human health and environmental reasons. Flushingunused pills down the toilet is no longer advised, as the activeingredients in drugs have been found in drinking water and aquaticenvironments. The new study found: If half of people threw away unused medications and half took themback to the drug store, the amount of active pharmaceuticalingredients in the environment would be reduced by 93 percentcompared with today. If everyone trashed their extra drugs, those amounts would bereduced by 88 percent.
That 5 percent improvement in pharmaceutical emission reduction dueto take-back programs would come at a significant cost, possiblymore than a billion dollars annually, along with a 300 percentincrease in other emissions such as greenhouse gases andsmog-forming substances. "Nobody has ever added up all the emissions associated withdisposing of medication," said Steve Skerlos, a professor inthe departments of Mechanical Engineering and Civil andEnvironmental Engineering and a co-author of the study. "Whenyou look at the available evidence to support take-back, it justdoesn't add up." The researchers focused on a 50 percent take-back compliance ratebased on actual practice in Sweden, which has had a nationaltake-back program for 40 years. The compliance rate there is just43 percent. Drugs that aren't returned tend to stay in the medicinecabinet, defeating the goal of getting unused medications out ofthe home quickly, the researchers say.
The U-M researchers considered a wide range of factors, includinghow often people would return medication, how far they live fromtake-back sites, how rainfall might affect landfill leachateleaking into groundwater, and what percentage of residents could beexpected to comply. The results surprised the team. "We didn't expect that landfilling would be the best option,because when you incinerate something, it's gone, and when it's ina landfill, it can remain for some time," said Nancy Love, aprofessor in the Department of Civil and Environmental Engineeringand a co-author of the study. "However, once we considered allthe environmental emissions for the three options, the results madesense." The researchers encourage policymakers to focus on getting morepeople to get rid of medicines by trash, rather than take-back.
"Trashing unused medications reduces the consumer'sinconvenience relative to take-back, and if there is a clearmessage perhaps we could increase the percentage of people puttingthem in the trash," Cook said. Currently, about 60 percent of people already use trash disposal,while 40 percent of people still flush unused medication down thetoilet. When discarding pills in the trash, the FDA recommends mixing themwith an unpalatable substance such as coffee grounds in a plasticbag. This helps to deter would-be abusers from picking them out ofthe garbage.
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