Review of human pharmaceuticals in the environment

From: Ian blenkharn@ianblenkharn.com
Category: Miscellaneous
Date: 16 Feb 2008
Time: 15:08:56 +0100
Remote Name: 86.134.111.185

Comments

A newly commissioned report "Review of human pharmaceuticals in the environment" is now available from the Environment Agency. It makes interesting reading, and raises many important questions.

Not least is the thorny question of what to do about these pharmaceutical residues? The report reveals that pharmaceuticals are finding their way into the water supply despite extensive purification treatments used by water companies. Trace levels of bleomycin, a cancer chemotherapy drug, and diazepam, a sedative, have been found during tests on drinking water, the report reveals.

Drinking water treatment works use a wider and technically more advanced range of processes, but again these are not specifically designed to remove pharmaceuticals and several compounds have been reported in drinking water."

But it adds: "Even in the worst-case situation, there is no significant risk to health from the intake of pharmaceuticals via drinking water.

How does this impact upon the disposal of clinical wastes, that comprise bulk waste pharmaceuticals, or pharmaceutical residues conventionally present within soft wastes or sharps residues.

• The report places great emphasis on the sources of pharmaceutical residues in water and identifies the excreted dose - sooner or later, patients receiving any drug excrete most of it in their urine
• The report considers the massive quantities of prescribed drugs that contribute to the environmental impact of pharmaceuticals
• The report does not consider the impact of OTC products, and of those pharmaceuticals administered to animals - these contribute massively to the environmental burden and significantly magnify the scale of this problem
• The report identifies significant deficiencies in water treatment facilities and an urgent need for upgrading of facilities together with more specific analysis of water treatment processes

What, therefore, is the need for the control of pharmaceuticals in clinical waste? Cytotoxics must be separately managed, and with great care due to the specific risks that the pose. Similarly, bulk waste pharmaceuticals can and should be separately managed.

But what about those pharmaceutical residues that may be present in the average sack of soft clinical waste, or in the 'empty' syringes present in a filled sharps bin?

• Are these pharmaceutical residues present in too small a concentration to make any significant contribution to the environmental burden?
• Do the pressures to improve still further the segregation of wastes - that undoubtedly fail in practice, though we still pretend - or to restrict those waste streams permitted for treatment by an otherwise approves ATT process make any sense?
• Is this making any real difference, or is the impact so trivial to be inappropriate and unnecessary?
• Or do we need to do everything possible, however inconvenient, inefficient and expensive?

These are difficult questions, that might be answered by consensus opinion supported by carefully presented scientific evidence, but not by dogma and ideology.

Perhaps the time is right to revisit this important issue, to take opinion and to consult widely, and to resolve these questions more effectively than has been the case so far. The report 'Review of human pharmaceuticals in the environment' should now act as a prompt for further review of the approaches to dealing with minor pharmaceutical residues in clinical wastes. Previous ex-Cathedra "rules" should not be considered as written in stone

First posted 14-Jan-2008

Last changed: 07/31/08