Takeback and disposal of medications in US

San Francisco’s city leaders are poised to pass an ordinance requiring name-brand drug manufacturers to pay for collection and disposal of unused prescription medicines to curb prescription misuse and environmental impacts.

The ordinance would require residents to store unused medicines at home and take them to a facility for incineration.

As noted in the San Francisco Chronicle, these are both bad ideas. Stockpiling prescription pharmaceuticals and other over the counter drugs at home increases the chance that those medicines might be stolen and used inappropriately, or create additional risks of deliberate overdoes or accidental poisoning.

The environmental cost of incineration on air quality and the transportation costs of getting the medications to the incinerator outweigh any benefit though take back and collection schemes, already common in the US exist widely and seem to operate with considerable success. Who pays for this is perhaps a mute point, as long as the collection process is effective.

The better approach is to teach and if necessary to regulate effectively against over-prescribing, and to impress upon patients the importabnce of taking the prescribed drug at the appropriate time and does, and for the prescribed number of doses. That way, no unused drug will remain.

But one problem exists. Concern about the environmental impact of unused medication disposal pales into insignificance when measured against excretion of the administered dose. That enters the environment via the toilet, excreted naturally in urine.  Up to 99% of the administered dose will be excreted as original drug substance with, on occasions, a considerable range of metabolites. Sewage treatment does not remove these substances and though many decay naturally their environmental impact is largely unknown.

Once more, regulation seems to be predicated on flimsy scientific evidence and with a particularly dubious rationale. There is certainly no need to abandon arrangements for the collection and appropriate disposal of unwanted medicines from domestic sources – we certainly need this in the UK – but the case is not well made if those arrangements result in cumbersome and impractical schemes that do not work well.

It is equally inappropriate to leap headlong into new legislation without linking this to changes in prescribing practice, and of course to overstate the environmental impact without the slightest thought about mass balance that puts up to 99% of the prescribed medications straight down the toilet.

An even greater environmental impact might be antcipated from veterinary drug administration, since the ‘patient’ is unlikely to use the toilet but deposit their urine directly to land.

Considerable funds will be spent in drafting and managing this legislation. This money would be better spent on the investigation of improved wastewater treatment processes, for hospitals and livestock facilities, and perhaps also for use in community wastewater plant.

See the Clinical Waste Discussion Forum archives for more on this subject

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