It’s a serious issue and the evidence coming from properly conducted research shows that we need to address as a matter of some urgency the escape of pharmaceutical agents into the environment, particularly via wastewater.

Regulators have, for several years now, been keen to prohibit any escape of pharma residues from ATT systems, though with a highly questionable legal and moral foundation for their decisions this has been highly selective in application.

http://www.newsworks.org/index.php/local/item/33534

On a wider basis, there is much attention to the presence of pharmaceutical residues in hospital wastewater. The concentration and diversity of drug residues is considerable, and regulators are now greatly exercised by the possibility that many hospitals may be disposing unwanted drug supplies into the drains.  Indeed, in the US, the New Jersey Legislature is currently introducing measures to prohibit healthcare facilities from discharging prescription drugs into public wastewater systems.

For a limited list of potent narcotic drugs, immediate disposal into the drain is permitted and is usually the required route for disposal since this puts any drug residue immediately out of harm’s way and impossible to recover. That dichotomy in disposal practice is an obvious cause for confusion but has never been a particular problem.

As we have discussed previously on the Clinical Waste Discussion Forum, it is in the regulators’ blind spot that drug residues in hospital wastewater result from disposal of drug waste to drain. The numbers simply do not add up.

As we have noted on many previous occasions, drug residues in hospital wastewater result almost entirely from the patient population receiving various drug therapies as part of their care who then excrete over 99% of the administered drug in their urine.

Hospital wastewater many well be appropriate for some local ion exchange resin treatment before discharge to the public sewer. This would take some of the pressure off sewage treatment discharges and reduce the burden to the environment.

Even so, this is only part of the problem. At home, householders may well dispose unwanted medications via the toilet. Where are the collection and disposal services for these wastes? A far greater impact will come from excretion of drugs in urine, both prescription medicines and over-the-counter products. This is magnified yet more by the widespread administration of pharmaceuticals to livestock and the immediate discharge to sewer of excreted drug substance from stocksheds, or directly to pasture.

A mass balance analysis of the pharmaceuticals cycle would further illuminate this problem and identify clearly those areas of greatest concern. That is a costly and difficult undertaking. However, simple common sense should apply, but that at present seems to escape the regulators who seem to use this issue as a stick to beat those who’s contribution to environmental pollution is negligible or non-existent while ignoring, perhaps deliberately, the elephant in the room.