Beyond the medicine cabinet: An analysis of where and why medications accumulate

Ruhoy, Ilene S.; Daughton, Christian G.

doi:10.1016/j.envint.2008.05.002

Cited by 192 publications

(128 citation statements)

References 21 publications

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“…Source control of pharmaceutical contamination begins with proper disposal of pharmaceutical waste streams, as well as expired and leftover pharmaceuticals. Daughton and colleagues have thoroughly reviewed the reasons for accumulation of pharmaceuticals and repercussions of disposing leftover pharmaceuticals into sewage and solid waste [1,15,52,53,114]. The recommendation from these reviews is simple: do not throw unused or leftover pharmaceuticals in the toilet or flush them down the drain.…”

Section: Sustainable Management Of Pharmaceuticalsmentioning

confidence: 99%

“…Intended uses of pharmaceuticals in humans and animals are plentiful and include the prevention, diagnosis, and therapy of diseases as well as cosmetic and lifestyle purposes [1]. In recent years, however, their occurrence in the environment has raised concerns, both nationally and internationally, regarding implied risks posed to aquatic and terrestrial life forms, including humans [2][3][4][5][6][7].…”

Section: Introductionmentioning

confidence: 99%

“…Additional studies investigated various strategies for efficient removal and transformation of pharmaceuticals using advanced treatment employing processes of chemical [32,[40][41][42][43], biological [44][45][46][47] and physical nature [48,49]. Since not all pharmaceuticals present in sewage are the result of intentional intake, metabolism and excretion, some researchers have investigated the composition of wastewaters from the pharmaceutical industry [50], and healthcare facilities [51], as well as the importance of disposal of unwanted or leftover pharmaceuticals into sanitary sewers [1,2,[52][53][54][55][56].…”

Section: Introductionmentioning

confidence: 99%

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Pharmaceuticals in the Built and Natural Water Environment of the United States

Deo

Halden

2013

Water

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Abstract:The known occurrence of pharmaceuticals in the built and natural water environment, including in drinking water supplies, continues to raise concerns over inadvertent exposures and associated potential health risks in humans and aquatic organisms. At the same time, the number and concentrations of new and existing pharmaceuticals in the water environment are destined to increase further in the future as a result of increased consumption of pharmaceuticals by a growing and aging population and ongoing measures to decrease per-capita water consumption. This review examines the occurrence and movement of pharmaceuticals in the built and natural water environment, with special emphasis on contamination of the drinking water supply, and opportunities for sustainable pollution control. We surveyed peer-reviewed publications dealing with quantitative measurements of pharmaceuticals in U.S. drinking water, surface water, groundwater, raw and treated wastewater as well as municipal biosolids. Pharmaceuticals have been observed to reenter the built water environment contained in raw drinking water, and they remain detectable in finished drinking water at concentrations in the ng/L to μg/L range.

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Section: Sustainable Management Of Pharmaceuticalsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Pharmaceuticals in the Built and Natural Water Environment of the United States

Deo

Halden

2013

Water

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“…Besides household sewage, other emission sources of human pharmaceuticals are waste waters from manufacturers, hospitals, and disposal of unconsumed drugs via solid waste. It is estimated that up to 65% of sold pharmaceuticals are never consumed (Ruhoy and Daughton 2008). Furthermore, large quantities of pharmaceuticals, e.g.…”

Section: Pharmaceuticalsmentioning

confidence: 99%

Emerging contaminants in surface waters and their relevance for the production of drinking water in Europe

Houtman

2010

Journal of Integrative Environmental Sciences

191

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An increasing part of drinking water in Europe is prepared from surface water. At the same time, a growing number of emerging contaminants is being discovered in surface water. This review provides an overview of classes of emerging contaminants nowadays detected in the aquatic environment that are of relevance for drinking water production. These comprise e.g. endocrine disrupting compounds, such as hormones and compounds with hormone-like properties, pharmaceuticals, illicit and non-controlled drugs, sweeteners, personal care products, complexing agents, nanoparticles, perfluorinated compounds, flame retardants, pesticides, and fuel additives. The individual compounds are observed in concentrations that are generally considered too low to cause acute effects. Nevertheless, health effects due to long-term exposure to a mixture of low concentrations of all kinds of emerging contaminants cannot be excluded with current knowledge. Moreover, contamination of drinking water with man-made substances is considered unwanted in principle. The precautionary principle is used to motivate that prevention of emission of emerging contaminants into the environment is the preferred approach to safeguard sustainable drinking water production. In the mean time, extensive monitoring of the sources and development and application of advanced treatment techniques are used to prepare safe drinking water.

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“…These conjugates may be recirculated either within the body (enterohepatic recirculation) or outside the body where the conjugates are cleaved by bacteria to reconstitute the active drug [34,39]. Bathing and laundry effluents have also been proposed as pathways for the introduction of pharmaceuticals into the environment [40][41][42].…”

Section: Introductionmentioning

confidence: 99%

Pharmaceutical Dispensing and Wasting In Health Care Facilities, Amounts, Costs and Evaluation of Potential Ecologic Effects

Mankes¹,

Silver²

2017

SOJPPS

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Drug waste from hospitals contributes to environmental contamination. Patient excreta, bathing or discarding of excess drugs are some sources of drug waste. We report on the wasting of 84 drugs of 14 therapeutic classes in two hospitals in Albany, NY. We consider drug metabolism, excretion, disposal and ecotoxicity in strategies for reducing drug waste, costs and potential environmental damage.Medication (12,345) and waste collection (199) records for: drugs dispensed, returned and wasted were examined. Of 2,700 drugs available, 84 drugs from 14 classes, weighing 56 kg were dispensed to patients, and 2.3 kg were wasted. Twelve drugs accounted for 80 percent of the drug waste and cost $111,000. Of the top wasted and dispensed drugs, all but ibuprofen are persistant and none were bioaccumulative. Ibuprofen, ipratropium ondansetron and oxymetazoline are "very highly toxic" or "highly toxic". Environmental Risk Ratio (PEC/PNEC) for the 20 top drugs were"Insignificant" or "Cannot Be Excluded".Acetazolamide is the most toxic to fish. Dexamethasone has the greatest chronic toxicity to Ceriodaphnia. Ibuprofen is predicted to be very highly toxic (acute and chronic) to zebra mussel, crab and fish. Neostigmine is the most acutely toxic (LC50<1 mg/L) to Daphnia. Ondansetron is the most acutely toxic to green algae. All but 2 of the drugs were 5 to 100% excreted. Fourteen were metabolised. Active metabolites were formed from 2 drugs. Nicardipine, ondansetron and prednisone formed drug conjugates which were excreted. Incineration was the manufacturer's recommended disposal method.We recommend excess drugs be returned to the hospital pharmacy for disposal by incineration. Drug use and disposal should be monitored by an expert committee according to recognized guidelines of pharmaceutical management. Knowledge of the adverse impacts from the release of highly toxic drugs into the environment must influence drug selection and disposal.Key words: Waste; Ecotoxicity; Wastewater; Abbreviations AMCH = Academic Medical Center Hospital; ASTER = Assessment Tools for the Evaluation of Risk. United States Environmental Protection Agency https://archive.epa.gov/med/med_archive_03/web/html/ aster.html Last accessed 6/4/17; B = Bioaccumulation is the general term describing a process by which chemicals are taken up by an organism either directly from exposure to a contaminated medium or by consumption of food containing the chemical; EC50 = Effective Concentration producing an adverse effect in 50% of a test species; EbC50 or ErC50 = EC50 in terms of reduction of growth rate; EyC50 = EC50 in terms of change in biomass yield; Ecosar = Ecologic Structure Activity Relationships is a computerized predictive system that estimates aquatic toxicity. The program estimates a chemical's acute (short-term) toxicity and chronic (long-term or delayed) toxicity to aquatic organisms such as fish, invertebrates, and plants by using computerized Structure Activity Relationships (SARs). https://www.epa.gov/tsca-screening-tools/ ecological-structure-...

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Beyond the medicine cabinet: An analysis of where and why medications accumulate

Cited by 192 publications

References 21 publications

Pharmaceuticals in the Built and Natural Water Environment of the United States

Pharmaceuticals in the Built and Natural Water Environment of the United States

Emerging contaminants in surface waters and their relevance for the production of drinking water in Europe

Pharmaceutical Dispensing and Wasting In Health Care Facilities, Amounts, Costs and Evaluation of Potential Ecologic Effects

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