Types and quantities of leftover drugs entering the environment via disposal to sewage — Revealed by coroner records

Ruhoy, Ilene S.; Daughton, Christian G.

doi:10.1016/j.scitotenv.2007.08.013

Cited by 89 publications

(67 citation statements)

References 16 publications

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“…These pharmaceuticals are combined in the sewer system with black water (feces and urine) and gray water (domestic process waters from, e.g., washing, bathing, showering and kitchen use) to form raw wastewater or its synonym, sewage (Raw WW or RWW). Expired and unwanted (leftover) pharmaceuticals may be flushed down the drain, thereby leading to direct loading to wastewater [53]. Another source of pharmaceutical contamination in Raw WW is from the influx of waste from pharmaceutical manufacturing companies [50] and healthcare facilities [51].…”

Section: General Overviewmentioning

confidence: 99%

“…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%

“…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: General Overviewmentioning

confidence: 99%

Section: Sustainable Management Of Pharmaceuticalsmentioning

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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“…Must be derived from sales figures and by making assumptions of average cost per dose and average mass per dose. When local coroner data is used [15], this can be derived from the dispensed amounts (but then it must also be known whether the medication was for short-term treatment or long-term maintenance). Multiple medications sharing the same API further complicate calculations.…”

Section: Total Consumptionmentioning

confidence: 99%

Environmental footprint of pharmaceuticals: The significance of factors beyond direct excretion to sewers

Daughton¹,

Ruhoy²

2009

Enviro Toxic and Chemistry

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193

112

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Abstract-The combined excretion of active pharmaceutical ingredients (APIs) via urine and feces is considered the primary route by which APIs from human pharmaceuticals enter the environment. Disposal of unwanted, leftover medications by flushing into sewers has been considered a secondary route-one that does not contribute substantially to overall environmental loadings. The present study presents the first comprehensive examination of secondary routes of API release to the environment and for direct but unintentional human exposure. These include bathing, washing, and laundering, all of which release APIs remaining on the skin from the use of high-content dermal applications or from excretion to the skin via sweating, and disposal of unused and partially used highcontent devices. Also discussed are the health hazards associated with: partially used devices, medication disposal practices of consumers, and interpersonal dermal transfer of API residues. Understanding these secondary routes is important from the perspective of pollution prevention, because actions can be designed more easily for reducing the environmental impact of APIs compared with the route of direct excretion (via urine and feces), for reducing the incidence of unintentional and purposeful poisonings of humans and pets, and for improving the quality and cost-effectiveness of health care. Overall, unintentional exposure to APIs for humans via these routes is possibly more important than exposure to trace residues recycled from the environment in drinking water or foods.

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“…The amount of pharmaceuticals reaching the environment depends on human consumption and excretion via feces/urine that reach the sewage system. Effluents of wastewater plants are the main source in the aquatic environment, followed by the release of outdated medicines down household (Ruhoy et al, 2007) and pharmaceutical industry waste (Kümmerer, 2004;Larsson et al, 2007).…”

Section: Introductionmentioning

confidence: 99%