Reducing the Ecological Footprint of Pharmaceutical Usage: Linkages Between Healthcare Practices and the Environment

Daughton, Christian G.; Ruhoy, Ilene S.

doi:10.1007/978-3-642-05199-9_6

Cited by 7 publications

(7 citation statements)

References 60 publications

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“…CDER also is collaborating with other government agencies on several projects, including prioritizing pharmaceuticals for research on environmental and human health exposure and effects (21,86), conducting additional analysis for drugs with hormonally active properties, developing methods for assessing the clinical endocrine disruption potential of drugs (87), and examining the results of recent efforts to identify and address the most critical questions remaining about drugs in the environment (88). New initiatives such as personalized medicine and "green pharma" are being studied by CDER, the American Medical Association, and others (83,85,(89)(90)(91)(92)(93)(94)(95)(96)(97). Also, wastewater treatment systems continue to improve and be replaced (98)(99)(100), which in turn likely will improve the removal of estrogens and other pharmaceuticals from human waste.…”

Section: Discussionmentioning

confidence: 99%

Ethinyl Estradiol and Other Human Pharmaceutical Estrogens in the Aquatic Environment: A Review of Recent Risk Assessment Data

Laurenson

Bloom

Page

et al. 2014

AAPS J

122

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Interest in pharmaceuticals in the environment has increased substantially in recent years. Several studies in particular have assessed human and ecological risks from human pharmaceutical estrogens, such as 17α-ethinyl estradiol (EE2). Regulatory action also has increased, with the USA and other countries developing rules to address estrogens and other pharmaceuticals in the environment. Accordingly, the Center for Drug Evaluation and Research at the US Food and Drug Administration has conducted a review and analysis of current data on the long-term ecological exposure and effects of EE2 and other estrogens. The results indicate that mean-flow long-term predicted environmental concentrations (PECs) of EE2 in approximately 99% or more of US surface water segments downstream of wastewater treatment plants are lower than a predicted no-effect concentration (PNEC) for aquatic chronic toxicity of 0.1 ng/L. Exceedances are expected to be primarily in localized, effluent-dominated water segments. The median mean-flow PEC is more than two orders of magnitude lower than this PNEC. Similar results exist for other pharmaceutical estrogens. Data also suggest that the contribution of EE2 more broadly to total estrogenic load in the environment from all sources (including other human pharmaceutical estrogens, endogenous estrogens, natural environmental estrogens, and industrial chemicals), while highly uncertain and variable, appears to be relatively low overall. Additional data and a more comprehensive approach for data collection and analysis for estrogenic substances in the environment, especially in effluent-dominated water segments in sensitive environments, would more fully characterize the risks.

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Section: Discussionmentioning

confidence: 99%

Ethinyl Estradiol and Other Human Pharmaceutical Estrogens in the Aquatic Environment: A Review of Recent Risk Assessment Data

Laurenson

Bloom

Page

et al. 2014

AAPS J

122

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“…Medicinal waste, synonymous with pharmaceutical waste and unused or expired medicines includes articles intended to prevent, diagnose, and treat diseases in humans or animals [7,8]. In recent decades, this kind of waste has been extensively studied [8][9][10].…”

Section: Introductionmentioning

confidence: 99%

Aspects Regarding the Pharmaceutical Waste Management in Romania

et al. 2018

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The issue of drug disposal, as well as the development and implementation of efficient collection strategies, represents an important concern at the highest European level. This research looks into the factors that could have an impact on the efficiency of pharmacies in collecting and disposing the medicinal waste of the population. There were 521 pharmacists from all over the country who filled in a questionnaire on their opinion/attitude related to the system of collecting and disposing the pharmaceutical waste of the population. Of the surveyed pharmacists, 16% work in pharmacies that do not collect unused/expired drugs from the population, and nearly 33% of those investigated have refused, at least once, to take the unused medicines from the people. Pharmacists' most important reasons for refusing to collect the pharmaceutical waste were the lack of procedure, incomplete legislation, exceeding the amount contracted with the operators, and high costs. Results show that pharmacies in Romania face several deficiencies in the pharmaceutical waste collection services. The lack of implemented programs has contributed considerably to lower standards of pharmaceutical waste management in Romania. This study is the first research on this topic in Romania, a country where the management of drug-based waste generated by the population is at the beginning. The results shown in this survey can provide a reference point for competent authorities in developing and implementing a take-back program for waste medicine whose efficiency is superior to the existing ones.

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“…One of particularly noteworthiness is the coupling of personalized medicine with a shift away from the current physician-patient paradigm, which is focused on medications, and toward one that emphasizes achieving desired outcomes. This approach essentially sells a service or desired outcome, rather than the drug itself; in other disciplines, this is known as 'material flow management service' [17,48]. An interesting example of this approach has been recently proposed by Kesselheim and Outterson, with the ultimate objective of reducing the incidence of antibiotic resistance (conserving effectiveness) [49].…”

Section: Perspectivementioning

confidence: 99%

“…But rarely discussed is the possibility of making use of pharmacogenomics to tailor medications to individual patients with the intention of lowering excretion of bioactive residues. By evaluating absorption, distribution, metabolism and excretion/elimination characteristics specific to the individual patient, various attributes of pharmacokinetics could be used to avoid prescribing specific APIs to those who are poor responders or to reduce the dose for those who are poor metabolizers [48]. Within a given therapeutic class, there may be APIs with more favorable metabolic profiles that result in less excretion.…”

Section: Perspectivementioning

confidence: 99%

“…Pollution prevention and sustainability • In contrast with end-of-pipe pollution control (which focuses on the handling of drug waste), a wide spectrum of approaches under a pharmEcovigilance program can be designed, which would minimize the generation of leftover drugs, thereby reducing the need for disposal in the first place. Prescribers and dispensers can play major roles in pharmEcovigilance [1,48].…”

Section: Perspectivementioning

confidence: 99%

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Green pharmacy and pharmEcovigilance: prescribing and the planet

Daughton

Ruhoy

2011

Expert Review of Clinical Pharmacology

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Active pharmaceutical ingredients (APIs) are ubiquitous environmental contaminants, resulting primarily from excretion and bathing and from disposal of leftover drugs by consumers and healthcare facilities. Although prudent disposal of leftover drugs has attracted the most attention for reducing API levels in the aquatic environment, a more effective approach would prevent the generation of leftover drugs in the first place. Many aspects of the practice of medicine and pharmacy can be targeted for reducing environmental contamination by APIs. These same modifications -focused on treating humans and the environment as a single, integral patient -could also have collateral outcomes with improved therapeutic outcomes, and with a reduced incidence of unintended poisonings, drug interactions and drug diversion, and lower consumer costs.

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Reducing the Ecological Footprint of Pharmaceutical Usage: Linkages Between Healthcare Practices and the Environment

Cited by 7 publications

References 60 publications

Ethinyl Estradiol and Other Human Pharmaceutical Estrogens in the Aquatic Environment: A Review of Recent Risk Assessment Data

Ethinyl Estradiol and Other Human Pharmaceutical Estrogens in the Aquatic Environment: A Review of Recent Risk Assessment Data

Aspects Regarding the Pharmaceutical Waste Management in Romania

Green pharmacy and pharmEcovigilance: prescribing and the planet

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