Last Updated: Friday - 09/24/2010
Week of November 1, 2004
What goes in eventually comes out
Pills, medicine, residue go from toilet bowl, to the drain, back to the waterways
By SUZANNE ELSTON
Caring for our personal health and the health of the environment presents an interesting paradox. To take a lesson from Biology 101, what goes in must ultimately come out. In other words, the vast majority of the pharmaceuticals and personal care products (PPCPs) that we use to improve our health is flushed down the drain or dumped into landfills. Over time, many of these will be released back into the environment and ultimately, back into our bodies.
It's estimated that our bodies do not absorb a whopping 50 to 90 per cent of the active ingredients in medications. Many of the drugs held in our bones and fatty tissues still end up in the environment after we die (along with mercury from dental fillings and several gallons of embalming fluid).
Deformed marine life
According to researcher Sharon Batt, author of Full Circle: Drugs, the Environment and Our Health, "The health impacts on humans are not known, but deformities in the reproductive system of marine life show that some of the chemicals contaminating the environment are not benign, despite the very low concentrations that have been detected."
The problem of what's good for our personal environment not necessarily being good for the greater environment is a function of regulation. Drugs are approved by Health Canada, based on direct health applications. Unfortunately, Health Canada's jurisdiction over drug disposal only extends to controlled substances whether illegal, such as heroin, or a registered narcotic, like morphine. These drugs make up a very tiny percentage of the total amount that is ultimately discarded.
The impact that drug disposal has on the environment is primarily the jurisdiction of provincial environment ministries. The actual disposal of hazardous drugs is the responsibility of municipal waste systems for individual households, and of licensed medical/hazardous waste disposal companies in pharmacy take-back programs.
This multi-level, multi-ministerial, public/private sector shared responsibility has created a jurisdictional gridlock and a lot of confusion. To make matters worse, the vast majority of prescription drugs are not classified as hazardous waste.
Clearly, this is a systemic problem that requires a major overhaul of how we license both prescription and over-the-counter medications. All levels of government need to develop an ecosystem approach to drug approval in Canada that not only considers the safety, use and efficacy of any drug, but also how that drug enters the environment after it has been used or discarded, and how it interacts with other drugs and chemicals already present.
The Environmental Impact Initiative, a program of Health Canada, is moving in this direction. This program includes regulatory changes, research and public education. But new requirements are unlikely to take effect for several years.
Harmonized national effort
To be truly effective, environmental considerations must become systemic and primary, in all levels of government decision-making, with a status similar to that of financial decisions. In order to accomplish this, Health and Environment ministries at the federal and provincial levels must make concerted efforts to harmonize their regulations.
Consumers also have an important role to play. Discarding drugs by flushing them down the toilet or throwing them in the garbage is not an acceptable option. Many pharmacies offer take-back programs for their customers.
Once drugs have been accepted by a pharmacy, provincial regulations govern their safe disposal by a licensed company, either through medical waste incineration or autoclaving (using pressurized steam to sterilize) and landfilling.
The second option for consumers is to utilize the household hazardous waste programs that have been established by many municipalities across Canada.
Even though they are technically not classified as hazardous, used and expired pharmaceuticals can be dropped off at hazardous waste centres along with household chemicals, paints and used batteries.
Unfortunately even if these programs recovered all post-consumer pharmaceutical waste, Daniel Kennedy, president of Medwaste Group, estimates that this would constitute only 10 per cent of the total tonnage of prescription drugs that ultimately ends up in landfills.
The remaining 90 per cent is shipped directly from pharmaceutical companies to landfill, since there are no regulations to prevent it.
Read Sharon Batt's excellent background paper Full Circle: Drugs, the Environment and Our Health and the fact sheet, Pharmaceuticals in Our Water: A New Threat to Public Health?
Both documents can be found on the Women and Health Protection's website www.whp-apsf.ca.
Women and Health Protection is a working group of the Centres of Excellence for Women's Health Program, which is located at www.cewh-cesf.ca.
The Canadian Women's Health Network can be found at www.cwhn.ca.
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