The Associated Press (AP) estimates that hospitals and long-term medical care institutions across the United States are dumping 250 million pounds of pharmacologically active drugs directly into public sewer systems each year.
Because the government does not require health institutions to keep records on their disposal of pharmaceutical products, there are no definitive numbers on the volume of drugs going into the water supply. In order to construct an estimate, AP investigators extrapolated from a survey of 14 urban and rural Minnesota hospitals.
Minnesota’s state government strongly encourages health care facilities to keep records of drug disposal.
After adjusting for Minnesota’s relatively low rate of prescription drug use and doubling the number to account for the greater waste typically produced by long-term care facilities, the AP concluded that at least 250 million pounds of drug waste and drug-contaminated packaging are thrown away each year. This includes expired or spoiled drugs, leftovers from too-large prescriptions, drugs that are prescribed but not needed, drugs that patients refuse to take or that are halted due to negative side effects, or drugs left over when patients die.
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The researchers could not determine what proportion of the 250 million pounds consists of packaging, but experts estimate that it may be roughly half.
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The vast majority of this waste is disposed of by flushing it down sinks or toilets, according to the Environmental Protection Agency (EPA). A 2006 survey by a water company of 45 long-term care centers found that roughly two-thirds of drug waste was disposed of through the sewer system.
“Obviously, we’re flushing them – which is not ideal,” said Mary Ludlow of White Oak Pharmacy, a company that works with nursing homes and assisted-living facilities.
This pharmacological waste is much more potent than the drugs that patients flush down their own home toilets, including not only stronger versions of over-the-counter drugs but also highly toxic chemicals like cancer treatments. Tests of hospital sewers in Oslo and Paris have revealed high concentrations of antibiotics, heart drugs, hormones, painkillers skin medication — in addition to the well-known high concentrations of bacteria, viruses and other pathogens.
Dumping drugs into water is far from harmless, although the exact nature of the danger remains poorly understood. But scientists agree that drugs remain pharmacologically active even after disposal, and can have severe effects on humans and wildlife. Studies of wastewater near hospitals in Europe and the United States have found higher concentrations of antibiotic resistant bacteria and of organisms with genetic mutations similar to those that can cause cancer in humans. Another study on antibiotics in the fluoroquinolone family, including best-seller ciproflaxin, found that these drugs could cause changes to bacterial DNA.