Expired drug disposal and the environment

The question about the impact of discarded drugs on the environment remains unanswered. Twenty-three years ago, as a pharmacist I thought the responsible method to dispose of expired drugs at the pharmacy was to pour liquids down the sink, open up capsules into the garbage bin and randomly toss the variety of 'useless' tablets in.

However, disposal of whole tablets into the bin was irresponsible, since garbage dump scavengers could rummage, then sell or swallow these pharmaceuticals.

Crush and flush

As time passed, best practice among pharmacists was to gather expired capsules and tablets into a bucket, fill it with water and allow the mixture to sit overnight for all to dissolve. I poured the weird-coloured gooey chemical concoction into the toilet, and off it went to what I thought was never-never land.

But crush and flush is not necessarily best practice anymore. That never-never land may be Kingston Harbour for those who flush in the Corporate Area. There is growing evidence that medication is polluting the world's water supply. Some pharmaceuticals are potentially hazardous to the aquatic environment. Unfortunately we still don't know the immediate consequences to health of humans and other animals.

Sewage treatment and pharmaceutical waste

Some countries have sewerage treatment plants which remove gunk from sewage, and treat sewage to make water fit for consumption again. In parts of Jamaica, we have waste-stabilisation ponds and other wastewater-treatment processes which remove germs and harmful solids. These aim to improve quality of sewage before it hits the environment.

Whichever way we treat sewage, medications which end up in sewage systems worldwide defy them, and are still alive and kicking after treatment. Most facilities cannot remove pharmaceutical contaminants from sewage. Buried drugs may leach into local water tables and eventually resurface in bodies of water, like rivers or streams.

In a recent United States study, chemicals like caffeine; paracetamol; an antibiotic, erythromycin; an antidepressant, fluoxetine; and an anti-asthma product, albuterol, were found in water. Others have found hormones in water.

Experts in the USA have rubbished claims that drugs in the sewerage harm people and the environment. They say medication in the sewerage, rivers or ocean is merely a drop in the bucket, so dilute that it cannot exert toxic effects.

Again, there are other considerations. Drugs are flushed in other media. Drugs we consume are processed for use in our bodies then the by-products (metabolites) largely leave our systems in urine and faeces. Some by-products are inactive while others are active but they all end up in the water.

Total destruction, the only solution?

Incineration (burning) of expired drugs by authorised persons may be one solution to drug-disposal challenges.

But if medical doctors prescribed more conservatively, if clients took all their prescribed medications, or if there was a system of recycling unused medication to other persons who need them, the need to dispose of unwanted and expired medication would decrease significantly.

Dr Dahlia McDaniel is a pharmacist with a doctorate in public health. She is the chief executive officer of two pharmacies and a medical practice in Kingston. Email yourhealth@gleanerjm.com.