Jun 08,2007 00:00
A chemical slurry of hormones, antibiotics, caffeine and steroids is coursing down many U.S. rivers and setting off ecological alarms. A solution could lie in curtailing what is flushed down the toilet.
"Don't flush," said John Preckshot, owner of Preckshot Professional Pharmacy in Peoria Heights, Ill. "At one time it was recommended to flush unused medications down the toilet, but these things have been showing up in the environment. Once a chemical, always a chemical. If you flush some of these substances, they show up in the water, the food chain, the environment. Some of these things stay forever."
Sewage treatment does not remove some of these substances from waste water.
MASH AND MIX
Instead of flushing, new recommendations call for mashing pills, emptying capsules and pouring liquids into kitty litter or used coffee grounds, mixing the substance, putting it in a nondescript container and disposing it in household garbage. The standard practice of most hospice organizations still is to flush unused medications down the toilet after a patient dies.
At OSF Hospice in Peoria, staff will soon have small zip-top bags filled with cat litter that will be used to mix with unused medications and then disposed of with household trash, said administrator Donna Medina.
"Some pharmacies are establishing a return depository, but then my staff would have to transport these medications. In today's world, you don't want staff carrying these drugs," Medina said.
At nearby Methodist Hospice, manager Jill Prosser said, "We are still flushing for the time being, but we're calling around checking out other avenues. The last thing we want is for the staff to have to carry these medications in their cars."
'AN EMERGING ISSUE'
Dr. Cindy Skrukrud, a biochemist and clean water advocate with the Illinois chapter of the Sierra Club, called the problems traced to flushing unused medications down the toilet "an emerging issue in aquatic science." In addition to the problem from disposed medications, toilet waste water also contributes problems from human waste, which contains steroids, caffeine and other chemicals not absorbed in the body. Waste water from showers and baths contains insect repellent.
"Changing the way we deal with old drugs is a simple way to deal with the problem. The recommendation to stop flushing unused medications can be followed immediately," Skrukrud said, noting that studies have documented the "feminization" of fish including small-mouthed bass.
Evidence continues to mount documenting this issue, and scientists speculate the cause may include women's birth control, sunscreen or a chemical mix from multiple sources that passes through sewage treatment and enters the environment. In a number of studies, scientists have found male fish that have become fully fertile females.
Ed Hopkins, director of the Sierra Club environmental quality program, said Maine and several provinces in Canada mandate that drug manufacturers take responsibility for unused medications. When the pharmacy director at OSF Saint Francis Medical Center was dealing with his mother's medications after she died, he knew about the new recommendations. Jerry Storm said he was careful to mix his mother's medications with wet coffee grounds and put them in the garbage.
He said the hospital used to incinerate medications but now subcontracts with a firm that periodically collects drugs and disposes them.
Duane Funk, spokesman at Methodist Medical Center, said Methodist no longer incinerates and also subcontracts with a specialty firm. Funk said Methodist also contributes medications to missionary groups with projects in the Third World.
Mail-order prescription drugs have added to the problem, Preckshot said, because a 90-day supply is encouraged as the order. If the medication is not tolerated or not effective and the doctor writes another prescription, months of the unused prescription could end up being disposed of.
"The public should be concerned with pharmaceuticals ending up in the Illinois River," said Joyce Blumenshine with the Heart of Illinois Sierra Club.
She worked on a "patch pouch project" providing zip-top bags to women to encourage them to dispose of used birth control hormone patches in sealed plastic bags.
"The problem is there. The impact of these pharmaceuticals in our waterways is yet to be adequately understood," Blumenshine said.Copley News Service