Mr. McAllister is a health-systems consultant based in Chapel Hill, North Carolina.
The source of drinking water contamination by pharmaceuticals includes normal human consumption, followed by excretion of both unmetabolized drugs as well as metabolites. Perhaps the most significant contributing factor, however, is that almost 6000 hospitals and 45,000 long-term care facilities discard an estimated 250 million pounds of pharmaceuticals and pharmaceutical waste each year. Many of these facilities dispose much of their pharmaceutical waste in the sink or toilet or in local landfills. It is interesting that, over 30 years ago, many hospitals were incinerating much of this waste, but legislative efforts to reduce air pollution forced facilities to find other ways to discard waste. The Environmental Protection Agency (EPA) has recently recognized that disposal in the trash is considered a best management practice, even though we know that drugs eventually leach into watersheds.
Apparently, very few water providers even test the water for pharmaceutical contaminants, nor are many watersheds tested. It is true that the hazards associated with long-term exposure to minute amounts of drugs have not been adequately researched. The AP investigation and reports prompted hearings at the state and federal levels and probably increased interest in learning more, but the fact remains that no federal laws or even EPA guidelines exist about the disposal of pharmaceuticals, in contrast to strict rules for disposing oil and other contaminants.
Few of us would suggest that exposing the public, especially pregnant women, children, and seniors, to any amount of drugs in the drinking water is safe. Yet, reflection on my career in hospitals reveals that it never really occurred to me what our department was doing as we poured unused intravenous fluids, tablets, capsules, and other drugs down the drain, in the toilet, or into the trash. Most hospitals have specific mechanisms to segregate and discard hazardous waste, especially sharps, and chemotherapy waste is often included. Perhaps we can examine whether our waste could be added to our hazardous waste disposal program or another existing mechanism to avoid drugs seeping into the water supply.
In addition, several companies offer programs and services that assist hospitals and their pharmacies to dispose of unusable drugs in an eco-friendly way.
It seems to me that organized pharmacy should not wait for research to prove that public exposure to pharmaceuticals is harmful. Don't we already know that? We also should not wait for regulators to mandate how pharmaceutical waste is most appropriately disposed. We should lead an initiative in each of our hospitals (and long-term care facilities and the pharmacies that serve them) to minimize or eliminate pharmaceutical waste that could find its way into our drinking water. While outsourcing this problem for resolution, I suggest that hospitals, health systems, and long-term care facilities can convene relevant stakeholders to develop cost-effective solutions to eliminate or minimize drugs reaching the water supply. What do you think?