What is it about?
Efforts to reduce the entry of drug residues to the environment have long focused on "down-stream" approaches relying on conventional, end-of-pipe pollution-control measures - primarily sewage treatment and systematic collection of leftover medication waste. Presented here is an evaluation of a more sustainable "up-stream" pollution-prevention approach. This shifted focus is directed at guiding the practice of therapeutic prescribing to reduce the excretion of drug residues.
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Why is it important?
Assessing the excretion profile of active pharmaceutical ingredients (APIs) was evaluated for guiding clinical prescribing to reduce the entry of APIs to sewers. This method was evaluated against existing data for API occurrence in the environment. The method might also be used to show which leftover drugs should not be disposed to sewers (those that are extensively metabolized) and which could be targeted for future environmental monitoring (those that are extensively excreted unchanged).
Read the Original
This page is a summary of: Eco-directed sustainable prescribing: feasibility for reducing water contamination by drugs, The Science of The Total Environment, September 2014, Elsevier,
DOI: 10.1016/j.scitotenv.2014.06.013.
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Resources
Supplementary Table S-1. Published environmental occurrence data for 322 APIs in BDDCS Class I.
Comprehensive published environmental occurrence data for 322 APIs in Class 1 of the Biopharmaceutics Drug Disposition Classification System (BDDCS) - a proxy measure for drugs that might be extensively metabolized.
Supplementary Table S-2. Published environmental occurrence data for 52 APIs in BDDCS Class IV.
Comprehensive published environmental occurrence data for 52 APIs in Class IV of the Biopharmaceutics Drug Disposition Classification System (BDDCS) - a proxy measure for drugs that might be extensively excreted unchanged.
The Matthew Effect and widely prescribed pharmaceuticals lacking environmental monitoring: Case study of an exposure-assessment vulnerability
Much of the data regarding the environmental occurrence of drug residues can be categorized as "data of absence" or "absence of data". These data can be used to assess the possibility that an environmental contaminant has been overlooked or ignored. These chemicals are called "Matthew Effect Orphaned Chemicals" (MEOCs), as described in more detail in: "The Matthew Effect and widely prescribed pharmaceuticals lacking environmental monitoring: Case study of an exposure-assessment vulnerability."
Lower-Dose Prescribing: Minimizing 'Side Effects' of Pharmaceuticals on Society and the Environment
This was the first article to evaluate the potential of pollution prevention for reducing the entry of drug residues to the environment. Its focus was on reducing a medication's dose as a means of: (1) reducing the impact of excretion as a source, and (2) reducing the potential for the generation of unwanted, leftover medications - which subsequently might be disposed to sewers; the latter is a consequence of improving patient compliance as a result of reduced adverse effects.
Green Pharmacy and PharmEcovigilance: Prescribing and the Planet
Prudent disposal of leftover drugs attracts the most attention for reducing the levels of drug residues in the environment. But a more effective and sustainable approach would prevent the generation of leftover drugs to begin with. Many facets of the practice of medicine can be targeted for reducing this environmental contamination. Sustainable approaches should focus on treating humans and the environment as a single, integral patient. These approaches could have major collateral benefits.
US EPA's Pathfinder Innovation Projects
This work resulted from a US EPA internal grants program - the Pathfinder Innovation Projects (PIPs). The 2012 PIP projects and associated blogs can be found at the URL.
Additional resources on the many facets of drugs and the environment, especially with regard to stewardship, sustainability, pollution prevention, and waste management
A comprehensive listing of additional publications by the author and numerous articles by scientists worldwide can be located or downloaded from the two URLs provided.
Contributors
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