INTRODUCTION:

The presence and potential adverse effects of chemicals in the aquatic environment have begun to receive increasing attention in the popular and scientific press in recent years¹. This increase is largely a result of a number of scientific papers published in the 1990s that reported trace levels of chemicals detected in environmental samples, including sewage effluent, surface water, groundwater, and even drinking water^2-5. There are two main routes for chemicals to enter the environment⁶. The first is via the effluent from wastewater treatment works (WWTWs) after excretion from the body. After administration, a significant proportion of a pharmaceutical may pass through the body unmetabolized.

The second route by which chemicals can enter the environment is by the disposal of out-of-date or unwanted medicines, which may occur via the sink/toilet or in household waste that is then taken to landfill sites. Entry into the environment by this route is dependent on the habits of the patient and the efficiency of prescription practices leading to fewer unfinished prescriptions. The traditional methods for managing household pharmaceutical waste (i.e., flushing them down the toilet or throwing them in the trash) have raised concerns about the potential for these substances to accumulate in surface and ground water^7,8and to otherwise harm human health and the environment^9,10. The risk of harm can be reduced by encouraging the col1ection of household pharmaceutical waste¹¹ for better management. After controlled substances are dispensed by a pharmacy, only law enforcement officials are allowed to accept them for management, including when they are brought to household col1ection events. Law enforcement officials must maintain custody of the controlled substances at all times, ending with witnessed destruction. As a result, law enforcement officers participating in household pharmaceutical waste collections will likely want to take the col1ected household controlled, substances back to their offices to securely store them along with other, confiscated controlled substances prior to the witnessed destruction.

HOUSEHOLD CHEMICALS:

Any product consumed or applied by an individual for personal health or cosmetic reasons can be defined as chemicals and personal care products¹². Once dispensed to or purchased by a member of the public, any unwanted pharmaceutical products and personal care products are classified as household pharmaceutical waste^13-15. These products include prescription and over-the-counter therapeutic drugs, fragrances, cosmetics, sprays, sunscreen agents, diagnostic agents, contact lens solutions, nutraceuticals, biochemicals, and many others product consumed by individuals for personal health or cosmetic reasons¹⁶. Some medications and personal care products contain hazardous chemicals ¹⁷ or even heavy metals, such as mercury which is used as a preservative. In New Hampshire, there has been increasing attention on mercury¹⁸ as a serious pollutant due to its toxic, persistent and bioaccumulative properties. All of these products applied externally or ingested have the potential to be excreted or washed into sewage systems and discharged to the aquatic and terrestrial environments.

· Contamination of drinking water.

· Non-biodegradable antibiotics, antineoplastics and disinfectants may kill bacteria necessary for the treatment of sewage.

· Burning medicines and cosmetics at low temperatures or in open containers results in release of toxic pollutants into the air which should ideally be avoided.

· Inefficient and insecure sorting and disposal may allow medicines and cosmetics beyond their expiry dates to be diverted for resale to the general public.

· In the absence of suitable disposal sites, if stored in their original packing there is a risk of diversion.

The purpose of safe management of household chemicals is to:

· Reduce pharmaceutical pollution.

· Provide environmentally safe disposal options for unwanted/expired medicines.

· Assess the quantity and value of household pharmaceutical waste in the Bay Area.

· Gain an understanding of types of medicines most commonly left unused and why.

· Develop the tools and educational material required to reproduce the program nationwide.

· Foster a model health that uses personal wellness strategies in minimizing pharmaceutical waste.

METHODS FOR USE AND DISPOSAL OF HOUSEHOLD CHEMICALS:

Basic method for use and disposal of household chemicals:

Once dispensed to or purchased by a member of the public, any unwanted pharmaceutical products are classified as household waste, and their disposal is not subject to any controls. Manufacturer packaging usually recommends disposal by returning to the pharmacist; however, disposal via the sink/toilet or in normal household waste is common. Chemicals in landfill sites are subject to biologic degradation processes, but some may persist and even leach into surrounding groundwater and rivers^13,14. Traditionally, disposal advice to consumers has been limited to flushing down the toilet or, in some cases, burning or grinding and discarding in household waste¹⁹ but emerging environmental concerns mean that this is sometimes modified.⁷

Recommended method for use and disposal of household chemicals:

Among the many possible strategies for managing residential pharmaceutical waste, the two most common are recommended management method and Recommended Disposal Methods for Prescriptions and Over-the-Counter Medications.

Recommended Management Methods:²⁰

The proper use and disposal of household chemicals and personal care products is simple.

For use:

1. Take prescription medicines as directed.

2. Unless you are having an adverse reaction or are instructed otherwise by your doctor, use all medicine as directed until it is gone.

3. Talk to your doctor if you have questions about your prescription or need a new medicine.

4. Only purchase what you need. Why waste money on chemicals to just sit on the shelf and expire over time?

5. Say “No” to samples if you are not going to use them. You will only need to dispose of them later.

6. Stop junk mail. Take your name off mailing lists so you don’t receive free sample products, such as pain relievers, lotions, and shampoos. If you don’t use them, then you will need to dispose of them later.

7. Centralize all chemicals in one location. This may help to limit over purchasing of products you already have.

8. Read the label. Some products contain mercury-added preservatives; if you see it on the label, find an alternative product.

Recommended Disposal Methods for Prescriptions and Over-the-Counter Medications:²¹

Follow these steps for proper disposal of medications.

Liquid Medications:²²

Remove from the original container and put the contents into a hard plastic container such as a laundry detergent bottle²³. Remember to mark out personal information on the prescription bottles before placing in the trash. Add a thickening material such as cat litter, flour, salt, charcoal or coffee grounds. Non-toxic powdered spice such as turmeric or mustard may be added to discourage wildlife or young children from trying to eat the resulting material. Seal the container and place it in the trash just prior to pick-up.

Solid Medications:

Remove from the original container and put the contents into a hard plastic container such as a laundry detergent bottle. Remember to mark out personal information on the prescription bottles before placing in the trash. Add a small amount of water to dissolve the medicine. Add a thickening material²⁴ such as cat litter, flour, salt, charcoal or coffee grounds. Non-toxic powdered spice such as turmeric or mustard may be added to discourage wildlife or young children from trying to eat the resulting material. Seal the container and place it in the trash just prior to pick-up.

Blister Packages, such as pills in foil wrapped containers, and Patches:

Keep these items in their original packaging. Remember to mark out personal information on the prescription bottles before placing in the trash. Wrap the pack with a thick tape such as duct tape. Place the pack into a hard plastic container such as a laundry detergent bottle. Seal the container and place it in the trash just prior to pick-up.

Other Household Concerns:

The following information is additional health care-related products of concern for households.

Sharps:²⁵

Place needles, syringes, lancets and other sharp objects in a hard plastic container with a screw-on or tightly secured lid. Many containers found in the household, such as a laundry detergent bottle or metal coffee container will be sufficient. You may also purchase containers specifically designed for the disposal of medical waste.Do not put sharp objects in any container you plan to recycle. Do not use glass or clear plastic containers. For optional chemical treatment of sharps, the Department of Health and Senior Services recommends mixing one part common household chlorine bleach with nine parts water. This solution should be poured into the container of sharps and allowed to remain for approximately 30 minutes. The solution must then be carefully poured off so the free liquid does not remain in the container. The solution may be disposed of in the sanitary sewer system. Reinforce the lid with thick tape such as duct tape and place in the trash just prior to pick-up.

Mercury Thermometers:

The greatest risk of exposure from elemental mercury in products such as fever thermometers is improper handling and disposal of spilled mercury. Mercury volatizes quickly and is easily inhaled. Improper clean up with a vacuum, paintbrush or household cleaner increases exposure. Indoor air may be contaminated by mercury vapors from a broken fever thermometer, or other products that have gone unnoticed, or improperly cleaned up.At a high level, mercury can cause damage to the central nervous system, tremors, inability to walk, convulsions and even death.

IMPORTANCE OF SAFE HOUSEHOLD PHARMA- CEUTICAL WASTE MANAGEMENT:

Recent research shows that pharmaceutical compounds exist in our environment both as a result of improper disposal of unused chemicals and because they are excreted by the person using the medication. Properly disposing of unwanted and expired prescriptions and over-the-counter medications in the trash promotes a healthy environment and prevents accidental poisoning and intentional abuse. The importance of this finding to ecosystems exposed to these substances and to people who rely on surface waters as a source of drinking water remains unclear, though many published studies indicate cause for concern For example:

· The occurrence of antibiotics in wastewater^26,27may be associated with the presence of antibiotic resistant bacteria in surface waters.

· Chemicals may have many subtle effects on both humans and aquatic life^28,29 such as disruption of normal endocrine system function.

· Lindane-based head lice and scabies treatments caused wastewater treatment plant lindane discharges to exceed surface water quality criteria designed to protect aquatic life.

· Antibiotics may also reduce the growth of aquatic plants. Mixtures of chemicals, which commonly occur in surface waters where discharges from municipal wastewater treatment plants flow, may have cumulative effects on organisms.

5. CONCLUSION:

The traditional methods for managing household pharmaceutical waste (i.e., flushing them down the toilet or throwing them in the trash) have raised concerns about the potential for these substances to accumulate in surface and ground water and to otherwise harm human health and the environment. The risk of harm can be reduced by encouraging the col1ection of household pharmaceutical waste for better management. The pharmacist may play an important role in safe disposal of household chemicals by counseling the people or community about safe disposal of household chemicals.

6. REFERENCES:

1. Jonathan PB. Household Disposal of Chemicals as a Pathway for Aquatic Contamination in the United Kingdom. Environ Health Perspect. 2005; 113(12): 1705–1711.

2. Jones OAH, Voulvoulis N, Lester JN. Aquatic environmental assessment of the top 25 English prescription chemicals. Water Res. 2002; 36: 5013-5022.

3. Heberer T., Occurrence, fate, and removal of pharmaceutical residues in the aquatic environment: a review of recent research data. Toxicol Lett., 2002; 131: 5-17.

4. Ternes TA. Occurrence of drugs in German sewage treatment plants and rivers, Water Res. 1998; 32: 3245-3257.

5. Mueller J., Ternes TA., Stumpf M., Haberer K., Wilken RD., Servos M. Behavior and occurrence of estrogens in municipal sew age treatment plants— I. Investigations in Germany, Canada and Brazil. Sci Total Environ. 1999; 225(1-2): 81-90.

6. Bound JP. Household Disposal of Chemicals as a Pathway for Aquatic Contamination in the United Kingdom. Environ Health Perspect. 2005; 113(12): 1705–1711.

7. Daughton C. Cradle-to-cradle stewardship of drugs for minimizing their environmental disposition while promoting human health, I. Rationale for and avenues toward a green pharmacy. Environ Health Perspect. 2003; 111: 757-774.

8. Daughton CG, Ternes TA. Chemicals and personal care products in the environment: agents of subtle change. Environ Health Perspect. 1999; 107: 907-942.

9. Buser HR, Muller MD, Theobald N. Occurrence of the pharmaceutical drug clofibric acid and the herbicide mecoprop in various Swiss lakes and in the North Sea. Environ Sci Technol. 1998; 32: 188-192.

10. Kolpin DW., Furlong ET., Meyer M., Thurman EM., Zaugg SD., Barber LB. Chemicals, hormones and other organic wastewater contaminants in U.S. streams, 1999–2000: a national reconnaissance. Environ Sci. Technol. 2002; 36: 1202-1211.

11. Joanie B. Enforcement Discretion (Extended) -Hazardous Waste and Solid Waste Requirements Pertaining to Collected Household Pharmaceutical Waste. Correspondence memorandum. State of Wisconsin. June, 2009.

12. Environmental fact sheet. Emptying the Medicine Cabinet Disposal Guidelines for Chemicals and Personal Care Products, New Hampshire department of environmental services. 2008.

13. Ahel M, Mikac N, Cosovic B, Prohic E, Soukup V. The impact of contamination from a municipal solid waste landfill (Zagreb, Croatia) on underlying soil, Water. Sci Technol. 1998; 37: 203-210.

14. Holm JV, Rugge K, Bjerg PL, Christensen TH. Occurrence and distribution of pharmaceutical compounds in the groundwater downgradient of a landfill (Grinstead, Denmark). Environ Sci Technol. 1995; 29: 1415-1420.

15. Mansfield, Jim. Solid Waste Program. Public Works Department. Clark Count. Washington. Telephone conversation. June, 2004.

16. Regulatory Guidance for Organizers of Household Pharmaceutical Collection Events. Wisconsin Dept. of Natural Resources Waste and Materials Management Program. August, 2006.

17. Clarke H., Young Joyce. Healthcare Waste Management Policy. V.1.0. February, 2008.

18. Pray WS., Pray JJ. Childhood poisoning. US Pharmacist. 2004; 29:3.

19. http://www.dnr.mo.gov/env/hwp/permanent-hazwaste-collectionfacs. htm.

20. http://www.tchd.org/pdfs/household_pharmaceutical_waste.pdf

21. Mohanta GP., Manna PK., Saravanakumar RT. Disposal practices for expired medicines. Pharmabiz.com. May, 2010.

22. Abby B. Fact Sheet. Household Pharmaceutical Waste Disposal, department of environmental quality. State of Oregon. February, 2008.

23. Environmental fact sheet. Medicine Disposal Options for School Nurses. New Hampshire department of environmental services. 2009

24. Code of Safe Working Practice. WSPCT Management of Clinical and Domestic Waste. May, 2005.

25. Nicola B. Antibiotics in wastewater. Chemical science. 2007; 05

26. Karthikeyan KG. Occurrence of Antibiotics in Wastewater Effluents and Their Mobility in Soils: A Case Study for Wisconsin. Project Summary. June, 2003.

27. Alistair BA., Boxall. The environmental side effects of medication, EMBO reports. 2004; 5 (12): 1110–1116.

28. Breton R., Boxall ABA. Chemicals and personal care products in the environment. Regulatory drivers and research needs. QSAR Comb Sci. 2003; 22: 399-409.

29. Christian G., Daughton. “Cradle-to-Cradle Stewardship of Drugs for Minimizing their Environmental Disposition while Promoting Human Health. Part I: Rationale and Avenues Toward a Green Pharmacy. Environmental Health Perspectives. May, 2003.

Received on 02.09.2015 Accepted on 20.10.2015

Asian J. Pharm. Res. 5(3): July- Sept., 2015; Page 158-161

DOI: 10.5958/2231-5691.2015.00024.6