Drug Topics - February 11, 2008 - (Page 13) FEBRUARY 11, 2008 DRUG TOPICS 13 Letters but it is irresponsible. Finally, with no security and/or management backup, many pharmacists will simply fill questionable or even obviously fraudulent Rxs for narcotics, rather than risk threats or attacks, thus contributing to the flow of narcotics into our communities. Ken Fagerman, R.Ph.,M.M. Director of Outpatient Pharmacies SJVNA Mishawaka, Ind. fagermank@sjrmc.com Drug disposal: No right or wrong answer I’d like to comment on the letter by John Fisher, “Evidence needed for drug disposal,” in your June 18 issue. I agree with all of his points wholeheartedly with the exception of one. It is well established that there are a number of products that mimic hormones in animal (including human) species. These can be very simple molecules as well as very complex ones. The amount of these chemicals in the environment needed to cause reproductive and development problems is very small. Concentrations in the nanomolar range have been found to alter amphibian species and some fish species. As to the disposal, Fisher is correct. All this hoopla about how to dilute with cat litter, crush, etc., is nonsense. It doesn’t change anything about how drugs ultimately end up in the landfill. It is, however, much better than flushing drugs down the toilet—not only for the reasons outlined above but for the simple reason that municipal waste treatment plants are not capable of removing chemical contaminants from the water. If you contact your local facility, it will tell you that it uses alum and other chemicals to remove items that can be bound to the flocculent. It does not remove dissolved chemicals, salts, etc. Thus, hormones and antibiotics pass right through the system into the water, where bacteria are supposed to break them down. This leads to antibiotic and viral resistance as well as increasing hormone levels in the water. One might say that we can alter this by dumping all our unused medications in the landfills where most (at least in the United States) have liners that do not allow runoff. However, almost all the hormone and hormone-like products found in rivers, streams, and wetlands are from human waste—that is, they are eliminated in the urine from birth control pills, treatment of BPH, and other hormone therapies. Thus, there is no right or wrong answer here. It’s going to be a multifaceted approach. We have no control over the wastewater treatment, but we can eliminate much by not flushing stuff down the toilet. In addition, if you make it inconvenient for the patient— crushing and/or mixing with cat litter—the patient will just flush drugs down the toilet because it’s easier, faster, and less expensive. Does one really believe that most people will go out and buy some carrier for medications they’re going to throw away? I believe in doing the right thing, but I believe in common sense even more. Kirk Ryan, Pharm.D. National Oncology Lead - KP HealthConnect Kaiser Permanente San Leandro, Calif. helipilot2m@hotmail.com
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