Magazine article American Nurse Today

Drugs in the Environment: Nurses' Roles and Responsibilities

Magazine article American Nurse Today

Drugs in the Environment: Nurses' Roles and Responsibilities

Article excerpt

News that pharmaceuticals have been found in our rivers and streams, fish, wildlife, and even our drinking water has captured our interest and concern. This isn't a new phenomenon. Active pharmaceutical ingredients (APIs) have been in the water since humans first started using and excreting drugs. But we're just beginning to recognize the magnitude of the problem. Drug prescriptions in this country have increased 61% over the past decade and now total about 3.4 billion annually, with retail sales of $250 billion. Nurses, who administer, dispose of, and in some cases prescribe drugs, can play a key role in developing policies and practices that help minimize the amount of pharmaceuticals that end up in the environment.

The U.S. Geological Survey has detected codeine, sulfa drugs, hormones (such as estradiol), and many other medications in a wide swath of surface waters around the country. Tissue samples of the nation's fish reveal that these drugs are being absorbed in fish, resulting in body burdens of pharmaceuticals that may travel up the food chain. About half the country derives its drinking water from surface water sources, yet no one knows how many APIs are in circulation, nor what percentage is derived from human excretion, animal excretion from veterinary use (particularly in agriculture), disposal activities, or manufacturing activities. Drinking water standards don't require testing for APIs.

With an aging population and delivery of more outpatient health care, nurses need to know the best ways to dispose of drugs in the home setting. A few local jurisdictions have provided guidance on pharmaceutical waste disposal from homes. While no federal regulations exist, federal guidelines do address pharmaceuticals used in homes. These guidelines instruct us to combine unused drugs with kitty litter or coffee grounds after destroying drug-identifying materials, and place the combined materials in the trash. This recommendation is meant to deter people from trash picking and dumpster diving to recover drugs for reuse or resale. In the context of pharmaceutical waste, the term "diversion" refers to absconding with unused drugs for reuse or resale. Preventing diversion is crucial for all pharmaceutical waste practices. In hospitals, drug disposal is regulated; not so in home situations.

The federal government also suggests using community drug take-back programs. In some areas, solid waste divisions of the local or county public works agency offer hazardous waste disposal opportunities. In others, police departments or community agencies have developed drug take-back programs at designated locations or during specified take-back days. …

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