A program of

191 Howard Street Boone, NC 28607

828-262-1500www.appalachianvoices.orgwww.iLoveMountains.org

Drugs and their impact on:• Rivers• Kids• Law Enforcement Agencies

Includes prescription and over-the-counter (OTC) medications, cleaning agents, cosmetics, nutritional supplements, & skin care products

Produced and used in larger volumes yearly

Released via small quantity generators

Biologically active

Pharmaceuticals and Personal Care Pharmaceuticals and Personal Care Products (PPCPs)Products (PPCPs)

Source: U.S. Center for Disease Control and Prevention. National Center for Health Statistics. National Health and Nutrition Examination Survey.

Percent of persons reporting prescription drug use in the past month by age

0 10 20 30 40 50 60 70 80 90 100

1988-1994

1999-2002

1988-1994

1999-2002

1988-1994

1999-2002

1988-1994

1999-2002

1988-1994

1999-2002

unde

r 18

year

s18

-44

year

s45

-64

year

s65

yea

rs a

ndov

eral

l age

s

one or two prescribed drugs three or more prescribed drugs

In some cases, medicines are not entirely consumed due to:

Change in prescription Patient’s health improves Patient death Patient doesn’t want to take the medicine Bulk “economy size” containers

of over-the-counter medicines contain more than is used before expiration date

Disposal of Unwanted MedicinesDisposal of Unwanted Medicines

Expired Medication Disposal Expired Medication Disposal HabitsHabits

Returned to Pharmacy

Did Not Dispose

Flushed Trashed

Used All Prior to Expiration

Boehringer, S. “What’s the Best Way to Dispose of Medications?” (2004)

500 patients surveyed:

54% disposed of medications in the trash

35.4% flushed drugs down the toilet or sink

7.2% did not dispose of medications

2% used all medication prior to expiration

1.4% returned medications to the pharmacy

More than half the 301 patients surveyed at a military base pharmacy in 2006 said they had flushed medications down a toilet; fewer than 20% said they had ever been given advice about proper disposal by a health care provider.

Improper Disposal PracticesImproper Disposal Practices

Environmental impact- Accumulation in waterways potentially harmful effects on

wildlife

Accidental ingestion (children & elderly)- 78,000 children under 5 treated for unintentional medication

poisoning each year in the U.S.

Illegal use or theft- Appropriation of pharmaceuticals by family and friends, workers

in homes, and burglars

Main Risks of Improper Disposal Main Risks of Improper Disposal PracticesPractices

U.S. Geological Survey monitoring studyU.S. Geological Survey monitoring study

• 139 streams analyzed in 30 states

• Contaminants identified in 80% of these streams

• 82 contaminants identified (many were pharmaceuticals)

• Co-occurrence common; average 7 distinct contaminants identified per stream

Medicines in the EnvironmentMedicines in the Environment

Kolpin, D.W. et al. 2002. “Pharmaceuticals, hormones, & other organic wastewater contaminants in U.S. streams, 1999-2000: A national reconnaissance.” Environmental Science & Technology. 36(6):1202-1211.

Medicines in the EnvironmentMedicines in the EnvironmentUSGS/CDCP study of drinking water facilityUSGS/CDCP study of drinking water facility

Analyzed for 106 contaminants in 24 water samples from locations within a drinking-water- treatment facility and the 2 streams serving the facility

40 contaminants detected in 1 or more samples of stream water or raw-water supplies in the plant

34 contaminants detected in >10% of these samples

Some prescription and non-prescription drugs and their metabolites were detected in finished water

Stackleberg, P.E. et al. 2004. “Persistence of pharmaceutical compounds and other organic wastewater contaminants in a conventional drinking-water-treatment plant.” Science of the Total Environment. 329:99-113.

Aquatic exposure – chemicals in the aquatic environment can result in continuous, multigeneration exposure.

Feminization of fish - link to estrogen exposure?

Ex: Boulder Creek, CO: female white suckers outnumber males by > 5 to 1; 50% of males have female sex tissue (David Norris, Univ. of Colorado at Boulder)

Effects of antidepressants on fish and frog development?

Ex: Lab studies show low levels of common anti-depressants, including Prozac, Zoloft, Paxil and Celexa, cause development problems in fish, and metamorphosis delays in frogs

(Marsha Black, Univ. of Georgia)

Effects on Aquatic Organisms: Effects on Aquatic Organisms: Cause for ConcernCause for Concern

Source: www.york.ac.uk/.../ gsp/esm/images/pharma1.jpg

Entry Pathways of Medicines into Entry Pathways of Medicines into the Environmentthe Environment

Outflow from wastewater treatment plants

Surface application of manure and biosolids

Commercial animal feeding operations and aquaculture

Landfill leachate sent to wastewater treatment plants

Septic tanks

Prescription Drug AbusePrescription Drug Abuse A study in Florida found that deaths caused

by prescription drugs were three times the number caused by illegal drugs in that state.

• Among young people ages 12-17, prescription drugs have become the second most abused illegal drug, behind marijuana.

• In the past year 9.3% of 12th graders used vicodin and 5% used OxyCotin (without a prescription)

Extent of Prescription Drug AbuseExtent of Prescription Drug Abuse• 48 million Americans have used prescription drugs

recreationally• 6.4 million Americans are abusing prescription drugs –

more than the number of Americans abusing cocaine, heroin, hallucinogens, and inhalants combined

•

In 2008 Wilkes County had the 3rd highest overdose rate in the nation

Where are Teens Getting Prescription Drugs?

What Can Be Done?What Can Be Done? Education and awareness

Pharmacies, Public Utilities, Health Providers and Law Enforcement

Collections One day drop-off events Long-term take-back program

Initial Partners 2009• Watauga Riverkeeper/Appalachian Voices, Co-operative Extension, Watauga

County Solid Waste, NCNR, WRCP, Boone Drug, Mountainkeepers & more:– Project Coordination – Volunteer Support– Graphic Design, web site– Media Outreach

• Watauga County Sheriff’s Dept. Lead Law Enforcement with support from Boone, Blowing Rock and Seven Devils Police Departments and the SBI– Law Enforcement Personnel– Transport to Incinerator and Disposal

• Watauga County, Cities of Boone, Blowing Rock and Seven Devils– Publicity (signage)– Funding – Resolutions of Support

A huge success in 2009

40,000 pills, 12 gallons of liquid medication, 2000 sharps needles, syringes and lancets, and a ‐

glucose meter.

Drugs collected included:

Hydrocodone, oxycodone, blood thinners, anti-allergens, iodine, insulin, antibiotics, steroids, hormones, anti-depressants, cough syrup, topical creams, over the counter medications, flu vaccinations, heart, blood pressure, cancer and heartburn medicine and even some pet medications.

Potential Partners May 22, 2010• Avery County Sheriff’s Department• Civic Organizations• Safe Kids• Drug Awareness Programs• High Schools• Local Churches• Watauga Medical Center• Medical Community• Assisted Living Center• Retirement Centers

Ways to get involved with the Watauga Riverkeeper program:

1. Report pollution by calling our toll-free pollution hotline 1-877-277-8642

2.Become a member of Appalachian Voices

3.Volunteer for Big Sweep, Operation Medicine Cabinet or Muddy Water Watch

4.Read and share our Appalachian Voices newsletter with others.

Thanks to all Appalachian Voices members of the Watauga Riverkeeper Program and the Helen M. Clabough Charitable Foundation for their ongoing

commitment and financial support.They make presentations like this possible!

Questions?