I recently finished a course of liquid antibiotics and I was about to rinse out the medication container and drop it in the recycling when I realised that doing so would contribute to a serious environmental problem: Medical waste in the water, air, and soil. A number of studies in recent years have identified traces of pharmaceuticals in water supplies and have documented a variety of environmental consequences as a result.
There are a number of paths pharmaceuticals take to end up in the water. One is the path my medication almost went down; people dispose of unused medications by flushing them or pouring them down the sink. This may be done to avoid poisonings, to get rid of clutter, to dispose of expired medications, or for other reasons. It seems like a logical step to take; people are advised not to keep old medications sitting around the house, and it seems counterintuitive to just throw them away.
Metabolites of pharmaceuticals expressed in urine, feces, and sweat also end up in the air, water, and soil. In some cases, people may express active ingredients due to the fact that the body fails to completely metabolize medications and in other instances, they secrete chemicals formed through metabolic processes in the body. Sometimes this can be extremely dangerous. People on certain types of radiation therapy, for example, are actually radioactive and have to observe special precautions until the medications are cleared from their bodies.
Initially, when medications were identified in the water supply, scientists took a wait and see approach. It doesn’t make sense to get concerned about a situation until evidence to support a cause for concern is presented, after all. As it turns out, there was a lot to be concerned about. Numerous anomalies have been identified in fish exposed to compounds like antidepressants and estrogens. In addition to fish, other microorganisms and plants near polluted water have also developed abnormalities. While polluted water may not pose a threat to humans directly, it certainly harms animals.
It also contributes to the development of antibiotic resistance. That antibiotic I almost gleefully poured down the drain happens to be a very aggressive broad spectrum antibiotic, prescribed because, in this case, my infection was not responding to other antibiotics. Introducing that antibiotic to the water supply would have exposed some bacteria to it, some of those bacteria could have had resistance, and those bacteria could have bred, creating a small pocket of antibiotic resistant bacteria. Multiply that by millions of households dumping antibiotics down the drain and what you end up with is infections which do not respond to antibiotic therapy. Like the infection I spent hundreds of dollars treating before we found an antibiotic which worked.
Antibiotic resistance isn’t just an expensive pain in the ass[1. Literally, in my case, I had a GI infection with some rather graphic symptoms.]. It also poses a serious risk to people (and animals) with compromised immune systems. The search for an antibiotic which will work may take too long, giving the bacteria a chance to take hold. Sometimes, bacteria kill. People are regularly reminded to finish their antibiotics to address antibiotic resistance, but they are not often reminded to dispose of antibiotics responsibly.
Furthermore, pharmaceuticals in the water are causing some problems at water treatment plants. Facilities which process wastewater need to use new filtering techniques to get pharmaceuticals out so that they are not introduced to the natural environment through release of treated water. This adds to the cost of water processing significantly as plants are forced to upgrade or risk not treating water fully and releasing medications into the environment. And, of course, medications floating in the water at such plants can disturb the balance of beneficial flora and fauna used in wastewater treatment, literally sickening a wastewater plant as hardier organisms start to multiply and fragile ones die off. In plants which use biological treatment methods (a lot, when you consider plants which use microorganisms during at least one stage of water treatment), meds in the water are a big problem.
So, great, drugs in the water are bad, what are you supposed to do about it?
One option which is frequently recommended for home disposal is the trash. Medication labels should be removed or scratched out and the bottles securely closed and wrapped in tape before dropping them in the garbage, preferably with unpleasant materials like cat litter to dissuade people who might be exploring the garbage from fishing the medications out. However, trashing poses two problems. The first is that it is not a safe method to dispose of certain medications, and sometimes people aren’t provided with notice about a safe way to dispose of drugs; it’s important to ask a pharmacist about the recommended disposal method. The second is that even if medications can be safely trashed, they can still leach in the landfill. It might take a while, but if a container cracks open or is damaged and the landfill is not well lined, that medication can end up exactly where you didn’t want it: in the water.
Another option is to save up medications and take them back. Numerous communities have hazardous waste pickup which includes pickup of medications and other medical waste like sharps containers and some hospitals accept expired and unused medications for disposal. When preparing medications for this type of disposal, people should remove or obscure the labels to get rid of identifying information, wrap up the containers in tape to tightly seal them, and store them in a secure place. When hazardous waste pickup is in the area, the medications can be taken to a drop off point.
It’s also sometimes possible to mail in hazardous waste in envelopes sent out by the disposal company. It can be worth calling to see if that’s an option. Another thing to consider is asking neighbors if they want to take turns handling hazardous waste for the neighborhood; if pickup happens once a month and people take turns delivering neighborhood waste to the dropoff, disposing of hazardous waste responsibly won’t be such a burden. Before doing this, however, it is a good idea to ask if there are limits on individual dropoffs; someone with a car load of materials may be refused, even if that person is doing the neighbors a favour!