A program of

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A program of
191 Howard Street Boone, NC 28607828-262-1500ww
w.appalachianvoices.orgwww.iLoveMountains.org
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Drugs and their impact on

• Rivers
• Kids
• Law Enforcement Agencies

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Pharmaceuticals and Personal Care Products (PPCPs)

• 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

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Source U.S. Center for Disease Control and
Prevention. National Center for Health
Statistics. National Health and Nutrition
Examination Survey.
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Disposal of Unwanted Medicines

• In some cases, medicines are not entirely
  consumed due to
• Change in prescription
• Patients health improves
• Patient death
• Patient doesnt want to take the medicine
• Bulk economy size containers
  of over-the-counter medicines
  contain more than is used
  before expiration date

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Expired Medication Disposal Habits

• 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

Boehringer, S. Whats the Best Way to Dispose
of Medications? (2004)
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Improper Disposal Practices
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.
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Main Risks of Improper 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

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Medicines in the Environment

• U.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

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.
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Medicines in the Environment

• USGS/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 gt10 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. 32999-113.
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Effects on Aquatic Organisms Cause for Concern

• 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 gt 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)

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Entry Pathways of Medicines into the 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

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

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Extent 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
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Where are Teens Getting Prescription Drugs?
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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

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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 Sheriffs 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

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A huge success in 2009
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40,000 pills, 12 gallons of liquid medication,
2000 sharps-needles, syringes and lancets, and a
glucose meter.
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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.
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Potential Partners May 22, 2010

• Avery County Sheriffs Department
• Civic Organizations
• Safe Kids
• Drug Awareness Programs
• High Schools
• Local Churches
• Watauga Medical Center
• Medical Community
• Assisted Living Center
• Retirement Centers

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• Ways to get involved with the Watauga Riverkeeper
  program
• Report pollution by calling our toll-free
  pollution hotline [phone]
• Become a member of Appalachian Voices
• Volunteer for Big Sweep, Operation Medicine
  Cabinet or Muddy Water Watch
• Read and share our Appalachian Voices newsletter
  with others.

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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!
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Questions?