Climate Corner: Medications and Ecotoxicity with Dr. Jay Slater

There are numerous examples of the potential harms posed by our patients’ unused pharmaceuticals. These include inadvertent ingestion by children or pets, diversion of drugs of misuse (opioids, benzodiazepines), and the reduced efficacy of taking outdated medications. As the prescriber of many of their drugs, we can engage with our patients about these harms.

Another aspect, that we may not often consider, is the negative environmental consequence of medications, so-called ecotoxicity. We know that many drugs end up in ground water, rivers, lakes, oceans and soil. The list includes hormones, opiates, oral hypoglycemics, chemotherapeutics, antibiotics and others. They get into the ecosystem in various ways including the manufacturing process and human excretion of compounds that aren’t effectively removed by sewage treatment facilities. In the case of individuals disposing of unused meds, they can leach from landfill or get into wastewater after being flushed down toilets. In turn, these chemicals have been found in drinking water across the country, albeit in trace amounts.

Studies show that fish and wildlife are affected by drugs in the environment. As for humans, it’s early to draw clear associations. These chemicals are in low concentrations, exposure is over the long term, and there may be interactions and additive effects. But we can’t ignore the possibility that pharmaceuticals, and their metabolites, could be harming our health. A Canadian paper in 2011, for example, discussed a potential connection between prostate cancer and estrogens in the environment. Endocrine disruption and breast cancer in women, and antibiotic resistance are among other areas of concern.

So, what do we tell our patients about their unused medications? Don’t take really outdated medications, their efficacy can’t be assured. Don’t flush medications down the toilet or put them in the garbage, they’ll end up in the water system. Return what you don’t use, ideally to the pharmacy where they were dispensed, otherwise to one participating in a Take Back program. The website gives a list of nearby drugstores by postal code. Returned meds will be neutralized through incineration.

Family docs have roles in educating patients and in medication stewardship. Safe disposal is included in that.