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drinking water

This was going to be a quick and easy post pinching the above video my mate Ves had on his blog showing the making of a information graphic for the National Geographic article Pharmaceuticals in Drinking Water. Here’s the link to the full size illustration.

But that idea went down the toilet (but not with any pharmaceuticals) when Ben from the Health Impact Assessment Blog sent me an article titled Drugs in the Environment: Do Pharmaceutical Take-Back Programs Make a Difference?. With this topic being a bit of a favourite of mine (here and here) along with me recently viewing a few videos of the inane way drug disposal is carried out in the States I couldn’t help myself.

Removing unwanted and unneeded pharmaceuticals from the home and also from waste reduces the chance of misuse. That in itself is an important enough reason for a removal program. However the article also states:

The bulk of human pharmaceuticals found in waterways most likely got there by way of sewage. Taking unused pharmaceuticals out of landfills may make only a small difference in the concentrations of APIs found in water, say critics and supporters alike of such programs.

The article looks at the SMARxT Disposal™ program:

a partnership of the U.S. Fish and Wildlife Service, the American Pharmacists Association, and the Pharmaceutical Research and Manufacturers of America recommends that medications be crushed and/or dissolved, mixed with kitty litter or other unappealing material (to discourage consumption), then enclosed in a container or sealable baggie before disposal in the trash.

In reading the article, despite a box talking of waste drugs flushed or placed into septic systems I get the feeling that they assume flushing medications down the toilet is not a huge problem and what appears in the sewage and waterways is entirely from urinary excretion into the sewage system.

Perhaps I am reading it wrong. But I can’t believe the majority of waste drugs is disposed of using the “approved” method. Look for yourself. Would you dispose of your unwanted medications this way each time?

No, I thought not.

The article is quite informative at looking at all aspects of the waste pharmaceutical process in the USA highlighting cases of drugs in waterways affecting fish populations, land fills, accepted and approved waste disposal methods and the hurdles in implementing “take back” programs. Compare this to Australia where the Return of Unwanted Medicines Project has been running for twelve years. A simple motto:

Consumers can return medicines

TO ANY PHARMACY – ANYTIME

The article highlights an unhealthy obsession about drugs, even waste drugs in the USA, worrying about diversion and legalities of who can accept them back. I think it goes to the absurd when we have to take back our out of date paracetamol to the police station for disposal.

Reference: Lubick N 2010. Drugs in the Environment: Do Pharmaceutical Take-Back Programs Make a Difference? Environ Health Perspect 118:a210-a214. doi:10.1289/ehp.118-a210
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The joint seminar recently presented by the Menzies School of Health Research and the Public Health Association of Australia mentioned in a previous post is now available on the web.

You can watch a recording of the seminar, view a PDF of the Powerpoint presentation and a summary of the Question and Brainstorm Points

The presentation had a number of points on drinking water. I find it disturbing that in Australia we are still discussing the need for sanitation and clean drinking water for its citizens.

The second slide focused on the achievements of John Snow in these areas.

Another slide discussed the prevention of illness as the key to improving public health.

Public Health – The key is prevention

•Clean water and sanitation
•Immunisation
•Health protection
•Peace and shelter
•Social determinants
•Health promotion

And then the question was posed:

Clean water and sanitation

•How many indigenous communities do not have this basic infrastructure 150 years after John Snow?

Unfortunately I believe many remote communities do not have this infrastructure. I know of some communities with drinking water nitrate levels regularly over 50ppm for at last two years and still have no filtration devices. (A discussion of inorganic chemicals in drinking water.)

In Western Australia we are only working towards implementing the drinking water standards of 1995. From the website of Parsons Brinkerhoff who manage the Remote Area Essential Services Program (RAESP) on behalf of Western Australia’s Department of Housing and Works (DHW)

RAESP delivers safe, reliable drinking water to some of the most isolated people in the driest part of the driest inhabited continent on earth.

The program is working toward implementing the Australian Drinking Water Guidelines 2004 (link now goes to current draft standards) and the Framework for Management of Drinking Water Quality. It provides monthly sampling of water supplies in 91 communities, and is achieving targets for microbiological and chemical water quality (95% compliance with the Australian Drinking Water Guidelines).

Water source protection plans are under way in 36 communities.

The Federal Government is promoting Preventative (sic) Health for all Australians and Closing the Gap in health for our Indigenous Australians.

Yet we cannot provide the basic public health measures for all Australians.

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