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EPA

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Fish oil supplements are widely available and the use of these products is considered to be associated with a range of health benefits (refer E bulletin Vol 38(1)). Two of the most important omega-3 fatty acids in fish oil are eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). A 1g capsule of fish oil does not supply a 1g dose of omega-3 fatty acids.

For example a 1g capsule of Blackmores Fish Oil® contains only 300 mg of omega-3 fatty acids (180 mg EPA and 120 mg DHA). Omacor® contains 840 mg of omega-3 fatty acids per capsule. For lowering triglyceride, 2 -5g of the omega -3 fatty acids are needed. To achieve this would require the daily intake of four capsules of Omacor® daily or seven capsules of Blackmores Fish Oil®.

Download (PDF, 11.83KB)

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A joint initiative of the Patient Services Section and the Drug and Therapeutics Information Service of the Pharmacy Department, Repatriation General Hospital, Daw Park, South Australia. The RGH Pharmacy E-Bulletin is distributed in electronic format on a weekly basis, and aims to present concise, factual information on issues of current interest in therapeutics, drug safety and cost-effective use of medications.
Editor: Assoc. Prof. Chris Alderman, University of South Australia – Director of Pharmacy, RGH © Pharmacy Department, Repatriation General Hospital, Daw Park, South Australia 5041.

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The health benefits of fish oil have been extensively studied since it was first hypothesised that the lower rates of heart disease found in Greenland Eskimos was associated with their consumption of omega-3 (n-3) polyunsaturated fatty acids from fish. The n-3 fats found in fish include eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). The claimed health benefits of fish oil are too numerous to fully cover here, and many are yet to be supported by clear evidence at this stage. However there are some benefits of fish oil that have strong evidence and are now well recognised

Download the E-Bulletin below to see the evidence for the use of Fish Oil in various disease states.

Download (PDF, 9.81KB)

The 2009 RGH E-Bulletins are archived here.

If you like this post and what else you see on the blog please subscribe by RSS feed (the orange button) or by email. Visit my subscription page.

A joint initiative of the Patient Services Section and the Drug and Therapeutics Information Service of the Pharmacy Department, Repatriation General Hospital, Daw Park, South Australia. The RGH Pharmacy E-Bulletin is distributed in electronic format on a weekly basis, and aims to present concise, factual information on issues of current interest in therapeutics, drug safety and cost-effective use of medications.
Editor: Assoc. Prof. Chris Alderman, University of South Australia – Director of Pharmacy, RGH © Pharmacy Department, Repatriation General Hospital, Daw Park, South Australia 5041.

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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
Link

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The Return of Unwanted Medicines (RUM) Project removes about 400 tonnes of pharmaceuticals from the Australian waste system each year ensuring protection for the public and environment. There are no figures that I can find but I guess a substantial amount is also discarded in the rubbish.

Some time ago I wrote about the major differences between the USA and Australian in the way they handle pharmaceutical waste.

The main difference is that in Australia consumers can return medicines TO ANY PHARMACY – ANYTIME

wasteAt the time of writing this post the Australian population clocked in at 22,018,292 people and the USA had 307,708,421 people.

Now bear with me as I fly by the seat of my pants on the back of an envelope and make some huge assumptions. Assumptions like both countries are prescribed the same number and collect the same number of prescriptions per head.

If we accept this it means the USA has roughly 5590 tonnes of pharmaceuticals being disposed each year, following the FDA recommendations. Using local collection services if they exist otherwise flushing controlled drugs down the toilet and the rest in the rubbish mixed with used kitty litter!

For my American readers that is about 6161 tons (US). This is the equivalent of 199 full semi trailers (semi-tractors) of pharmaceutical waste each year.

No wonder there are worries about water contamination by pharmaceuticals in the United States.

Truck calculation
In the USA a loaded semi trailer (semi tractor weight)can weigh up to 80 000 pounds. Lets say each semi trailer weighs 18000 pounds. With each truck carrying 62000 lbs it requires the equivalent of 199 semi trailers (semi tractors) to remove the 6161 tons of waste. If they were still in their packaging it would be at least twice that number of trucks.

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