Green pharmacy and pharmEcovigilance: prescribing and the planet

Abstract

Active pharmaceutical ingredients (APIs) are ubiquitous environmental contaminants, resulting primarily from excretion and bathing and from disposal of leftover drugs by consumers and healthcare facilities. Although prudent disposal of leftover drugs has attracted the most attention for reducing API levels in the aquatic environment, a more effective approach would prevent the generation of leftover drugs in the first place. Many aspects of the practice of medicine and pharmacy can be targeted for reducing environmental contamination by APIs. These same modifications – focused on treating humans and the environment as a single, integral patient – could also have collateral outcomes with improved therapeutic outcomes, and with a reduced incidence of unintended poisonings, drug interactions and drug diversion, and lower consumer costs.

Keywords::

• APIs
• disposal
• environmental contamination
• evidence-based prescribing
• personalized medicine
• pharmaceuticals
• pollution prevention
• sustainability
• US EPA
• wastewater

Acknowledgements

The authors appreciate the review comments provided by Julia Jernberg (University of Wisconsin, Madison, WI, USA) and by the anonymous external reviewers.

Financial & competing interests disclosure

The US Environmental Protection Agency through its Office of Research and Development partially funded and managed the research described here. It has been subjected to the Agency’s administrative review and approved for publication as a US Environmental Protection Agency document. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Notes

Data from [55,105].

ADME: Absorption, distribution, metabolism and excretion/elimination; API: Acute pharmaceutical ingredient; CSA: Controlled Substances Act; DTC: Direct to consumer; LTCF: Long-term care facility; OTC: Over the counter; Rx: Prescription; TDDS: Transdermal delivery system.

Most of these factors are covered in more detail in [105].

Data from [56].