It might seem to be a viable argument that all that needs to be done to curb the problem is to design much better and more effective water filtration systems. “Techniques for removing compounds from drinking water include advanced oxidation, membrane filtration and filtration with granular activated carbon, as well as these combined with reverse-osmosis, which eliminates the drugs” (Frank, 2007).
However, while these are promising solutions on the surface, all options come with staggering drawbacks, including unreasonably high costs, high consumption of energy resources, polluting processes, and other issues that make this a difficult alternative to consider. In other words, the solutions for this problem will only create others—this time some with more immediate results.
Most states recognize through discussions in their scientific and medical community’s leadership, that there is a problem but as of yet, there are few large-scale policy actions geared towards correcting this issue. There are minor corrective and preventative initiatives such as Senate Bill 966 in California which requires drug companies to collect and properly dispose of outdated medications but it is likely to not pass another round of legislative action due to resistance from drug companies and lobbyists.
Another way to best address is the issue is to organize community efforts to halt the problem. For instance, in one area of San Francisco an effort was arranged to allow people to drop off their old and unused medications. This is a great way for nurses to help further the effort to reduce the problem as they can be leaders in disseminating information about these public locations and tell patients why this is important.
Community-based efforts, especially if led by nurses in terms of provision of information, can be successful. In the San Francisco experiment just discussed, this one effort “in four locations collected nearly 590 pounds of unwanted drugs in just four months at the cost of $924, plus the costs of police to control the drugs” (Frank, 2007).
This effort to make people aware enough of what is happening with medications after they are done with them in both the active sense (making them understand why flushing them is not acceptable) and passively (through helping them understand the problem in the greater sense) is through the efforts of nurses. Nurses can work together to formulate handouts as well as use their verbal communication skills to discuss with patients how they can help prevent some parts of this problem.
If nurses were to mention this as an issue worth paying attention to, little by little, fewer people would improperly dispose of their medications and would seek out more alternatives. Patients have inherent trust for their nurses and this relationship can be used to halt the problem. This relationship can be exploited in a positive way as patients can see that this is not a “conspiracy theory” and is a genuine problem with legitimate fixes and prevention measures.
The Environmental Protection Agency (EPA) just released a new initiative called the Information Collection Request (ICR) that is geared specifically towards monitoring and evaluating how the healthcare industry itself handles medication disposal issues, which is an important step in regulating the problem of medication disposal at the macro level.
As another part of the new program by the EPA, the environmental organization is bringing the National Academy of Sciences (NAS) into the project to “provide scientific advice on the potential risk to human health from low levels of pharmaceutical residues in drinking water” (Biocycle, 2008). In their efforts these agencies in tandem have developed and used sensitive monitoring equipment that looks for low levels of many common types of medications.
Frank (2007) uses estimates from national data sources to predict that between 50 and 90% of ingested drugs are excreted. Clearly, there is little that anyone can do about this problem which is one of the most prevalent transmission modes of medications into water supplies. Eventually, nurses will need to understand how certain medications in someone’s drinking water might have an impact on their current dosage, but most reports suggest that the amounts are not yet large enough to alter medication’s effects or produce side effects… not yet.
Nurses are responsible for telling patients about this in addition to their warnings about the dangers of flushing or otherwise disposing of medications that might end up in water supplies for patient information purposes, even though there is little patients will be able to do to prevent this, obviously.
To counter this, medications need to be designed to break down more quickly, which is an effort already underway for some drugs. Between these and the public education efforts on the part of nurses, this problem can be mitigated before more sustainable solutions are developed.
Currently, there is only speculation about some of the long-term effects of this slow process of millions of Americans’ consumption of low doses of drugs ranging from sex hormones to tranquilizers. Some suggest that “the chlorine used to disinfect drinking water could increase the toxicity of some chemicals. Also, drug safety testing generally has not looked at the effects of the long-term, low-level exposures that could occur over a lifetime” (Berg, 2008, p. 66).
With this is in mind, it is critical for nurses to stay abreast on all of the new literature on this topic so they can best understand what some of the most serious risks are and also they can begin to detect issues of possible interactions with trace amounts of drugs in the water supply. While the likelihood of this occurring now is slim, if such water contamination occurs this will become a growing problem.
Nurses must reinforce the fact that it is not suitable for patients to ever flush unused medicines down the toilet or in other drains and that they also should not allow them to be transported to landfills either as eventually they can leach into the soil and the water table.
What can nurses tell patients? “Bottled water is not the solution; in fact, it often comes from the same sources as tap water and is it is subject to fewer regulations” (Berg, 2008, p. 67) and most home-based water filtration systems are not designed to break down the complex chemical structures of most medicines. Thus it seems that there is no way to offer patients ideas that involve no consumption of this water, especially when nurses already generally advise people to drink 8 glasses of water per day.
Instead of trying to find ways around the problem, nurses must inform patients of the problems with medication disposal and immediately offer them solutions, such as in the form of medication disposal bags that they can mail for free to drop off to the hospital or drop site where such medicines can be properly disposed of and how they can become mobilizing forces in their communities.
Your last slide should present some links and one more should provide the references list which is above. Please note that most of the references you gave me were not credible peer-reviewed academic sources and were just rehashing of the news story with minimal research or insight. I added two of my own to make this slightly more credible and academic.
