By Dustin Renwick
Christian Daughton, an EPA research scientist, does just that by looking at the connection between the examination room and the expansive beauty of the outdoors in his research paper, Lower-dose prescribing: Minimizing “side effects” of pharmaceuticals on society and the environment.
The paper is a result of his Pathfinder Innovation Project that explores the idea of considering the environment and the patient as one entity.
When someone ingests a drug, not all of it is absorbed. The human body excretes parts of that medication, including active pharmaceutical ingredients (APIs) that often end up in the sewers and eventually disperse into the environment.
The most common methods for reducing APIs in nature is by treating wastewater (remediation) and organizing take-back programs, where people in a community drop off unused medications for proper disposal. For example, National Prescription Drug Take-Back Day occurred in late October.
“My interest has long been on solving the upstream problem – minimizing the generation of waste rather than its more costly remediation,” Daughton says. “That aspect has long been discounted.”
Daughton is now directing his attention to identifying and reducing inefficiencies of pharmaceuticals in health care: how they are prescribed, dispensed, and ultimately used by the patients.
His research points to two major changes that could positively affect the types and quantities of APIs that infiltrate aquatic ecosystems.
First, doctors can focus on doses. Based on patient needs, physicians can prescribe lower doses of pharmaceuticals to prevent leftover drugs as well as decrease the excreted amounts. The strategy could keep the environment cleaner, reduce costs for patients and improve therapeutic outcomes.
“The idea isn’t to benefit environment at the expense of possibly jeopardizing the patient,” Daughton says. ”It’s a win-win for environment and health care.”
A second aspect of Daughton’s research involves tracking reliable data about which APIs are extensively metabolized by the body and which are excreted unchanged.
Imagine two similar drugs. The one that the human body thoroughly processes has what’s called an “environmentally favorable excretion profile,” and that drug is likely to do less damage to the local creek.
Unfortunately, that information isn’t easy to find.
“Excretion data submitted for regulatory approval purposes isn’t sufficiently comprehensive for examining the potential for environmental impact,” Daughton says. In other words, drug companies don’t need to scrutinize an API beyond what is relevant for human safety.
“That becomes a major stumbling block” to discovering which APIs could have negative environmental impacts.
As the topic of health care moves to the forefront of national discussions, Daughton’s work points to the environment as one missing component in those conversations.
“That’s where I get this expression – treating the environment and the patient as an interconnected whole.”
About the author: Dustin Renwick works as part of the innovation team in the EPA Office of Research and Development.