Drugs go where?

         Recently, I started to see more PSAs like this pop up in places at work. I came across this particular one in the bathroom. The grayed out part is drop off locations for outdated and expired drugs. Given there is an opiate issue in my state, this is part of nailing two birds with one stone.

         Yeah, it should be common sense that drugs entering the environment is a problem. It is already affecting aquatic life. At what point does it affect people in physical ways? That is anyone's guess. However, these pharmaceutical products already affect healthcare more than many people realize.

         We talk of antibiotic resistant bacteria (ARBs), the rise of their genes (ARGs), and "superbugs". Some people may think this is due to overuse of antibiotics. They are not wrong, but it is not the utilization of them on patients that create them. Remember, the patients recover from the infection through successful treatments.

         One of the problems is the disposal from these drugs. Another is the current technology used in water treatment. Drugs pass through your system, that is a physiological fact. Your body does not always break down everything. A certain level antibiotics will make their way into the sewage system.

         Now, imagine flushing whatever drugs you take straight down the toilet. It turns out, more than a third of the people do that according to this Penn State article back in 2012. Can you understand how germs become more and more resistant? We are speeding up evolution by eliminating wild type bacteria that are susceptible. In return, we leave mutants with resistance genes to proliferate.

         This is a global issue. It should be obvious that whatever trace of antibiotics in the water is above the MICs. MIC refers to the minimum inhibitory concentration of a drug. This means the concentration is more than enough to prevent visible bacterial growth. This has been a known concern even in the early 2000s in a study done in Germany. (Kummerer K., Henninger A.)

         Affluent countries have water treatment facilities that surpass their less fortunate neighbors. How do lower income countries fare when it comes to this growing threat? Turns out there was an one-year study done in Vietnam on the subject. It looked at both antibiotic usage of a rural and urban hospital. It then analyzed and compared their wastes. It showed that the presence of drugs are generally lower after water treatment. How much different from countries like USA? Well, in some cases, better, but in some, worse. (La Thi Quynh Lien, et al)

Other things to consider

         Now, what of those ARBs that make their way into your drinking water? Different disinfection methods exist to kill the bacteria. But, the most important thing is to disrupt the ARGs.

         In a piece written by Joan B Rose this year, it touched on some of those methods. Can our technology help mitigate the pending crisis? Only time will tell. As it stands, we can kill off harmful ARBs with certainty. Eliminating the ARGs from the ecosystem is quite another story.

         Before I moved to the USA, I have never consumed tap water. People boiled their water due to the risks of parasites, etc. that aren't visible to the naked eye. Would water filters help reduce the level of drugs in your drinking water? I have yet to research into those.

At work

         It is evident that antibiotic resistance is on the rise. I have worked at the current hospital for five years. In that time, I have seen the increased resistance of various bacteria.

         For example, Morganella and Pseudomonas species with imipenem resistance are no longer questionable. When I started my job, those were things I had to retest to make sure they were not errors.

         The instances of other carbapenem drug resistance are also increasing. By protocol, the lab runs tests to see if the bacteria contain those ARGs or are they due to some other mechanisms. And that's how much the bacteria have evolved in FIVE years.

What now?

         Do yourselves a favor, do not dump your prescription in the trash or flush them down the toilet. Please dispose them at a designated location.

         Not only our behavior needs to change, but our technology as well. I don't expect researchers will find a way to super-boost our immune system anytime soon. In this case, better waste treatment methods and strategy need to be priority before it is too late.