Gund Institute for Environment & Larner College of Medicine, University of Vermont, Burlington, VT, USA.
Community Development and Applied Economics, University of Vermont, Burlington, VT, USA.
J Environ Manage. 2021 May 1;285:112106. doi: 10.1016/j.jenvman.2021.112106. Epub 2021 Feb 14.
Human and veterinary pharmaceuticals offer many benefits, but they also pose risks to both the environment and public health. Life-cycle stewardship of medications offers multiple strategies for minimizing the risks posed by pharmaceuticals, and further insight is required for developing best practices for pharmaceutical management. The goal of this study was to clarify points of intervention for minimizing environmental and public health risks associated with pharmaceuticals. Specifically, our objectives were to provide insight on purchasing, use, and disposal behaviors associated with human and veterinary medications. This study used a state-wide representative sample of Vermont adults (n = 421) to survey both human and veterinary pharmaceuticals as potential sources of the unintended consequences of prescribed and over-the-counter (OTC) medications. The majority (93%) of respondents had purchased some form of medication within the past twelve months, including OTC (85%), prescription (74%), and veterinary (41%) drugs. Leftover drugs of any kind were reported by 59% of respondents. While 56% of people were aware of drug take-back programs, the majority reported never being told what to do with leftover medications by their physician (78%), pharmacist (76%), or veterinarian (53%). Among all respondents, take-back programs were the most common disposal method (22%), followed by trash (19%), and flushing (9%), while 26% of respondents reported keeping unused drugs. Awareness of pharmaceutical pollution in the environment and having received information about proper disposal were both significantly associated with participation in take-back programs. These findings indicate that a large volume of drugs are going unused annually, and that only a portion of leftover medications are returned to take-back programs where they can be appropriately disposed. Our results warrant further investigation of clinical interventions that support lower dose prescribing and dispensing practices in order to reduce the unintended environmental and public health consequences of pharmaceuticals within the consumer sphere. In addition, our findings suggest that directed efforts to raise awareness of proper disposal may be more effective than broad awareness campaigns, and we recommend research on the efficacy of providing disposal instructions on drug packaging.
人类和兽医药品有很多好处，但也给环境和公众健康带来风险。药物生命周期管理提供了多种策略，可以最大限度地降低药品带来的风险，需要进一步深入了解，以制定最佳的药品管理实践。本研究的目的是阐明干预点，以最大限度地降低与药品相关的环境和公共卫生风险。具体来说，我们的目标是提供有关人类和兽医药物购买、使用和处置行为的见解。本研究使用佛蒙特州成年人的全州代表性样本（n=421），调查了人类和兽医药物作为处方和非处方（OTC）药物意外后果的潜在来源。大多数（93%）受访者在过去 12 个月内购买过某种形式的药物，包括 OTC（85%）、处方药（74%）和兽医（41%）药物。59%的受访者报告有剩余的任何类型的药物。虽然 56%的人知道药品回收计划，但大多数受访者表示，他们的医生（78%）、药剂师（76%）或兽医（53%）从未告诉过他们如何处理剩余药物。在所有受访者中，回收计划是最常见的处理方法（22%），其次是垃圾（19%）和冲洗（9%），而 26%的受访者报告保留未使用的药物。对环境中存在药物污染的认识以及收到有关适当处置的信息，与参与回收计划都有显著关联。这些发现表明，每年有大量药物未被使用，只有一部分剩余药物被送回回收计划，以便在那里进行适当处理。我们的研究结果表明，需要进一步研究支持较低剂量开处方和配药实践的临床干预措施，以减少药品在消费者领域带来的意外环境和公共卫生后果。此外，我们的研究结果表明，有针对性地提高对正确处置的认识可能比广泛的宣传活动更有效，我们建议研究在药物包装上提供处置说明的效果。
