Osakidetza Basque Health Service, Debagoiena Integrated Health Organisation, Pharmacy Service, Nafarroa Hiribidea 16, 20500 Arrasate, Gipuzkoa, Spain.
Pharmacy Service, Araba Integrated Health Care Organization, Vitoria-Gasteiz, Alava, Spain; Bioaraba, Clinical Pharmacy Research Group, Vitoria-Gasteiz, Spain.
Sci Total Environ. 2022 Apr 15;817:152954. doi: 10.1016/j.scitotenv.2022.152954. Epub 2022 Jan 8.
Healthcare workers can be exposed to dangerous drugs during their daily practice. The National Institute for Occupational Safety and Health (NIOSH) considers "hazardous drugs" as those that had shown one or more of the following characteristic in studies with animals, humans or in vitro systems: carcinogenicity, teratogenicity or other toxicity for development, reproductive toxicity, organ toxicity at low doses, or genotoxicity. In the actual list (draft list 2020), drugs classified in group 1 are those with carcinogenic effects. Moreover, the global human and veterinary cancer is expected to grow, so antineoplastic drug consumption may consequently grow, leading to an increase of anticancer pharmaceuticals in the environment. Not all drugs pertaining to group 1 can be classified as "antineoplastic" or "cytostatic". Since most of the research on environment presence and ecotoxicological effects of pharmaceuticals has been focused on this therapeutic class, other carcinogenic drugs belonging to different therapeutic groups may have been omitted in previous studies. In this study we aim to review the presence in the environment of the hazardous drugs (NIOSH group 1) and their possible environmental impact. Of the 90 drugs considered, there is evidence of presence in the environment for 19. Drugs with more studies reporting positive detections are: the antibiotic chloramphenicol (55), the alkylating agents cyclophosphamide (39) and ifosfamide (30), and the estrogen receptor modulator tamoxifen (18). Although the original purpose of the NIOSH list and related documents is to provide guidance to healthcare professionals in order to adequately protect them from the hazards posed by these drugs in healthcare settings, we believe they can be useful for environmentalists too. Absence of data regarding the potential of environmental risk of certain hazardous drugs might tell us which drugs ought to be prioritized in the future.
医护人员在日常工作中可能会接触到危险药物。美国国家职业安全卫生研究所（NIOSH）将“危险药物”定义为在动物、人类或体外系统的研究中表现出以下一种或多种特征的药物：致癌性、致畸性或其他发育毒性、生殖毒性、低剂量器官毒性或遗传毒性。在实际清单（2020 年草案清单）中，第 1 组的药物是具有致癌作用的药物。此外，预计全球人类和兽医癌症将增加，因此抗肿瘤药物的消耗可能会随之增加，导致环境中抗癌药物的增加。并非所有属于第 1 组的药物都可归类为“抗肿瘤”或“细胞毒性”药物。由于大多数关于药物在环境中的存在及其对生态毒理学影响的研究都集中在这一治疗类别上，因此在以前的研究中可能忽略了属于不同治疗组的其他致癌药物。在这项研究中，我们旨在审查危险药物（NIOSH 第 1 组）在环境中的存在情况及其可能产生的环境影响。在所考虑的 90 种药物中，有 19 种药物在环境中存在证据。有更多研究报告阳性检测结果的药物是：抗生素氯霉素（55）、烷化剂环磷酰胺（39）和异环磷酰胺（30）以及雌激素受体调节剂他莫昔芬（18）。尽管 NIOSH 清单及其相关文件的最初目的是为医护人员提供指导，以使其在医疗环境中免受这些药物带来的危害，但我们认为它们对环保主义者也有用。某些危险药物的环境风险潜力缺乏数据可能会告诉我们，未来哪些药物应优先考虑。
