Permanent prescription drug collection boxes will be required at all retail pharmacies in New York State, paid for by pharmaceutical manufacturers, under a proposal developed by the the State Department of Environmental Conservation.
In a report released Friday afternoon, the State DEC recommends a sweeping statewide pharmaceutical stewardship program, to be developed, implemented and paid for by a newly created pharmaceutical stewardship organization fully funded by drug manufacturers.
The new organization would bear the approximately $5.75 million cost of supplying collection receptacles for all 4,600 retail pharmacies in New York as well as the cost of collection box liners and disposal, an estimated $10.6 million per year. The organization would also pay the cost of postage-paid mail-back envelopes to be distributed by retail pharmacies in the state, as well as the cost of an extensive education and outreach program to secure consumer participation.
The proposal was developed by DEC after Gov. Andrew Cuomo vetoed legislation passed by the State Legislature last year that would have required all “chain pharmacies” — those with at least 10 locations — to offer mail-back envelopes to consumers. In his veto message, Cuomo objected to the disproportionate burden on chain pharmacies and consumers, who would have been charged a fee of up to $2 per mail-back envelope. Cuomo directed the DEC to meet with stakeholders and investigate the feasibility of a statewide pharmaceutical stewardship program “provided by manufacturers at no cost to consumers.”
While manufacturers agree they “should play a key role in a pharmaceutical stewardship program,” industry representatives, including the Pharmaceutical Research and Manufacturers of America (PhRMA) and Pfizer have expressed opposition to a program fully funded by manufacturers, according to the report.
New legislation would be needed to implement the proposal. The appetite of state legislators for adopting such a plan, especially if opposed by the powerful pharmaceutical industry lobby, remains to be seen.
Pharmaceuticals are, of course, big business. Prescription drug use has drastically increased over the past two decades, thanks to the combination of an aging population, pharmaceutical industry marketing efforts and physician prescribing practices. The total number of prescriptions filled by all Americans increased by 85 percent between 1997 and 2016, while the total U.S. population increased by just 21 percent over that same period, according to Consumer Reports
Pharmaceutical and biotechnology sales revenue increased 45 percent — from $534 billion to $775 billion — between 2006 and 2015, according to the U.S. Government Accountability Office. Drug company profit margins also increased during that period, with some companies’ margins reaching 20 percent in some years. Meanwhile drug industry spending for research and development increased 8.5 percent in roughly the same time frame, from $82 billion in 2008 to $89 billion in 2014.
The health and environmental impacts of improper disposal
Failure to properly dispose of prescription medications is widely believed to be a contributing factor prescription drug abuse and the increase in drug overdose deaths. Pharmaceuticals are also a common cause of poisonings in children. The number of opioid-related hospitalizations requiring pediatric intensive care doubled between 2014 and 2015, according to a study published this year in the journal Pediatrics.
“Removing expired or unused pharmaceuticals from the home reduces the risk of off-label, nonmedical use, both intentional and accidental,” the report states.
But many consumers remain unaware about the proper disposal of prescription medications and the environmental and health risks associated with improper disposal.
Flushing unused drugs or putting them down the drain used to be the recommended method of disposal. But pharmaceuticals began showing up in water bodies early in this century, prompting environmental and health regulators to look at the issue and reconsider flushing as a disposal option.
The full range of health and environmental impacts of these pharmaceuticals is still unknown, according to the DEC, but the primary concern is the biological risk to aquatic life.
“Studies have shown that common drugs, such as antidepressants, birth control, and beta-blockers, can affect spawning and fertility among fish living in contaminated waters. A 2017 study of the fish populations in the Niagara River found high concentrations of antidepressants in the brains of 10 species,” according to the report.
“There is additional concern that long-term exposure to low concentrations of antibiotics may result in the evolution of antibiotic-resistant bacteria. A 2013 study measured the Hudson River estuary and found antibiotic resistant bacteria at all 10 sample sites, attributable to effluent from wastewater treatment plants,” the report states.
Also, there is very limited research on the long-term impacts to humans of continuous exposure to low levels of these kinds of pharmaceuticals through treated drinking water,” the DEC said.
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