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Pharmaceuticals and Personal Care Products in the Canadian Environment: Research and Policy Directions

5.3 Source Control, Prudent Use, and Source Separation

Another general category of management options that received discussion at this workshop and has garnered more attention in other publications, is that of preventing PPCPs from entering the wastewater stream in the first place. The potentially high cost of advanced centralized treatment options for PPCPS has also generated more interest in reductions at the source. Consequently, at this time, source control and source separation options are seen as a complement to end-of-pipe treatment, though it remains to be tested whether source control / source separation options represent the most cost, energy and removal efficient approach.

Source control generally refers to managing which compounds and how much of them enter the water system. Essentially, effective source control reduces the consumed quantities as well as the ecological exposure of selected compounds. Existing literature suggests several options here:

  • Ecolabelling – Eco-labelling aims to provide consumers with trustworthy information on the ecological soundness of products, allowing them to opt for more environmental friendly products. Schemes to assess specific product groups within personal care products already exist. The Nordic European countries have set up criteria for ecolabel awards for shampoo, body shampoo, liquid and solid soaps. Strategies for ecolabelling of pharmaceuticals are also being developed in Europe (Joss et al., 2006b).
  • Product take-back programs – Pharmaceutical producers have been particularly active in setting up programs allowing consumers to return (at no charge) their residual medications to pharmacies. The pharmaceutical industry of British Columbia, for example, voluntarily established the Medications Return Program in 1996. As of 2004, over 90 per cent of pharmacies in the province participate in it (BC MOE, 2007), though more research is needed to assess the cost-effectiveness of these programs (e.g. types and amounts of medicine being collected, the participation rates, regulatory compliance issues, programs costs, funding sources and final disposal). In Canada, the Post Consumer Pharmaceutical Stewardship Association’s (PCPSA) website provides updates on various province-wide and municipal take-back programs (www.medicationsreturn.ca).
  • Reducing medical consumption – Clearly many medications are essential and for some drugs, no substitute exists to date. However in some cases, it is possible to opt for alternate therapeutic choices and supporting complementary strategies (e.g. improved sanitation, nutrition and access to general health care). Sweden is developing an environmental classification of pharmaceuticals which will help health care workers choose less persistent and bio-accumulative drugs when deciding on a prescribed therapy.
  • Education – Education campaigns and programs aimed at providing information on the effects of PPCPs in the environment and on available solutions are a critical component of increasing the uptake of other source control alternatives. The actions taken by the public will inevitably impact all other initiatives and can make a major contribution towards reducing PPCP residuals entering the environment.
  • Fostering a product stewardship culture – Often called extended producer responsibility or life cycle management, this option involves the process of managing the entire life cycle of a product from its conception, through design and manufacture, to service and disposal programs. It means improved product stewardship by extending the responsibility of industry and services sectors towards the effects of their product on the environment. Various measures, voluntary or legislated, can induce a shift to more environmentally friendly products and can influence the pace at which new solutions enter the market. Enhanced attention to life cycle management programs is one key need identified from this workshop.
  • Prudent use of veterinary drugs in agriculture– Conventional livestock production systems typically use antibiotics therapeutically, prophylactically, and to enhance feed conversion. Although the role of agricultural use in promoting the resistance of bacteria to antibiotics generally is difficult to define, the consensus in the scientific community is that the widest approach is to adopt a practice of “prudent use”. This consists essentially of implementing various management practices to minimize the use of antibiotics consumed for all purposes, and avoiding the veterinary use of drugs that are employed in human medicine. Some livestock systems (e.g. organic) characteristically use fewer pharmaceuticals.

Source control initiatives involve a variety of stakeholders from consumers to physicians to industry. Consequently, significant changes will require concerted action from all parties. Some initiatives like ecolabelling and education are synergistic: they can initiate the public discourse necessary to trigger voluntary product stewardship from the industry, and the demand for eco-labelled products will drive the supply. Many voluntary programs have been quite successful to date, however, back-up by legislation can achieve broader compliance.

Source separation is a specific form of source control, involving separating and treating concentrated PPCP waste streams before discharging into the wastewater collection system, where they will mix with and affect the quality of all wastewater. Options include:

  • On-site treatment – treating industrial, hospital and nursing home wastewaters before discharge will prevent waters with high concentrations of specific compounds from “contaminating” waters with much lower PPCP concentrations. More aggressively, local authorities can regulate the composition of wastewaters entering the sewers through sewer use by-laws. With respect to health care facilities specifically, the American not-for-profit organization Hospitals for a Healthy Environment has developed a blueprint for managing/minimizing pharmaceutical waste at health care facilities (Pines, 2006).
  • Disposal of unused pharmaceuticals – Complementing the take-back programs, developing predetermined pathways for disposal of unused pharmaceuticals to prevent disposal in sewers or dump sites represents another understudied area. Conveyance to incineration, however, may not be viewed as a sustainable option here, and more research on suitable pathways is needed.
  • Urine separation – Urine separation upon excretion is one of the most efficient domestic measures of source separation. Since a large proportion of ingested pharmaceuticals are excreted via urine, separation of this waste stream allows collection of a significant amount of the total pharmaceutical consumption at a concentration about 100 times higher than that in municipal wastewater (IWA, 2006). This remains an active research area.