Wednesday, July 15, 2015
Eco-directed sustainable prescribing is comprised of 2 concepts:
1. Reducing the dose or usage of certain medications
2. Prescribing drugs based on the amount of drug eliminated from the body
This is the approach Dr. Christian Daughton proposed in his paper on reducing the amount of medicinal waste excreted into the environment.
Over the last decade the primary approach to reducing drugs in the environment has been to decrease the amount of medication in our water supply once it has already entered the ecosystem. The main way this has been accomplished is through efforts of improving water treatment plants and having drug collection sites or events. Daughton argues these current practices are still needed, but are not sustainable solutions.
In theory, the eco-directed sustainable prescribing is a valid approach since the primary source of medication entering the water supply is through human excretion. The goal behind this idea would be to provide prescribers and patients with an excretion profile for each drug to determine its level of entry into the environment. With this profile they could then determine the best treatment option while also considering the environmental impact. By considering the excretion level of a drug, this could limit the amount of drug eliminated into the water supply by preferentially prescribing drugs that are extensively metabolized.
Unfortunately, there are many uncontrollable factors affecting the amount of drug excretion from person to person. This somewhat limits the feasibility of the eco-directed sustainability approach. However, it is a good start to understanding alternative options to address the issue of medicinal waste.
If you would like to read the entire article it is available at: http://www.sciencedirect.com/science/article/pii/S0048969714008560
Image courtesy of U.S. EPA.