1. A program of 191 Howard Street Boone, NC 28607 828-262-1500 www.appalachianvoices.org www.iLoveMountains.org

2. Drugs and their impact on: Rivers Kids Law Enforcement Agencies

3.  Includes prescription and over-the-counter (OTC) medications, cleaning agents, cosmetics, nutritional supplements, & skin care products  Produced and used in larger volumes yearly  Released via small quantity generators  Biologically active Pharmaceuticals and Personal Care Products (PPCPs)

4. Source: U.S. Center for Disease Control and Prevention. National Center for Health Statistics. National Health and Nutrition Examination Survey.

5. In some cases, medicines are not entirely consumed due to: Change in prescription Patient’s health improves Patient death Patient doesn’t want to take the medicine Bulk “economy size” containers of over-the-counter medicines contain more than is used before expiration date Disposal of Unwanted Medicines

6. Expired Medication Disposal Habits Boehringer, S. “What’s the Best Way to Dispose of Medications?” (2004) 500 patients surveyed: 54% disposed of medications in the trash 35.4% flushed drugs down the toilet or sink 7.2% did not dispose of medications 2% used all medication prior to expiration 1.4% returned medications to the pharmacy

7. More than half the 301 patients surveyed at a military base pharmacy in 2006 said they had flushed medications down a toilet; fewer than 20% said they had ever been given advice about proper disposal by a health care provider. Improper Disposal Practices

8.  Environmental impact - Accumulation in waterways  potentially harmful effects on wildlife  Accidental ingestion (children & elderly) - 78,000 children under 5 treated for unintentional medication poisoning each year in the U.S.  Illegal use or theft - Appropriation of pharmaceuticals by family and friends, workers in homes, and burglars Main Risks of Improper Disposal Practices

9. U.S. Geological Survey monitoring study 139 streams analyzed in 30 states Contaminants identified in 80% of these streams 82 contaminants identified (many were pharmaceuticals) Co-occurrence common; average 7 distinct contaminants identified per stream Medicines in the Environment Kolpin, D.W. et al. 2002. “Pharmaceuticals, hormones, & other organic wastewater contaminants in U.S. streams, 1999-2000: A national reconnaissance.” Environmental Science & Technology. 36(6):1202-1211.

10. Medicines in the Environment USGS/CDCP study of drinking water facility  Analyzed for 106 contaminants in 24 water samples from locations within a drinking-water- treatment facility and the 2 streams serving the facility  40 contaminants detected in 1 or more samples of stream water or raw-water supplies in the plant  34 contaminants detected in >10% of these samples  Some prescription and non-prescription drugs and their metabolites were detected in finished water Stackleberg, P.E. et al. 2004. “Persistence of pharmaceutical compounds and other organic wastewater contaminants in a conventional drinking-water-treatment plant.” Science of the Total Environment. 329:99-113.

11.  Aquatic exposure – chemicals in the aquatic environment can result in continuous, multigeneration exposure.  Feminization of fish - link to estrogen exposure? Ex: Boulder Creek, CO: female white suckers outnumber males by > 5 to 1; 50% of males have female sex tissue (David Norris, Univ. of Colorado at Boulder)  Effects of antidepressants on fish and frog development? Ex: Lab studies show low levels of common anti-depressants, including Prozac, Zoloft, Paxil and Celexa, cause development problems in fish, and metamorphosis delays in frogs (Marsha Black, Univ. of Georgia) Effects on Aquatic Organisms: Cause for Concern

12. Source: www.york.ac.uk/.../ gsp/esm/images/pharma1.jpg Entry Pathways of Medicines into the Environment  Outflow from wastewater treatment plants  Surface application of manure and biosolids  Commercial animal feeding operations and aquaculture  Landfill leachate sent to wastewater treatment plants  Septic tanks

13. Prescription Drug Abuse  A study in Florida found that deaths caused by prescription drugs were three times the number caused by illegal drugs in that state. Among young people ages 12-17, prescription drugs have become the second most abused illegal drug, behind marijuana. In the past year 9.3% of 12 th graders used vicodin and 5% used OxyCotin (without a prescription)

14. Extent of Prescription Drug Abuse 48 million Americans have used prescription drugs recreationally 6.4 million Americans are abusing prescription drugs – more than the number of Americans abusing cocaine, heroin, hallucinogens, and inhalants combined In 2008 Wilkes County had the 3 rd highest overdose rate in the nation

15. Where are Teens Getting Prescription Drugs?

16. What Can Be Done?  Education and awareness  Pharmacies, Public Utilities, Health Providers and Law Enforcement  Collections  One day drop-off events  Long-term take-back program

18. Initial Partners 2009 Watauga Riverkeeper/Appalachian Voices, Co-operative Extension, Watauga County Solid Waste, NCNR, WRCP, Boone Drug, Mountainkeepers & more: – Project Coordination – Volunteer Support – Graphic Design, web site – Media Outreach Watauga County Sheriff’s Dept. Lead Law Enforcement with support from Boone, Blowing Rock and Seven Devils Police Departments and the SBI – Law Enforcement Personnel – Transport to Incinerator and Disposal Watauga County, Cities of Boone, Blowing Rock and Seven Devils – Publicity (signage) – Funding – Resolutions of Support

19. A huge success in 2009

20. 40,000 pills, 12 gallons of liquid medication, 2000 sharps‐needles, syringes and lancets, and a glucose meter.

21. Drugs collected included: Hydrocodone, oxycodone, blood thinners, anti-allergens, iodine, insulin, antibiotics, steroids, hormones, anti- depressants, cough syrup, topical creams, over the counter medications, flu vaccinations, heart, blood pressure, cancer and heartburn medicine and even some pet medications.

22. Potential Partners May 22, 2010 Avery County Sheriff’s Department Civic Organizations Safe Kids Drug Awareness Programs High Schools Local Churches Watauga Medical Center Medical Community Assisted Living Center Retirement Centers

23. Ways to get involved with the Watauga Riverkeeper program: 1. Report pollution by calling our toll-free pollution hotline 1-877-277-8642 2.Become a member of Appalachian Voices 3.Volunteer for Big Sweep, Operation Medicine Cabinet or Muddy Water Watch 4.Read and share our Appalachian Voices newsletter with others.

24. Thanks to all Appalachian Voices members of the Watauga Riverkeeper Program and the Helen M. Clabough Charitable Foundation for their ongoing commitment and financial support. They make presentations like this possible!

25. Questions?