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By M. Petrovic, et al.,

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Drug donations have long proved problematic to humanitarian efforts because of the sometimes-massive quantities of inappropriate or outdated medications, or simply because of large surpluses that cannot be used before expiration. Thousands of tons of drugs are sometimes received and necessitate storage and eventual disposal; this is discussed further in the second section of this chapter. A second example, but one that could only have a possible effect on local groundwater, relates to the burial of bodies in cemeteries.

Even properly engineered landfills can serve as delayed sources of drug residues, especially if leachates seep into the ground or are actively pumped out for disposal at water treatment facilities. Landfills and PPCPs have been discussed by Bound and Vouvoulis [70]. Disposal to sewerage occurs not just in domestic residences but also in certain healthcare facilities such as those used for long-term care. The driving forces behind the necessity of disposal include the expiration of medication, cessation of therapeutic need, and patients’ ‘‘non-adherence’’ (non-compliance) such as discontinuation of medication because of adverse effects, failure to treat, or lack of motivation to continue therapy.

Removal of PPCPs is essentially a collateral or incidental function of a sewage treatment plant, as these facilities were never specifically designed to remove exotic, bioactive xenobiotics. Two principal effluents result from sewage treatment—one consisting of the liquid effluent and the other sludge. While the liquid effluent is usually discharged to surface waters, it is sometimes used for irrigation; PPCPs are known to occur in the reclaimed water and to accumulate in and migrate through irrigated soils at concentrations in the nanogram-per-gram range [80].

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Analysis, Fate and Removal of Pharmaceuticals in the Water Cycle [Comp Anal Chem Vol 50] by M. Petrovic, et al.,


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