Open Access

Peer-reviewed

Research Article

Main Article Content

Dror Avisarcorresponding author
Zach Klein
Gefen Ronen-Eliraz

Abstract

High drug consumption and polypharmacy, especially in the elderly, is one of the 21st century phenomenon. It has different undesirable side effects, which may directly affect the environment. It is known that pharmaceutical residues are excreted via patients’ urine or feces to wastewater, which is then discharged to the environment. Therefore high drug consumption is contributing to the continual rise in pharmaceutical residues in the aquatic environment, and address a rising cause for concern. Alternative treatments that can relieve or improve the patient’s clinical condition, thereby reducing the consumption of pharmaceuticals, hold great potential for reducing drug residues in the environment. The purpose of this research was to evaluate the reduction in pharmaceutical consumption in a nursing home for the elderly, as a result of treatment with medical cannabis. With time, medical cannabis treatment dramatically improved patients’ symptoms and their medical indexes. As a result, the local physicians stopped prescribing drugs that were defined as unnecessary. Overall, 39 dosages of prescription drugs were canceled for the 19 elderly individuals included in this research, indicating that medical cannabis can be an effective treatment that also reduces the environmental drug load, thereby preventing water pollution

Keywords
contamination, medical cannabis, pharmaceutical residue, water resource, pain, symptoms improvement, prescribing drug reduction

Article Details

How to Cite
Avisar, D., Klein, Z., & Ronen-Eliraz, G. (2020). Will medical cannabis treatment reduce pharmaceutical residues in the aquatic environment? A case study from an elderly nursing home. Advances in Health and Behavior, 3(1), 118-124. https://doi.org/10.25082/AHB.2020.01.003

References

  1. Carey ET, Hill C and Carolina N. Opioid Use, Misuse and Abuse: The Rise and Fall of a National Opioid Epidemic. Clin Obstet Gynecol, 2019, 62(1): 1-2. https://doi.org/10.1097/GRF.0000000000000426
  2. Zimmermann S, Gruber L, Schlummer M, et al. Determination of phthalic acid diesters in human milk at low ppb levels. Food Addit Contam Part A. 2012, 29(11): 1780-1790. https://doi.org/10.1080/19440049.2012.704529
  3. Komiya H, Umegaki H, Asai A, et al. Factors associated with polypharmacy in elderly home-care patients. Geriatrics & Gerontology International, 2018, 18(1): 33-41. https://doi.org/10.1111/ggi.13132
  4. WHO. The Role of Education in the Rational Use of Medicines. SEARO Technical Publication Series No. 045
  5. [Internet]. New Delhi, 2006. http://apps.who.int/medicinedocs/en/m/abstract/Js16792e
  6. Wieczorkiewicz SM, Kassamali Z and Danziger LH. Behind Closed Doors: Medication Storage and Disposal in the Home. Ann Pharmacother, 2013, 47(4):482-489. https://doi.org/10.1345/aph.1R706
  7. Jones CM, Mack KA and Paulozzi LJ. Pharmaceutical Overdose Deaths, United States, 2010. JAMA, 2013, 309(7): 657. https://doi.org/10.1001/jama.2013.272
  8. Bradley MC, Fahey T, Cahir C, et al. Potentially inappropriate prescribing and cost outcomes for older people: a cross-sectional study using the Northern Ireland Enhanced Prescribing Database. Eur J Clin Pharmacol, 2012, 68(10): 1425-1433. https://doi.org/10.1007/s00228-012-1249-y
  9. Halling-Srensen B, Nielsen SN, Lanzky PF, et al. Occurrence, fate and effects of pharmaceutical substances in the environment- A review. Chemosphere, 1998, 36(2): 357- 393. https://doi.org/10.1016/S0045-6535(97)00354-8
  10. Richardson ML and Bowron JM. The fate of pharmaceutical chemicals in the aquatic environment. Journal of Pharmacy & Pharmacology, 1985, 37(1): 1-12. https://doi.org/10.1111/j.2042-7158.1985.tb04922.x
  11. Aus der Beek T, Weber FA, Bergmann A, et al. Pharmaceuticals in the environment-Global occurrences and perspectives. Environ Toxicol Chem, 2016, 35(4): 823-835. https://doi.org/10.1002/etc.3339
  12. Avisar D, Lester Y and Ronen D. Sulfamethoxazole contamination of a deep phreatic aquifer. Science of The Total Environment, 2009, 407(14): 4278-4782. https://doi.org/10.1016/j.scitotenv.2009.03.032
  13. Madikizela LM, Ncube S and Chimuka L. Uptake of pharmaceuticals by plants grown under hydroponic conditions and natural occurring plant species: A review. Science of The Total Environment, 2018, 636: 477-486. https://doi.org/10.1016/j.scitotenv.2018.04.297
  14. Rowney NC, Johnson AC and Williams RJ. Erratum: Cytotoxic drugs in drinking water: a prediction and risk assessment exercise for the Thames catchment in the United Kingdom. Environmental toxicology & chemistry, 2011, 30(7): 1729-1729. https://doi.org/10.1897/09-067.1
  15. K¨ummerer K. Pharmaceuticals in the Environment. Annual Review Environment Resource. 2010, 35(1): 57-75. https://doi.org/10.1146/annurev-environ-052809-161223
  16. Coetsier CM, Spinelli S, Lin L, et al. Discharge of pharmaceutical products (PPs) through a conventional biological sewage treatment plant: MECs vs PECs? Environment International, 2009, 35(5): 787-792. https://doi.org/10.1016/j.envint.2009.01.008
  17. Kostich MS, Batt AL and Lazorchak JM. Concentrations of prioritized pharmaceuticals in effluents from 50 large wastewater treatment plants in the US and implications for risk estimation. Environment Pollution, 2014, 184(1): 354- 359. https://doi.org/10.1016/j.envpol.2013.09.013
  18. Lester Y, Avisar D and Mamane H. Ozone Degradation of Cyclophosphamide Effect of Alkalinity and Key Effluent Organic Matter Constituents. Ozone: Science & Engineering, 2013, 35(2): 125-133. https://doi.org/10.1080/01919512.2013.761107
  19. Shafrir M, Avisar D. Development Method for Extracting and Analyzing Antibiotic and Hormone Residues from Treated Wastewater Sludge and Composted Biosolids. Water Air & Soil Pollution, 2012, 223(5): 2572-2587. https://doi.org/10.1007/s11270-011-1049-5
  20. Boehnke KF, Scott JR, Litinas E, et al. Pills to pot: observational analyses of cannabis substitution among medical cannabis users with chronic pain. Journal of Pain, 2019, 20(7): 830-841. https://doi.org/10.1016/j.jpain.2019.01.010
  21. Kruger DJ and Kruger JS. Medical Cannabis Users’ Comparisons between Medical Cannabis and Mainstream Medicine. Journal of Psychoactive Drugs, 2019, 51(1): 31- 36. https://doi.org/10.1080/02791072.2018.1563314
  22. Haroutounian S, Ratz Y, Ginosar Y, et al. The Effect of Medicinal Cannabis on Pain and Quality-of-Life Outcomes in Chronic Pain: A Prospective Open-label Study. Clinical Journal of Pain, 2016, 32(12): 1036-1043. https://doi.org/10.1097/AJP.0000000000000364
  23. Lucas P and Walsh Z. Medical cannabis access, use, and substitution for prescription opioids and other substances: A survey of authorized medical cannabis patients. International Journal of Drug Policy, 2017, 42: 30-35. https://doi.org/10.1016/j.drugpo.2017.01.011
  24. Abuhasira R, Schleider BL, Mechoulam R, et al. Epidemiological characteristics, safety and efficacy of medical cannabis in the elderly. European Journal of Internal Medicine, 2018, 49: 44-50. https://doi.org/10.1016/j.ejim.2018.01.019
  25. Boehnke KF, Litinas E and Clauw DJ. Medical Cannabis Use Is Associated with Decreased Opiate Medication Use in a Retrospective Cross-Sectional Survey of Patients with Chronic Pain. Journal of Pain, 2016, 17(6): 739- 744. https://doi.org/10.1016/j.jpain.2016.03.002
  26. Romero-Sandoval EA, Fincham JE, Kolano AL, et al. Cannabis for Chronic Pain: Challenges and Considerations. Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy, 2018, 38(6): 651-662. https://doi.org/10.1002/phar.2115
  27. Campbell G, HallWand Nielsen S. What does the ecological and epidemiological evidence indicate about the potential for cannabinoids to reduce opioid use and harms? A comprehensive review. International Review of Psychiatry, 2018, 30(5): 91-106. https://doi.org/10.1080/09540261.2018.1509842
  28. Vyas MB, Lebaron VT and Gilson A. The Use of Cannabis in Response to the Opioid Crisis: A Review of the Literature. Nursing Outlook, 2018, 66(1): 56-65. https://doi.org/10.1016/j.outlook.2017.08.012
  29. Briscoe J and Casarett D. Medical Marijuana Use in Older Adults. Journal of the American Geriatrics Society, 2018, 66(5): 859-863. https://doi.org/10.1111/jgs.15346
  30. Kojima T, Akishita M, Kameyama Y, et al. High risk of adverse drug reactions in elderly patients taking six or more drugs: Analysis of inpatient database. geriatrics & gerontology international, 2012, 12(4): 761-762. https://doi.org/10.1111/j.1447-0594.2012.00868.x
  31. Kaskie B, Ayyagari P, Milavetz G, et al. The Increasing Use of Cannabis Among Older Americans: A Public Health Crisis or Viable Policy Alternative? Gerontologist, 2017, 57(6): 1166-1172. https://doi.org/10.1093/geront/gnw166
  32. Mahvan T, Hilaire M, Mann A, et al. Marijuana Use in the Elderly: Implications and Considerations. Consult Pharm , 2017, 32(6): 341-351. https://doi.org/10.4140/TCP.n.2017.341
  33. Haroutounian S, Ratz Y, Ginosar Y, et al. The Effect of Medicinal Cannabis on Pain and Quality of Life Outcomes in Chronic Pain: A Prospective Open-label Study. The Clinical journal of pain, 2016, 32(12): 1036-1043. https://doi.org/10.1097/AJP.0000000000000364
  34. Reiman A, Welty M and Solomon P. Cannabis as a Substitute for Opioid-Based Pain Medication: Patient Self-Report. Cannabis & Cannabinoid Research, 2017, 2(1): 160-166. https://doi.org/10.1089/can.2017.0012
  35. Vigil JM, Stith SS, Adams IM, et al. Associations between medical cannabis and prescription opioid use in chronic pain patients: A preliminary cohort study. PLoS One, 2017, 12(11): e0187795. https://doi.org/10.1371/journal.pone.0187795
  36. Nielsen S, Sabioni P, Trigo JM, et al. Opioid-Sparing Effect of Cannabinoids: A Systematic Review and Meta-Analysis. Neuropsychopharmacology, 2017, 42: 1752-1765. https://doi.org/10.1038/npp.2017.51