Disposing of old drugs

by S&M

What do people do with old meds otherwise? Do they worry about effects of meds in their water?

National Prescription Drug Take-Back Day

Pharmaceuticals in the environment: a growing problem


115 thoughts on “Disposing of old drugs

  1. We had a drug take back sometime earlier this year – between April and now – I know because I took what I then thought was ALL my parents drugs. However, I came across more in the more detailed cleaning out of their apartment. I noticed *some* Walgreens in *some* cities have a take back kiosk on a permanent basis. At least one is in my city, but not near me.

    My parents’ doctors were generally good about working with them to use up their “old” supplies when dosages changed. My mom took some of my dads when she got put on that drug after he passed. We also would take 2 or 1/2 of the pills before ordering the new dosage. But that doesn’t help when they change the drug completely.

  2. I take back stuff that is really, really old and I hold on to narcotics just in case because they are so hard to get anymore.

  3. The second article is from a pharmaceutical publication, not a tree-huggers’ group.

    In the year since Flint’s lead problem was discovered, there have been many other pollutants found in water across the country. Water safety is on people’s minds around Tampa Bay because Red Tide, dumping of raw sewage during storms, and high levels of E Coli have closed several area beaches.

  4. The claim in the pharmaceutical publication that metformin levels were 1 mg/L in Lake Michigan set off my alarm bells, so I google searched.

    The highest level listed here for metformin is 840 parts per trillion, which sounds a lot more realistic.

    I think pharmaceutical residuals in bodies of water is likely a problem, but I don’t like inaccurate information about chemicals.

    I think y’all know that I divide chemicals into “probably doesn’t affect humans/animals” and “probably does affect humans/animals” and pharmaceuticals DO affect humans/animals. I worry less about herbicide/pesticide residue because those chemicals affect PLANTS and plants have entirely different metabolic systems (they breathe in CO2 and breathe out O2 and photosynthesize their food) than animals.

  5. I have a very basic question. If the concern is drugs in water bodies. How does throwing old prescriptions in the garbage, which presumably go to landfills affect the problem? Is there a reason why just throwing old drugs away is a problem?

  6. I worry less about herbicide/pesticide residue because those chemicals affect PLANTS.

    The google says the term pesticide includes insecticides.

  7. I usually don’t get rid of much of anything. If I do, it’s in the trash, where it goes to a fully-lined and enclosed landfill. But I also don’t have the kinds of drugs people root through the trash for — as Moxie says, if I have any kind of highly controlled drug, I hang onto it forever in case I need it. Of course, even those drugs are pretty innocuous — I’m talking about tylenol with codeine (best thing in the world for when you have had a cough for so long it’s become like a tic you can’t get rid of, which is also a really stupid thing to go to the doctor for). I guess we do have a few Oxy left from DD’s surgery; they can go right next to the 10-yr-old percocet.

    I do think the water supply issue is a thing, because our wastewater treatment plants are simply not designed to remove/treat those kinds of issues. And any pharma company worth its salt should be on top of this because they don’t want giant toxic tort suits in 10 years.

    “I worry less about herbicide/pesticide residue because those chemicals affect PLANTS” — don’t pesticides, by definition, affect bugs? I thought some of the issue/concerns were with longer-term food-chain effects, given that those bugs are major food sources for other animals. I could also see the same issue with herbicides (if there is residue that gets eaten by bugs, which then accumulates in the animals that eat the bugs, etc.). But I don’t know enough about the specific chemicals involved or current research to say how significant those concerns are – I can see how it *could* happen but can’t assess the risk that it *will*.

  8. I worry less about herbicide/pesticide residue because those chemicals affect PLANTS.

    Some herbicides are REALLY toxic to humans. Paraquat leaps to mind.

    One of the reasons I am so pro GMO is that we can use herbicides that are signficantly to humans than we can with conventional crops.

  9. I popped in on here the other day, but just wanted to say I miss you guys.

    Work is insane right now so I haven’t had time to even lurk.

    I’ll try to catch up sometime at home to chat!

  10. I probably should have just said herbicide residue-I was explaining in part why I don’t worry about chemical residue on my food and buy organic. But I still think hormones are the biggest chemical type to worry about (what many pharmaceuticals are) because they affect humans/animals at very low concentrations. I don’t know much about how insecticides work.

  11. WCE, we can always count on you for accurate chemical measurements and formulae! But whether things affect plants rather than animals doesn’t seem to me like such a huge distinction, for example in the huge problems caused by too much nitrogen in the recent releases of water from Lake Okeechobee. Nitrogen is a fertilizer, so when the water carries high levels of it, algae grows like crazy, shading whatever is supposed to grow in deeper water below it, and sucking up carbon dioxide from the water. That affects fish and other animals. I give that example because I don’t know the specifics of the chemicals you mention, but we generally need to be on the lookout for contingent relations and chain reactions.

  12. We don’t really have a lot of medicines other than children’s motrin/tylenol but I have thrown old prescriptions in the trash (really occasionally because we don’t take anything regularly). I do worry about antibiotics and hormones in the water – it is really easy for hormones to become imbalanced which seems to have a pretty bad effect on human health. On the other hand, I also worry about fluoride and chlorine in the water, which municipalities put in the water themselves.

  13. Atlanta, I’d worry about fluoride in the water more if I knew my kid brushed his teeth half as often as he claims! I used to be opposed to it, but now I accept the trade off.

    Landfills are supposed to have liners, but they have to let some water through, and dissolved meds go along with it. Fully impermeable liners would turn landfills into lakes when it rains or when contents rot.

    I hang onto narcotics too, partially because they are hard to get but mostly because if they are needed in our household, either I’m in serious pain & going to the pharmacy is hard or my kid hurts badly & I don’t want to leave him.

    Laura, that cough is the kind of thing we use CVS’s minute clinic for.

  14. I took a whole ton of drugs to the MGH dropoff (in the lobby, v convenient if you are going there anyway) before we moved in the spring. I had a giant bag of needles for my anti-coagulants (only used during pregnancy) and a bunch of expired percocet etc. that I never took. DH is hoarding some narcotics from his dental surgery a few years ago, but given how reluctant he is to take tylenol I expect that we will end up taking those to a dropoff at some point too.

  15. Rhett, there is no way not to release water. The first paragraph at your link mentions ways of doing that–into sewer systems, surface water, or ground water. Sewer systems don’t treat for most of these things, and ground and surface water are by definition untreated. Landfills cannot be impermeable; chemicals thrown into the trash will not remain in the landfill.

  16. The strongest prescription we have is Tylenol, besides the antibiotics. I do worry about the chemicals leaching into our environment.
    I have had root canals and surgeries and I have not been prescribed anything stronger than Vicodin which does not work for me. I have to fall back on high strength Tylenol. I wonder how people manage to get prescription for narcotics.

  17. S&M – it’s hard to know what to believe about fluoride. I didn’t live in a place with fluoridated water until I was 22 and have never had a cavity. On the other hand, my sister eliminated fluoridated water when she was pregnant and got a few cavities. Some suggest that studies really haven’t proven that fluoridated water helps to prevent dental decay and the thought of where the fluoride comes from just grosses me out. I took my son to the dentist yesterday and there was a sign on the sink that said “Please save the sink and do not pour fluoride down me,” yet we’re ingesting this stuff every day and absorbing it through our skin.

  18. I have had root canals and surgeries and I have not been prescribed anything stronger than Vicodin which does not work for me. I have to fall back on high strength Tylenol. I wonder how people manage to get prescription for narcotics.

    Vicodin is a narcotic – it’s hydrocodone and tylenol.

  19. “Landfills are supposed to have liners, but they have to let some water through, and dissolved meds go along with it. Fully impermeable liners would turn landfills into lakes when it rains or when contents rot.”

    From what I know (there was a great City Paper issue on landfills and (alleged) City mismanagement several years ago):

    First, landfills are supposed to have largely impermeable caps on the closed areas — the rain is supposed to run off and get managed elsewhere before it contacts any of the stuff in the landfill. So rain is (again, theoretically) only an issue for the parts of the landfill that are currently open/in use.

    Second, they are not supposed to be installing new landfills in areas with high groundwater or near sensitive environmental areas (MD has a Critical Areas program, for ex., with significant restrictions). YMMV, of course.

    Third, landfills need a leachate collection system that is supposed to collect that leachate from the bottom and pump it up for treatment. I assume these treatment systems share the failings of our wastewater treatment plants, in that they are not designed to remove these chemicals. Maybe that’s the next area of regulation. But at a minimum, this is no worse than flushing the drugs.

    Fourth, landfill leachate develops over decades as stuff rots and decays, etc. So I suspect the impact from degrading drugs tossed in the trash would be spread out over little bits at a time, vs. the immediate impact from flushing a whole container of Oxy.

    It’s not 100%, of course. But it strikes me that the contribution from properly-managed modern landfills should be orders of magnitude lower than you’d get from flushing the same drugs.

    And I think the elephant in the room isn’t how we manage expired drugs – it’s the vast quantity of drugs that we take and that pass through our systems. What percentage of the US population do you think takes some drugs/medicine at some point in an average year — 95%? 99%? And how many of those meds aren’t fully metabolized, or are metabolized but then turn into other components that are passed through? I suspect if you actually had data, much of the measured levels of medication-related components come from medications that are properly prescribed and used per the package direction.

  20. Some suggest that studies really haven’t proven that fluoridated water helps to prevent dental decay

    Are these the same people that think vaccines cause autism?

    and the thought of where the fluoride comes from just grosses me out.

    Where do you think is comes from?

  21. Winemama, thanks for checking in! I lost track of whether you had found a new home or are still living with the inlaws. Hope work settles down soon.

    On the topic, I’m afraid that we simply discard unneeded or expired medications in the trash. They are all in at least two layers of plastic in addition to their plastic containers. When I consider all of the other things that end up in the trash that are not supposed to end up in the trash — such as old paint and toxic chemicals, light bulbs, electronics and batteries, and whatever else has been put on that list — it’s hard to be too concerned about the medications. We are on well and septic, so I wouldn’t flush them down the toilet.

    I also bought a case of Cascade with Phosphates Professional Fryer Boil Out when Amazon recently made it available. It used to be labeled as a Professional Dishwasher Detergent and then disappeared for a few years, but it’s back now. Dishwasher detergent without phosphates does not work well in extremely hard water, even with a water softener.

    But I do have four large compost bins.

  22. “I wonder how people manage to get prescription for narcotics.”

    Have surgery. I got them without any problem, although some providers were reluctant to authorize refills.

  23. “‘Some suggest that studies really haven’t proven that fluoridated water helps to prevent dental decay’

    Are these the same people that think vaccines cause autism?”

    +1. I don’t actually think there is any scientific question about the effectiveness of fluoridated water in preventing tooth decay. The question, as always, is the proper dosage to maximize effectiveness while minimizing side-effects.

    It’s sort of like chlorine (another thing I’ve been reading about in tap water). You definitely, absolutely want your wastewater treatment plant to be using chlorine to kill nasty deadly bacteria in their systems. You even want to err a little on the high side (have a little leftover) to make sure you got all of the giardia and e coli and such. But you don’t want too much left over, because that’s not necessarily good either.

    I refuse to get worked up over fluoride and chlorine, because the problems they may cause are *so* much better than the ones they prevent (something that I, as a pre-fluoridation baby with tons of cavities, got the privilege of living first-hand). You can’t have it all; there is no “perfect” safety that comes with no tradeoffs.

  24. I’ve read a few times about a study (studies?) that showed that most drugs maintain a large %age of their efficacy well after their ‘expiration’ dates. So I tend to take the Mooshi approach and just accumulate, although I couple that with trying to use up what we have. E.g., if I need some ibuprofen, I’ll take one from one of the bottles we have, even if it’s years past the date on the bottle.

    ” it’s the vast quantity of drugs that we take and that pass through our systems”

    I agree. This is one reason I work with my MD to minimize the amount of maintenance meds I take. E.g., with one of them, for a while I was getting the smallest dose pills available, and splitting them, and I currently take that smallest dose 4x/week. With another I recently started, I’m taking the lowest dose, and I think we may experiment with splitting pills and taking half a pill 2x/day before we go to increasing dosage in the hope of metabolizing more of the drug.

  25. Some suggest that studies really haven’t proven that fluoridated water helps to prevent dental decay

    That’s not what your link says. It says that the advent of fluoridated toothpaste has rendered the need to fluoridated water redundant.

  26. Rhett – right, so topically it does seem to prevent tooth decay but ingesting it in water has not been proven effective and seems to have a whole host of side effects, including fluorsis. Tooth decay has gone down in Europe too, where they do not fluoridate their water.

  27. Regarding the question of nitrogen bloom, here are the questions I think about regarding chemicals.
    1) Does the chemical primarily affect plants, non-mammals, and/or mammals? (Because of how insects reproduce compared to mammals, insecticides probably require separate study from pesticides that affect, say, mice and rats.)
    2) At what dose does an effect appear to occur?
    3) What is the background dose? How does it vary around the world? (This especially applies to heavy metals. People in Asia routinely have mercury levels higher than what one US government agency deemed “safe” with no apparent ill effects.)
    4) What is the half-life of the chemical? Does the half-life depend on whether the chemical is in land or water and on temperature? What are the by-products of the chemical? What about chemicals that never break down?
    5) How much does it cost to reduce the level of the chemical during waste treatment? (For example, can we choose a bacteria mix in our sewage treatment plant that “eats” hormones, which are chemically also proteins? How long does waste need to be resident in a treatment plant or lagoon for the bacteria to “eat” the hormones? Would it be OK to use genetically modified bacteria to “eat” hormonal contraception residue? I expect this is an area of research in biochemical/civil engineering.)
    6) What is the cost of providing a given margin of safety? We shouldn’t require removing a chemical to well below its background level, in most cases.
    7) The cost-risk-benefit analysis in 6) ties into, “What is the global cost of reducing this chemical to the level we deem safe in the United States? If we make it too expensive for Dow and DuPont to make drugs and batteries here, companies in China and India will make drugs and batteries with even less concern for the environment. Note that the place in the world with “therapeutic” levels of drugs in the wastewater was Hyderabad, India.

  28. and the thought of where the fluoride comes from just grosses me out.

    Fluoride is the byproduct of the extraction of phosphorous from the mineral apatite.

    In the old days the largest source of phosphorous was guano. Did someone get their wires crossed and tell you that fluoride comes from guano?

  29. “” it’s the vast quantity of drugs that we take and that pass through our systems””

    Oh goodness… emerging contaminants (antibacterial agents, drugs, etc.) are really coming on to the scene. In a good and bad way. The harm to the environment is just starting to be explored. But the more we find out the more we realize how bad these things are. In a lot of ways, Silent Spring was just the beginning…

    The remains of drugs that pass through your system, or the antibacterial agents washed down the drain with your soapy water cannot be removed by wastewater treatment facilities. We lack the technology. We’re getting there though (i was just visiting our local plant this morning to talk with them about this very issue).

    The good news is the FDA just called for the ban of 19 antibacterial contaminants – including triclosan. Let’s hope that cutting off the source will be enough.

    Scarlett – thinking about your phosphate dishwasher detergent… are you on sewer, septic, or cesspool?

    S&M – I read about Tampa’s issue with Hermine. I have so many suggestions that won’t work because your water table is too high. But, I do feel for you. My region was there ~10 years ago. A push by the state to remove nitrogen from wastewater and then work to build tunnels to contain stormwater overflow has been a huge success. The state is even looking into opening a beach on the shores of Providence because the bacterial contamination has been so low. Still have ways to go, but progress nonetheless.

  30. Scarlett,’why would paint, etc be in your trash, although you know it’s a problem?

  31. LfB, I don’t get the fluoride: cavities relationship. My dad’s dentist, when he was growing up, thought fluoride was a fad. Dad has a mouthful of metal. Mom used fluoridated toothpaste growing up (they both use it as adults) and has a ton of fillings too. My sisters and I grew up on well water with neither fluoride nor chlorine; one of us got a cavity as a kid, my other sister got one years after moving out, and I’ve never had one. Extremely small sample size, I know. It doesn’t look like fluoride helps (but I’m still counting on it for my kid’s teeth)

  32. Rhett – right, it’s an industrial byproduct of the aluminum and fertilizer industries. To each their own – I’d rather not drink it and will just use a fluoride toothpaste.

  33. Rhett – right, so topically it does seem to prevent tooth decay but ingesting it in water has not been proven effective

    The chart posted in your link clearly shows significantly lower levels of tooth decay in countries with fluoridated water. That indicates it does work. However, the impact has been overwhelmed by the advent of fluoridated toothpaste.

    The author of that article wants to say that fluoridated water doesn’t work. But, the data doesn’t show that. What it shows is that it works but fluoridated toothpaste works better.

  34. “We shouldn’t require removing a chemical to well below its background level, in most case” but there are some places where the water naturally contains things harmful to humans, just as there are some places where groundwater contains minerals beneficial to humans.

  35. Yay! Rhode is chiming in :)
    Coastal water issues here get attention in as much as they threaten tourism. Other than that, I don’t think the state has as much political will to do anything as RI does. Tampa did just recently vote to improve its storm water handling. The biggest sewage problem seems to be in St Pete right now, but given the way the population is growing, I can’t believe there wouldn’t be more problems all along the coast.

  36. @SM: The vast weight of the evidence is that fluoride helps prevent cavities — it’s not a cure-all, but it helps significantly. What we are arguing about now is the delivery vehicle: as Rhett said, Atl’s article suggests that fluoridated water is no longer necessary, because fluoridated toothpaste is now so prevalent and provides a more-effective way to get fluoride to the teeth with fewer side-effects (I grew up before both).

    IIRC, the original argument for fluoridated water was to make sure poor people without access to fluoridated toothpaste and dental care would receive the benefits of fluoride. That was obviously a much bigger issue 50 years ago, before grocery stores contained entire shelves of fluoridated toothpastes and dental rinses for $3/tube.

  37. Laura, yes, I know, but lik at how my family of origin simply does not bear that out. None of us had fluoridated water. It’s just weird. And like I said, I still am glad my kid has fluoride in his water, and I try to get him to use it topically as well.

  38. @SM — as in most things, I think genetics have a lot to do with it. For ex., we clearly have some weak enamel that runs in my family. DD is totally fine, but DS seems to have inherited my teeth. Comparatively speaking, he is in a much better place — he has only had one or two small cavities, and they have been in baby teeth and have not required filling (since the teeth will fall out before the decay threatens the root or the other teeth). This is with decent dental care and fluoride everywhere. By comparison, though, by his age I had probably 8-10 cavities in my baby teeth that required filling, starting at about the age of 5. So if I had to extrapolate from my anecdata, I would say that fluoride may help plug some genetic gaps, e.g., help harden/thicken enamel in those who may be genetically susceptible to weakness there — not enough to prevent all of the cavities, but enough to reduce the number quite notably. But by that same token, it may not have as much effect on people without that genetic predisposition who already have strong enamel — and it also probably can’t override the effects of poor dental hygiene, etc.

    This is also why anecdotes are not data and epidemiology is both essential and scarily inexact.

    Interestingly, DS’s dentist is a partial believer in the link between weak enamel and celiac — he pointed me to some articles that suggest a genetic link between the two (and possibly some other autoimmune issues as well). He was clear that the concept doesn’t yet have solid scientific support, but he thought they were interesting.

  39. S&M – political will is hard to come by, even in RI (locally, federal is a different story). It took a massive fish kill for the legislation to go through – tourism got it done. But, Tampa’s Estuary Program, with partners, industry, and politicians got the region to want seagrass back in the bay. That initiative worked, and there are more acres of seagrass now than in 1950 (which was their benchmark year). Yes that’s still coastal, and inland waters need help too.

    I think the trouble with your region is sea level – your infrastructure will be swimming if predictions are correct. Upgrades to help that are expensive. Tax and rate payers can’t afford the extra burden.

  40. Our town has a receptacle in the public safety building for pills and sharps – does not take liquid meds. It is probably not a good idea to keep random bottles of unneeded pills in a home with the easily confused elderly or teenagers. We do have a very small quantity of leftover post surgical pain stuff, but certainly will throw it out or lock it up when the grandkids get to age 12. We also hang onto the cipro (me) and cephalexin (DH) that we get in the exotic trip prevention package, just in case of disaster.

  41. Rhode, ‘saac did a program a couple summers ago with an organization that talks a lot about restoration of the Bay, Tampa Bay Watch. (No red swimsuits involved). Correct me if I’m wrong, but I think the raw sewage dumping and the extra nitrogen are problems that have developed more recently. Of course there have sugar plantations all along, but maybe they didn’t have so much fertilizer?

  42. Headline in yesterday’s local paper was about how dental health here is, overall, much lower than the rest of the country. We are also one of the few (only?) states without fluoridated water (exception being military bases).

    What’s the mechanism by which fluoride improves dental health? I’m guessing that Fl forms bonds with Ca instead of Cl, and Fl being more reactive than Cl results in stronger bonds that are better able to resist things like the acid in soda and juice. But how does the Fl get incorporated into the enamel? Is there any evidence or theory to suggest that ingested Fl, vs topical Fl, improves dental health?

    I’m also curious as to whether the popularity of bottled water is having a negative impact on dental health, especially in areas with fluoridated water supplies.

  43. Thinking back, when the kids were young, their pediatrician had them take vitamins that included fluoride, but stopped; I don’t remember the exact point at which they stopped, but it was well after they’d lost all or most of their baby teeth.

    This suggested to me that there is at least a theory that ingested Fl gets incorporated into teeth while the teeth are developing.

  44. Finn, I remember seeing my kids teeth in their heads during their numerous, extended ultrasounds when I was pregnant. I wonder if the mother’s diet affects the development of the tooth and subsequent vulnerability to decay. There is some evidence that enamel changes/replenishes itself over time, too, so it’s not all based on the mother’s diet during pregnancy.

  45. Am I the only one who marched with the rest of my elementary school down to the multi-purpose room, had fluoride painted on my teeth, held my breath while the Dentist-in-Charge counted down, and then rinsed and spat? One or two kids barfed, but that was partly because the Dentist-in-Charge warned us that some kids would barf. Or was this just a California commie-pinko practice?

  46. The Weston A. Price Foundation is based on the ideas of Weston A. Price who thought that good physical health and good dental health (healthy teeth and teeth that do not require braces) went hand in hand. It makes sense to me that a mother’s diet would impact both physical and dental health.

    I have very strong teeth with no cavities and my husband had quite a few cavities as a kid. DH and I both needed braces and so far DD1 has also needed them. I did eat better with the younger two so it will be interesting to see what happens with their teeth.

  47. RMS, I have never heard of such a thing. Maybe it was a Bay area commie-pinko practice

  48. RMS – right there with you! But maybe that doesn’t count since we lived only ~50 miles apart.

  49. Cordelia – maybe Rocky & I were the test cases before letting farming community folks in on the secret.

  50. I think genetics plays a bigger role than flouridated water. My family has a history of “high peaks/low valley” molars, which are very hard to brush enough to get food/etc out of the valleys and results in more cavities. I had flouridated water all growing up and had good oral hygiene, but still a lot of cavities. One DD has my family’s teeth. The dentist recommended sealing as soon as they came in. Not one cavity. I think it is the sealant vs the flouride.

  51. “I guess we do have a few Oxy left from DD’s surgery; they can go right next to the 10-yr-old percocet.”

    LfB – we are two peas in a pod. My deal is that I will always save it for another, worse situation and never, ever use it. I’ll probably ask the kids to bury me with all my old narcotics!

  52. Cordelia and Fred, it would have been somewhere around 1970, but I can’t seem to find any newspaper mention of it.

  53. RMS – we were super high-tech, had fluoride in ENVELOPES that the teacher passed out (like the ones that the cheese comes in in the mac and cheese boxes, but smaller) and then we all rinsed together. I remember one year my mom didn’t sign the sheet giving them permission to give me fluoride and I was mortified bc all the other kids in the class got to have it.

  54. “I’ll probably ask the kids to bury me with all my old narcotics!”

    @Moxie — but is the coffin appropriately waterproofed? :-)

    I also thought of Milo’s question. Makes me wonder if incineration isn’t the best answer.

  55. I don’t remember the fluoride treatment, but I remember the little tablets that stained your teeth pink in areas in which you didn’t brush well. They don’t do that anymore.

    I, too, got my kids’ teeth sealed. My cavities act as a sealant for me. I never got cavities until I was in my 30’s. Don’t know why.

  56. Milo, drugs in our area go into a locked box by the 24 hr-day-manned police station desk and are incinerated.

  57. “good physical health and good dental health (healthy teeth and teeth that do not require braces) went hand in hand”

    I’ve read that poor dental health correlates with poor cardiac and circulatory health, and more specifically, dental inflammation can spread and lead to cardiac and circulatory issues.

    Crooked teeth can result in pockets that are difficult to clean, leading to dental inflammation, leading to cardiac and circulatory inflammation.

  58. How do *they* dispose of the old drugs that are turned in?

    It looks like the preferred method is high temperature incineration.

  59. We didn’t have a multi-purpose room in my elementary school.

    But I do have a hazy recollection of fluoride treatments.

    I know my kids get them at their regular dental treatments, as do I. My dentist and the kids’ dentist also both recommend nightly use of fluoride rinse. The kids’ dentist says that imminent cavities can be treated with brushing, flossing, and fluoride rinses, facilitating recalcification.

  60. “the little tablets that stained your teeth pink in areas in which you didn’t brush well.”

    The local drugstore sells rinses that do something similar, but I think they turn the unbrushed areas blue.

  61. Fluoride can occur in water naturally. We have spring water with a well backup. When we have our water tesed ever year, DH and I always talk about also testing the water for floride, but we have yet to do that. I gave DD daily flouride drops when she was very young. Now, she fills up her water bottle at school, which is on fluoridated city water.

  62. This story is off topic, and it doesn’t have much point, nor does it end with anyone buying a new boat.

    I was hanging out with my FIL recently and we’d been talking about boats over lunch at a restaurant, and strolling around the water admiring different ones, including a very nice looking Fleming 58.

    We wandered into a Fleming brokerage and got a casual tour of one from the salesman. These have a reputation, I’ve learned, of being extremely well-built and reliable classic motor yachts that are even surprisingly fuel-efficient at lower speeds. Of course, the model we were touring was two years old with an asking price of nearly $3M, so any interest I may have in them is purely academic.

    While we were talking, one of their best customers came by to hang out and we got to talking with him for about an hour. He’s clearly one of the brand’s most enthusiastic proponents and told us the whole story about how he ended up buying their Fleming 75 (it’s a small community, and this person is identifiable, but the selection was based on the remarks of a toddler).

    I remarked to FIL afterward that 1) they must have believed that we were people of means, or they were just bored; and 2) I’m very lucky to be married to someone who is easygoing and adaptable enough to be happy with what we will ultimately get, which will be much, much less.

    But while I normally don’t dwell on these things, I haven’t gotten that guy and his $7M? boat out of my head.

  63. Milo. I feel the same way about the quarter of a million dollar and up watches sported by some of my collector buddies.

    My water was first fluoridated in 52, so for my entire life. I have amazing enamel, but need lots of preventative care for my gums.

    It is not so long ago that lower income – i dont mean dirt poor – people reached old age with fewer than half their original teeth. At least the over 50s among you can recall the old people with their ill fitting full dentures, and they are still common in areas that resisted fluoride. It is like anti vaxx stuff, people just don’t have any memory of what it used to be like. If a prosperous person wants fluoride treatments for the kids and pure water, you have the choice of living with a well or buying bottled water in bulk.

  64. But while I normally don’t dwell on these things, I haven’t gotten that guy and his $7M? boat out of my head.

    I’m always curious how people make their money.

  65. “I’ve read that poor dental health correlates with poor cardiac and circulatory health, and more specifically, dental inflammation can spread and lead to cardiac and circulatory issues.”

    I’ve heard that too. But I am equally wondering whether the causal link runs the other way, i.e., poor cardiac health causes inflammation and circulatory issues that can lead to dental inflammation that can lead to tooth gingivitis etc.

  66. Mémé’s comment reminds me of Mr WCE’s grandmother, born in 1925, who had lost all her teeth by 30. She came from a family of poor migrant workers and didn’t brush her teeth, have dental care or have regular, nutritious food as a child during the Depression. I think she and Mr WCE’s grandpa left school around 6th-8th grade.

    People have far more opportunities now.

  67. All these theories about cavities are interesting, but I haven’t seen any that explain how the parents in our family had massive cavities while the kids had practically none. Clearly not genetics. Not fluoride or Mom wouldn’t have had cavities. Weird!

    Houston, were you pregnant in your 30? I’ve heard that women are more likely to get cavities when they are with child.

  68. Watching the Great British Bake Off, I am struck by the contestants teeth. Quite a few have teeth that require braces. I just don’t usually see adults in my day to day life here in the U.S. with misaligned teeth. Even those who don’t get braces as kids, go get them as soon as they can afford to.

  69. “Houston, were you pregnant in your 30? I’ve heard that women are more likely to get cavities when they are with child.”

    Yes, but I’ve gotten cavities after pregnancy as well.

  70. Overall dental care has improved significantly over the last 40-50 years or so. Besides fluoridated water and fluoride toothpaste, people go to the dentist more often. There’s a much greater awareness of the importance of it, and there are better treatments, sealants, etc.

  71. On the topic of prescription medicines that don’t help or make you feel sick: I had a root canal last year, and the surgeon did not give me an RX for anything afterwords. He had me take a full dose of Advil and Tylenol at the same time to deal with the pain. It worked!

  72. She came from a family of poor migrant workers and didn’t brush her teeth

    I had assumed everyone had been brushing their teeth in the 19th century if not before. But, it appears the practice wasn’t widespread:

    In the United States, although toothbrushes were available at the end of the 19th century, the practice did not become widespread until after the Second World War, when US soldiers continued the toothbrushing that had been required during their military service.

  73. ” I feel the same way about the quarter of a million dollar and up watches sported by some of my collector buddies.”


    “I’m always curious how people make their money.”

    In this case, he was just very successful and probably willing to work and travel a ton. Not the risk taking business owner.

  74. My parents have had lots of cavities and root canals. They grew up without fluoride in the water (and probably no fluoride in the toothpaste). The only cavities I’ve had was when I was pregnant (5 filings in one visit!). I don’t recall my brother having cavities when we were growing up.

    My problem now is the enamel is thinning on my front teeth. It started in my early twenties. I’ve been to multiple dentists and they have no explanation for it. My current dentist suggested that I avoid any of the whitening toothpaste, for fear that the ingredients will cause more harm. But do you know how hard it is to find toothpaste without whitening ingredients? It is ridiculous how that has become a huge buzzword in marketing.

  75. Late to the party. I never throw drugs away. Well almost never. I can always imagine a situation where they would be good to have on hand. If I had a bottle of long-expired tylenol (and a couple of fresh ones), I would just toss the bottle in the trash. For narcotics, the current recommendation is to mix with coffee grounds or cat litter and throw away.

    I read the pharmacology article and find the numbers difficult to believe (as WCE did). I’m skeptical that sewage outflow could have 40mg/L of metformin. An average diabetic taking the drug would have 400mg/L of metformin in their urine. (Normal dose 1000mg/day, 80% excreted unchanged, 2L urine per day). The implication is that 10% of sewage outflow is pure, unadulterated urine from a type II diabetic. Or that the process concentrates the drug before releasing it into the environment.

    Oh! I found the primary source: http://www.sciencedirect.com/science/article/pii/S0045653513010412

    They found that there was 3800 ng/L in the most concentrated area. Which translates to .0038mg/L – which makes so much more sense. However, if you google “40mg/L metformin” – it turns out that all kinds of publications propagated the mistake.

    Anyway, for those of you still reading my late night stream of consciousness pharmacology rambling – I don’t think disposing of the unused drug is the problem (at least not the environmental problem). What is the ratio of metformin pills taken vs metformin pills that get into the water supply some other way? I would guess 100 or 1000 to 1. Drugs pass mostly unchanged out via the urine. Dealing with throwing away a few stray pills is much less significant that the 200 you took and peed out.

  76. I had my third root canal after my third baby and the dentist told me that there is an old saying, “one tooth per baby” – the hormones increase the risk of decay and you lose one tooth for every pregnancy .

    In terms of dental health relating to other health (such as heart disease, etc.) It was long presumed to be a correlation, not causation situation. However, we know that improving dental health in the absence of any other intervention can improve some seemingly unrelated health outcomes.

    Specifically: http://www.medicaldaily.com/one-dental-visit-pregnant-women-could-see-risk-premature-birth-decrease-third-244099

  77. Ada, I enjoyed seeing how you reasoned through the metformin statistic. I read it and thought “1 mg/L is a part per million. There’s no way that a particular drug taken by a small fraction of the population at a low volume dose could wind up at a ppm level in semi-dilute sewage…”

  78. SM – hope you are doing OK, seems like your area is out of the direct danger zone of the hurricane.

  79. My in-laws are looking brilliant right about now — they are directly in the path of one of the projected landfall areas, but they were already scheduled to head up to MD today for a visit. :-) Here’s hoping those who don’t have such conveniently-timed trips make out well.

  80. Thanks for thinking of us! Things are fine here on the West coast. My main concern remains the selfish little one I posted the other day–Isaac’s birthday weekend at Disney. That really doesn’t rank at all compared to the very real concerns others have. I assume our friend in Miami is busy boarding up windows and stocking up on TP, Coors lite, and other essentials. Wonder it SoFla has a dry dock for the boat.
    Louise, I think you are also well to the west of the “cone”, right?

  81. Laura, is their flight still scheduled? Assuming they get to your place, they’ll be riding it out in style, sort of like the guests at a hotel where we used to go for brunch. They posted today that they are packed with East Coasters!

  82. There’s an article in the NY Times today about organ transplants, and the way fatal drug overdoses are upping the number of available organs for transplant. I am usually very skeptical about frantic screaming about “drug epidemics!!!” because we’ve seen those recur over the decades and it’s usually just cultural hysteria. But the Times cites a statistic that impresses me: “But overdoses (47,000 in 2014) have surpassed car crashes (32,000 in 2014) as the leading cause of accidental death in the United States.”

    But maybe that just means cars have become incredibly safe.

  83. In our county the number of emergency room visits due to drug overdose has surged, but I’m not sure about deaths. Locally among recent high school graduates we hear of more overdose deaths than I can ever remember, but I’m not sure of the actual numbers.

  84. I’ve personally encountered two overdose incidents within the last six months, one on our local streets and one in the ER. Never have I experienced that before. Maybe because it’s affected people like me it seems like an epidemic.

  85. Yes, right, I’m not saying there’s no drug problem. It’s just when words like “epidemic” and “surge” and so on get bandied about, I start to think that it’s more about selling newspapers than it is about facts. I mean, what’s the numerical difference between an “uptick” and a “surge”? And it all just reminds me of all the old Dragnet episodes about drugs!!! and LSD!!! and kids today!!! and Art Linkletter’s daughter jumping out the window!!! Yeah, I’m just old, maybe.

  86. S&M, they’re not. The article addresses that. But Hep C and HIV can both be managed, whereas an entirely failed liver cannot. So the patients choose the suboptimal liver rather than certain death. The article argues that in many cases it works out okay. If you get another 5 to 7 years, then hey, you’re ahead of where you were.

  87. I think many fatal overdoses die from anoxic brain injury – the brain gets fried from no oxygen. The brain is more sensitive than the other organs, so it is not surprising that a heroin death could lead to a healthy set of kidneys being available.

    I’m not seeing a ton of this, but I’m hearing about it all the time. If someone has a pulse when EMS arrives, they usually do just fine – and may not hit the ER. If they are pulseless on arrival they don’t make it to the ER either.

    There’s an implantable narcan coming. It’s unclear how it will work, but it may be a real innovation to prevent relapse, and perhaps overdose death. It will definitely generate a lot of money for a drug company – I think it costs 10k/year or more.

  88. There’s an implantable narcan coming.

    If it works, I can see it becoming a condition of parole and/or getting your kids back.

  89. Just had a patient tell me she was going to a second funeral for a grandchild (in 20s), died from multidrug overdose. Hard to fathom.

  90. I have seen numerous stories like this.

    “While Appalachia and the Northeast have been hardest hit by the new opioids, the upper Midwest is also reeling. On the other side of a bridge from Superior, in northern Minnesota, police working for a tri-county task force have intercepted 64.5 grams of fentanyl so far in the third quarter, enough of the deadly narcotic to kill 32,000 people, up from 12 grams in the second quarter. Officials in and around Fargo, N.D., are grappling with a rash of fentanyl-related overdoses this year, including among high-school students who were snorting the drug through nasal-spray bottles.”


  91. I had to google narcan. One of the autofill suggestions included the name of a state. Guess which one! Yep, this one. :/

    I was thinking more of organs not involved in metabolism, like lungs and corneas. But if the liver can go, then I guess the rest must be able to also.

    I just realized that if a hotel here is full of people fleeing Matthew, then Disney must be as well. Their phone lines are jammed. I think we will skip the Polynesian show and celebrate the boy’s birthday by painting his room.

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