The Disposal Act allows for individuals to dispose of legally possessed controlled substances via take-back events, mail-in programs, and collection facilities. Improving public awareness and availability of these methods of disposal will offer added protection for the marine environment against flushed pol lutants. However, illicit drugs cannot be legally disposed of using these methods, and the U.S.Because illicit drugs thrown out as household refuse pose a threat to humans and animals that may find them, and domestic incineration of illicit drugs is potentially hazardous, flushing is the only remaining disposal option. To reduce the amount of illicit drugs that are flushed into POTWs, and ultimately into the marine environment, a safe and legal method for disposing of illicit drugs must be developed. Drug possession prohibition laws severely complicate efforts to dispose of illicit drugs.Individuals looking to dispose of illicit drugs will be unwilling to transport or mail them out of fear of criminal prosecution. Additionally, illicit drugs that are found or intercepted pose a high risk of accidental overdose. For these reasons, developing a mechanism for individuals to dispose of small amounts of illicit drugs will prove to be challenging, perhaps prohibitively so. Individuals looking to dispose of large quantities of illicit drugs, however, may warrant more contemplation. Relaxed enforcement of possession laws may be considered in limited circumstances to allow individuals to forfeit illicit drugs through prescribed mechanisms. Drug rehabilitation facilities that collect illicit drugs from their residents also have no legal disposal mechanism,vertical racking system and likely resort to flushing. Regulations should be drafted to provide a process by which these facilities can destroy illicit drugs onsite or can transfer them into DEA custody for destruction. Keeping these drugs out of human hands and out of the marine environment through safe and legal confiscation and destruction is an important cause that is worthy of innovative regulatory reform. Pharmaceutical Extended Producer Responsibility programs should also be implemented throughout California. Alameda County devised the first mandatory drug take-back program in the state by enacting the Safe Drug Disposal Ordinance.
The ordinance requires pharmaceutical manufactur ers who sell or distribute certain prescription and over-the-counter medications in Alameda County to develop, fund, and implement a Product Stewardship Program that facilitates the collection, transportation, and disposal of unwanted pharmaceuticals.Trade associations representing pharmaceutical manufacturers challenged the ordinance, alleging violation of the Dormant Commerce Clause.107 The Dormant Commerce Clause places an implied limitation on a state’s power to enact laws that burden interstate commerce.108 The Ninth Circuit Court of Appeals validated the ordinance, holding that the ordinance did not discriminate against or directly regulate interstate commerce, and that the burden on interstate commerce did not clearly exceed the local benefits of the ordinance. The United States Supreme Court declined to hear the case on appeal, allowing the ordinance to stand and opening the door for similar legislation in other California counties.Similar EPR laws have been passed in Marin County, the City and County of San Francisco,San Mateo County,and Santa Clara County.An EPR ordinance has also been proposed in Los Angeles County.Another way to reduce pharmaceutical flushing is to abandon the U.S. Food and Drug Administration Flush List and to adopt a universal no-pharmaceutical-flushing policy. The FDA Flush List recommends disposal by flushing for pharmaceuticals that present particular concern for abuse and overdose. While this policy is meant to keep humans and pets from ingesting potentially dangerous unused drugs, it favors the introduction of these pharmaceuticals into the marine environment. Because we currently lack sufficient safeguards to prevent flushed pollutants from harming marine organisms and ecosystems, these pharmaceuticals should instead be disposed of through take-back events or transfer to a DEA-authorized collector. Adopting a universal no-pharmaceutical-flushing policy would encourage the use of these alternative disposal methods. Because many of the pharmaceuticals on the FDA Flush List present an especially high risk of overdose to children and others to whom they were not prescribed, the adoption of a universal no-pharmaceutical-flushing policy could be met with potentially insurmountable political opposition.
The development of safe disposal alternatives that are more accessible and convenient than current methods would make the adoption of such a policy more feasible. Innovation of wastewater treatment technology targeted at listed pharmaceuticals and development of marine-safe versions of listed pharmaceuticals would also help to reduce the impact that these flushed pollutants have on the marine environment. In order to evaluate the scope and severity of this issue, research is desperately needed to determine the amounts of flushed pollutants entering the marine environment and the effects these pollutants have on marine organisms and ecosystems. Further research is required to determine acceptable levels of flushed pollutants in treated wastewater effluent discharged into the marine environment to eliminate or minimize these effects, and to determine whether existing technologies are sufficient and economically viable to attain discharge levels deemed acceptable. Imposing comprehensive monitoring requirements and stringent effluent limitations specific to flushed pollutants in POTW effluent will encourage the development of more efficient technological processes for removing pharmaceuticals, illicit drugs, and caffeine from wastewater. Establishing similar requirements and limitations for discharges from healthcare facilities such as hospitals, pharmacies, rehabilitation centers, and long-term care facilities may also put pressure on pharmaceutical companies to engineer medications that are benign to the marine environment and may even prompt government agencies to develop safe and legal disposal alternatives to flushing illicit drugs. Public education is one of the strongest tools for reducing the effects that flushed pollutants have on marine organisms and ecosystems. Household flushing contributes a significant percentage of pharmaceuticals, illicit drugs, and caffeine entering POTWs, yet the general public knows very little about wastewater treatment and oceanic discharge. Campaigns to dispense information about safe and legal disposal methods for unwanted pharmaceuticals and to raise awareness of the potential effects that flushed pollutants may have on marine organisms and ecosystems could help to reduce household flushing of unwanted pharmaceuticals. Despite having a comprehensive tobacco control policy, cigarette smoking continues to be the leading cause of preventable morbidity and mortality in China and other developing countries,indoor grow facility as it already is in developed countries today, and accounts for 5 million deaths globally each year.
When cigarettes are smoked, a host of harmful chemicals contribute to the deleterious effects. Mounting scientific evidence proves the association between chronic smoking and lung cancer, chronic obstructive pulmonary disease, , vascular disease, stroke, and peptic ulcer disease, as well as a wide range of other adverse health effects. Understanding the mechanism of nicotine dependence and developing better therapies to help with smoking cessation is an urgent need. Emerging technologies, such as neuroimaging and genomics, have contributed to new insights into the neurophar macology of tobacco addiction. There is considerable literature from functional neuroimaging studies assessing the effects of chronic cigarette smoking on brain structure and function. However, while several studies have examined gray matter differences between smokers and non-smokers, much is less known about the white matter structural changes in brain in chronic cigarette smokers. Using magnetic resonance imaging to examine the brain structure and function in chronic cigarette smoker provides a better understanding about the adverse effects of chronic cigarette smoking on brain. Diffusion tensor imaging is a sensitive method to measure micro-structural changes by detecting self-diffusion of water molecules caused by Brownian motion and providing parameters of the diffusion tensor, the most commonly used parameter is fractional anisotropy. FA is a commonly used measure for examining white matter spatial organization and integrity. Increased FA indicates a non-spherical tensor with preferential orientation in a particular direction, while a decreased FA indicates more isotropic diffusion which has been found to becharacteristic of disrupted or damaged whiter matter. It has been widely used to identify and quantify white matter abnormalities in psychiatric and neurological diseases, such as schizophrenia showed significantly higher levels of FA in the corpus callosum than nonsmokers; the low Fagerstro¨m scores group exhibited significantly higher levels of FA in the body of the corpus callosum than the high Fagerstro¨m group and the nonsmokers. Jacobsen et al reported that prenatal and adolescent exposure to tobacco smoke showed higher FA in anterior cortical white matter; adolescent smoking also showed higher FA in internal capsule.
Recently, Xiaochu Zhang et al examined a relatively large sample of smokers and found that the most highly dependent smokers exhibited lower prefrontal FA, which was negatively correlated with Fagerstro¨m Test of Nicotine Dependence. In the present study, we examined white matter changes in a relatively large sample of nicotine dependent smokers and non smokers matched for a number of demographic variables using DTI.Eighty-eight subjects , 19–39 years of age, were recruited from the local community using advertisements. They were initially screened during a semi-structured telephone interview to assess smoking, medical, psychiatric, medication, and substance use history. Smokers who had smoked 10 cigarettes per day or more during the previous year and had no period of smoking abstinence longer than 3 months in the past year, and met DSM-IV criteria for nicotine dependence were eligible for this study. All smokers self reported no smoking for the 12 hours before scanning. Nicotine patches were provided as needed. Nonsmoking history was defined as having smoked no more than five cigarettes lifetime. Participants were excluded if they were a minority other than Han Chinese or had: a diagnosis of mental retardation, current or past alcohol or drug abuse/dependence, a current or past central nervous system disease or condition, a medical condition or disease with likely significant central nervous system effects, history of head injury with skull fracture or loss of consciousness greater than 10 min, a physical problem that would render study measures difficult or impossible, any current or previous psychiatric disorder, a family history of a psychotic disorder, current or previous use of electroconvulsive therapy or psychotropic medications, or a positive pregnancy test. A licensed psychiatrist conducted all clinical interviews. The protocol was approved by the university ethics committee and the studies were carried out in accordance with the Declaration of Helsinki. Subjects were fully informed about the measurement and MRI scanning in the study. Written informed consent was given by all study participants. None of the participants reported daily consumption of alcohol, and none reported experiencing social consequences secondary to alcohol use, or any history with difficulty ceasing alcohol intake. All non-smokers in this sample reported no history of smoking behavior in the past.Between-group tests were performed on diffusion tensor images of FA using a parametric two sample t-test on a voxel-by-voxel basis using SPM5 software. A prior white matter mask from WFU_PickAtlas was used to restrict the search volume for analysis. Clusters of 100 voxels or more, surviving an uncorrected threshold of p,0.001, were considered significant. For visualization of the regions showing significantly different FA values between the two groups, significant clusters were superimposed onto SPM5’s spatially normalized template brain. Fiber tracts corresponding to the clusters were identified with reference to the Johns Hopkins University DTI-based White Matter Atlas analyses was performed. MarsBar 0.41 was used to extract ROIs containing all the voxels classified as white matter from spatially normalized and smoothed FA images. Then, mean FA values of the ROI were calculated using log_roi_batch v2.0 . Finally, the aver age FA values of individual clusters were calculated for each subject. A two-sample t-test was used to compare these FA values of the clusters between smokers and non-smoking controls. We used P,0.05 as a statistical threshold to search for significant differences. Correlational analysis of FA values with smoking-related factors including age of smoking onset, number of cigarettes smoked per day, years of smoking and smoking cravings were examined using bivariate correlational analysis . The T1-weighted images were segmented by using VBM5.1 procedures into white matter, gray matter, and CSF . Then, the white matter volumes were compared between groups by univariate GLM using total brain volume as covariate.The present study provides evidence of micro-structural white matter modifications in chronic smokers as measured by whole brain analysis of FA using DTI. Specifically, increased FA was found in white matter of the bilateral fronto-parietal cortices in cigarette smokers relative to healthy non-smoking comparison subjects. In contrast to the findings here with chronic cigarette smokers, previous studies with other drug dependent subjects revealed decreased FA in white matter of the brain. In patients with heroin dependence, reduced FA was observed in the bilateral frontal subgyral cortices, right precentral, and left cingulategyrus.