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Medication Chart - for poop and pee

 
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Does anyone know of a reliable resource on medications and the environment?

The chart I am looking for would list a medication, for example Penicillin, list how it is eliminated such as in pee or poo, and how it degrades or if it degrades in the environment.

The question I want to be able to answer is whether is if we should treat someone's humanure as nuclear waste when/if they are taking various medications.   If it is safe to use but requires additional time or special treatment to help the medication degrade.

We separate our pee from poop, so I also need to know which route the medication comes out of our bodies.

Using humanure is against the law in our area, so I cannot ask the doctor these questions.   But I have not been able to find a source online.

Please feel free to move this post if it is the wrong forum.
 
master pollinator
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Based on this article, it looks like we need to compost the heck out of our humanure if we're taking medications:  https://www.rootsimple.com/2013/05/compost-and-pharmaceuticals/

I would include a good long period of mycoremediation.

More info:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6393367/

https://www.jenkinspublishing.com/messages/messages/1366/2167.html?1460557973
 
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Pharmaceuticals in groundwater is something I think needs to be looked at a little harder.
Septic systems in rural areas do little to filter out many pharmaceutical inputs.
Constructed wetland treatment systems show promise in remidiation. Hot composting is not something I have looked at.
Reclaimed water used in irrigation has been shown to have residual pharmecuticals.
Just what is the impact going to be in the long run?
 
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Wesley Kohn wrote:

The question I want to be able to answer is whether is if we should treat someone's humanure as nuclear waste when/if they are taking various medications.  


I personally default to "it's nuclear waste." although I also consider things like eating at McDonald's a source of nuclear waste. I'm still building, and having a hard time with the idea that I don't want some people using my bathroom, since it goes to good uses. I don't think I can socially have a handle to flip for "if you eat or take anything horrifying, move the lever to the right  so your output gets extra processing." Maybe if I just have an unlabeled one that I can switch before company comes over...

Good complex question, I have no good answers, and I would LOVE some. I'll add this to some other forums so it gets noticed by people who might know more.
 
Wesley Kohn
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Robert Ray wrote:Pharmaceuticals in groundwater is something I think needs to be looked at a little harder.



I honestly never thought of that.   Very good point.  
 
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Separating pharmeceuticals from water is amazingly hard and expensive to do, especially on a city scale, requiring reverse osmosis and nanofiltration, and who knows what else.  I can't find the source now, but I've seen some proposals that suggest that you can remove the majority of the pharmaceuticals from the waterways most cheaply by mandating that all long-term care homes and hospitals install a system to clean pharmaceuticals out of the wastewater before it joins the rest of the water system. It's crazy, but I've heard they can even detect measurable amounts of caffeine in wastewater! Someone once told me there is more gold in sewage from fillings, etc, than in most gold mines (g/ dry tonne) but we don't know how to process it to take it out.

As for on a personal, humanure scale? I'd just default to using it on things like trees, and maybe consider "supplementing/innoculating" the bacteria somehow. No way to prove this, but I suspect that humanure may be one of the best ways to degrade the medications short of a multimillion dollar filtration system.  Unless you are on some major cancer drug long term, I (personally) wouldn't worry too much.
 
Robert Ray
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The number one thing you will see mentioned is nitrate transport in ground water. A good thing to look for and simple to test for. Nitrate is very soluble and a good indicator of the septic plume that spreads from a septic system. Challenges to the dangers of nitrates from 1940's studies are becoming more prevalent.
Caffeine another simple and cheap test is something that is probably more undeniably a human waste byproduct that allows mapping of septic plumes.
However pharmaceutical are far more varied and just what does one look for, which ones? What is the long term effect of low dosages of my neighbors anti cancer treatment? Are superbugs becoming more resistant to antibiotics present in waste water. Opiates? Hormones?  
 Expensive filtration in a rural area is not going to be a viable option at present. Constructed wetland some times refered to as green machines a more Permie approach have been used for septic treatment and appear to do better in pharmaceutical remediation than standard systems or current ATT systems legal in Oregon.
 
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Dr. Mehran Keshe has described how each thing can be pulled by its magnetic opposite/equal (?), don't remember the exact term used).  Some years ago he shared research using iron as an example, iron being easy to relate to, in which nails were buried across a patch of land.  Then a magnet was dragged across that area, removing the nails from as deep as two feet if I recall accurately.  He said everything has such an opposite and the research was intended to explore removing heavy metals from soil, water, and air.
 
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"The solution to pollution is dilution" - The Magic Schoolbus

There are *lots* of good questions here, but my "common sense" meter says:
1. There's a big difference between 1 person composting just their own humanure and on drugs for months vs
2. One out of 10 people adding to a humanure pile who's on a single anitbiotic for 10 days.

Sooo... in Pearl Sutton's case, if she thinks a 1 day visitor might be on drugs, she could make sure she puts that day's output somewhere where it will compost longer than average, but I'd still choose composting over most of the alternatives because of things I recently read in the Humanure Handbook. Jenkins seems to be particularly concerned about the "plume" which can result from either old-style pit toilets or septic systems. I know that I've read places that the biggest drawback from septic fields is that the "field" is below the active biological level of soil. What confused me is that people talk about digging 3 ft deep "compost" holes in an effort to rehabilitate compacted soil. (I believe that's discussed in the lawn section of the Better World Book, but don't quote me on that as I haven't read it for a while.) Is this because the average pit toilet is much deeper than 3 ft? Probably. I wouldn't have thought the average septic field is that deep (I know my neighbor's isn't as I saw him build it - but maybe he didn't build his to code due to trying not to kill some large trees in the area.) So many people see things as "out of sight, out of mind" that they may not realize that burying things deeper is worse than shallow. Traditionally people were buried 6 ft down and would be there a long time. The deer that got hit by a car and landed in a ditch by my place was nothing but fur on the ground in something like 2 weeks. It went through a nasty, stinky stage, and if my neighbor had looked a little harder and spotted it when he smelled it, I would have covered it with some dirt to help the smell, but the winds were such that by the time I smelled it myself it was pretty much done. If I need to compost a dead animal, I try to make sure there's lots of absorbent "brown" material like straw underneath the corpse and I often compost them in a raised compost, but sometimes if the raccoon pressure is high, I like to do it 1-3 feet underground, but I still put something "brown" under it.  

The articles Tyler Luden's posted certainly support the idea that composting this stuff is better than most of the alternatives, particularly if some effort is made to add mushrooms to some part of the process.
 
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Here's a pdf of a Canadian study that has some good data on the effectiveness of various methods for removing pharmaceuticals from sewage sludge.
I've only read the 17 page summary and some of the conclusion charts (pg 159). Looks like aerobic composting was the most effective. But then there is the question of how much is ok even if 98% is gone.
Sometime I'll read the methodology portion to see if it would be worth it to do a sludge composting test with before&after measurements. I'm on a council that will be deciding how to deal a municipal sewer lagoon sometime in the next 20 years. It may have 50 years of sludge by then.

http://www.protectmillcanyon.org/wp-content/uploads/2017/09/Emerging-Substances-of-Concern-CANADA.pdf
 
Jay Angler
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Grady Houger wrote:

But then there is the question of how much is ok even if 98% is gone.

Exactly the point of my quote above - if what's gone is 98% when starting with only 1 person contributing the drug for 10 days on say a 10 acre permaculture garden, I'd be comfortable because I'd expect the healthy soil biome to be able to continue processing it or sequestering it. Fifty years of sewage sludge is a totally different ball game! That said, there's been some excellent bioremediation work on brownfields in England and I was pretty impressed with the results. Usually the issue with such things is one gets a sort of "half-life" situation - the first half of the process seems easy, but the last 2 remaining percent seems to take just as long, and just as many resources to bioremediate as the first 98%. Maybe a better expression is the "law of diminishing returns"?
 
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Based on this study. It seems that some plants bio-accumulate in their roots and leaves to levels 30x times what was found in the 'offending' humanure.
https://www.ncbi.nlm.nih.gov/pubmed/31472377

Based on another study it seems like the cabbage family is more likely to leave the compounds as is. But the spinach family will metabolize it. The new metabolites are bio-active and might be worse than the original.

In general it seems that most of the pharmaceuticals levels were higher in the roots then leaves very similar to heavy metal uptake in plants root>leaves>stem>fruits
 
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Someday I would like to see someone do trials of remediation of pharmaceutical-laced wastewater with biochar, and with wood chips inoculated with fungi. I think a combination of those two methods would be a winner.

Our city council is a possible test subject and I'm involved in some conversations about the next generation of treatment infrastructure for municipal sewage. I've already put biochar into consideration, so a fungal bioreactor wouldn't be a very big leap.
 
Wesley Kohn
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Jay Angler wrote:Grady Houger wrote:if what's gone is 98% when starting with only 1 person contributing the drug for 10 days on say a 10 acre permaculture garden, I'd be comfortable because I'd expect the healthy soil biome to be able to continue processing it or sequestering it.



Unfortunately, my mother-in-law had a mild stroke.   Fortunately, she is coming to live with us.   Unfortunately, she is taking Metformin & Atorvastatin daily and I am sure there are other drugs as well.   So, my example of penicillin was a poor example since that is a temporary drug.  

We have been blessed so far with a household that has maintained a drug-free lifestyle because all of us are very healthy.   This topic begs for a study and documentation to be made public.   I am rather surprised that in our over-medicated society you cannot look up a drug online and find out by what means the body disposes of it and the consequences of the drug on the environment.  It seems to me that pharmaceutical firms should be able to answer questions about secondary exposure to their drugs and whether or not plants will absorb the drug and expose others to it.

 
S Bengi
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It would be nice to figure out which microbes can actually turn these pharmaceuticals and metabolites into CO2. It seems that some microbes actually use the waste material to make more pharmaceuticals. https://www.scientificamerican.com/article/bacteria-may-be-remaking-drugs-in-sewage/

Most waster treatment facilities also chlorinate the waste water, chlorine react with the pharmaceuticals and their metabolites.

It seems like similar to heavy metals we can use plants and charcoal to filter out these toxins but where do we now dump these toxic filter?
 
Catherine Windrose
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Cattails also.  

Cattails and reeds are the most common plants in constructed and semi-natural wetlands for wastewater treatment, and can play an important role in both nutrient and heavy metal retention.


https://www.researchgate.net/publication/244144827_The_Biomass_and_Nutrient_and_Heavy_Metal_Content_of_Cattails_and_Reeds_in_Wastewater_Treatment_Wetlands_for_the_Production_of_Construction_Material_in_Estonia

Recently, while collecting ideas for poopers I found these sources.  It occurred that medical facilities must have something in place for dialysis.  Interesting to note, that the Nanoguard filter is reusable and cleaned with bleach.  H2O2 is a bleach found in rain, that our bodies make, and prior to to use of chlorine bleach was used in water/waste management.  I've been pondering about experimenting with diluting 35% food grade hydrogen peroxide with poo/pee.

NANOGUARD-C
   Ideal for any application requiring ultrafiltration
   Reduces Total Suspended Solids and traps particulates as small as 5nm in size
   Expected life up to 10,000 gallons per 10” of ultrafilter, depending on water quality
   Attains and maintains high flow rate (up to 3 GPM @ 20 psi per 10” segment)
   Meets ASTM F838-05 standard on bacterial retention


https://www.nephros.com/commercial/#nanoguard

Pathogen reduction in septic tank sludge through vermicomposting using Eisenia fetida.


https://www.ncbi.nlm.nih.gov/pubmed/20093021

Composting Human Waste from Denali with Worms


https://www.nps.gov/articles/denali-mountain-compost.htm

Compost Toilet Research Project


https://oaec.org/our-work/projects-and-partnerships/compost-toilet-project/

For nuclear waste - chemo? - I am thinking about spirulina and similar.


The adaptive potentials of those who worked in the cleanup of the aftermath of the accident at the Chernobyl Atomic Electric Power Station under the influence of different treatment methods.

Abstract

A comprehensive evaluation was done in 162 patients-liquidators of the Chernobyl accident. Of these, 80 percent were diagnosed as having stage I and II dyscirculatory encephalopathy (DE), 20 percent were in stage III. It is shown that DE progression is caused by great strain on and breakdown of autoregulatory mechanisms of different biological systems (vascular, central nervous and vegetative, hormonal), and of central regulatory mechanisms as well. Under certain conditions there may occur their breakdown, with syncopal states, crises, and even insults developing in its wake. Treatment and rehabilitation of DE liquidators with pyracetam, vinpocetine, cerebrolysine with magne B6, and phytosorbents (spirulina, quercitrol, and vitapectine) lead to reconditioning of central and autoregulatory compensatory-and-adaptive mechanisms, long-lasting remission, provide complication prophylaxis and promote work activity.


https://www.ncbi.nlm.nih.gov/pubmed/10921251
Filename: NanoGuard-C-Brochure-NEW.pdf
File size: 261 Kbytes
 
S Bengi
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Filtration by bio-accumulation in plants/etc , 'activated charcoal' or bio-char or soil, or nano-filters or reverse osmosis or 'artificial kidney' all begs the same question. Where do I now put this super concentrated toxic waste>

It would be nice if I could just separated the urine at the source and then boil it in a solar oven or add some ozone or hydrogen peroxide and then BAM these weird hydrocarbon pharmaceuticals turn into harmless water and carbon dioxide.

I wonder what percentage of the drugs we take end up in:
1) Urine Filtered by our kidney
2) In Feces, un-absorbed
3) Filtered by our liver sent to our bile/gall-balder/Feces.

Seeing as how most drugs are just hydrocarbon, I think pressing fungi into service might be our best bet.
 
Pearl Sutton
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Wesley Kohn wrote:  I am rather surprised that in our over-medicated society you cannot look up a drug online and find out by what means the body disposes of it and the consequences of the drug on the environment.  It seems to me that pharmaceutical firms should be able to answer questions about secondary exposure to their drugs and whether or not plants will absorb the drug and expose others to it.


They'd lose  money if they did that....
 
Catherine Windrose
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S Bengi wrote:Filtration by bio-accumulation in plants/etc , 'activated charcoal' or bio-char or soil, or nano-filters or reverse osmosis or 'artificial kidney' all begs the same question. Where do I now put this super concentrated toxic waste.


Based on the wheelie bin pooper at Wheaton Labs, I was thinking about something like the wheelie bin image below.  Doesn't need to be a wheelie bin.  If you decide what container type will work best for your circumstances, the rest might follow.

If you were researching this, what would be your specific questions?  "What to do..." on an individual basis seems subjective and dependent on needs and circumstances.

What did you find regarding:  

I wonder what percentage of the drugs we take end up in:
1) Urine Filtered by our kidney
2) In Feces, un-absorbed
3) Filtered by our liver sent to our bile/gall-balder/Feces.


I think even regulating authorities don't have a definitive answer to these questions.  I think if authorities did know, they might not be inclined to share that knowledge.  I think individuals will  have to lead the the leaders in working this out because so far they haven't been forthcoming.

I did a study on MSDS sheets some time ago.  It turned out that manufacturers don't have to investigate IFs, ANDs, or BUTs.  They only have to state very limited information about chemicals and compounds they make.  Kind of leaves a mystery.  On the other hand, some things work that lack complete understanding, so the sooner individuals experiment, the more likely a viable solution will be discovered.
poo-and-pee-bin-ideas-3.png
[Thumbnail for poo-and-pee-bin-ideas-3.png]
 
Catherine Windrose
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I was just thinking... as much as I prefer not to consider moving human waste daily, considering vaccines, hormones, and medications that go into animals makes that silly-ish.  It bothers me more to collect human waste for a longer period of time than animal waste.  

We always shoveled stalls morning and evening.  Why are humans different?  Considering human waste probably contains more toxic gick than animals, different handling makes sense.  Managing human waste daily seems even more important.  Just occurred that considering the innumerable chemical cocktails created daily, how many more are added to the mix by letting human waste sit untreated?

Then there are the sad code peoples who only care if a code is violated even when code is exceeded.  Bah! :.)

I am thinking that if a commercial dialysis filter only requires 1% bleach to disinfect, realistically there is less to be concerned with than sad authorities claim.  So what remains is to "learn the rules well enough to break stretch them properly" until a viable solution is achieved = progress.
 
Wesley Kohn
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Catherine Windrose wrote: It bothers me more to collect human waste for a longer period of time than animal waste.  

\

We Bokashi our poo-pail.   In about 2 weeks it smells like beer and then we bury it with about 6" of clean soil on top.   I know Jenkins doesn't do it that way, but it means that no one is exposed to any of our "droppings" because it is buried.   And it is pickled so there is no stink.  We use peat moss as a cover because it is a soil amendment our ground needs anyway.

I use a tractor to dig a ditch, then dump the pail and cover it as needed.  For me, it is far less work and feels cleaner than the Jenkins composting system.

However, I don't think either Bokashi or Jenkin's style composting will degrade pharmaceutical products.   And Metformin has caused male fish to become effeminate, so ignoring medications is not responsible land-husbandry.

 
Catherine Windrose
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Wesley Kohn wrote:

However, I don't think either Bokashi or Jenkin's style composting will degrade pharmaceutical products.   And Metformin has caused male fish to become effeminate, so ignoring medications is not responsible land-husbandry.



Possibly.  My thoughts keep returning to only 1% bleach is needed to disinfect a commercial dialysis filter.  

Followed by, H2O2 is a natural bleach.  The snag I see with H2O2 is that a sufficient amount neutralizes ammonia and ammonia raises compost temperature.  So maybe use animal waste ammonia for composting growies and find areas with soil that will most benefit without ammonia?
 
Jay Angler
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S Benji wrote:

It would be nice to figure out which microbes can actually turn these pharmaceuticals and metabolites into CO2. It seems that some microbes actually use the waste material to make more pharmaceuticals.

"The Scottish physician Alexander Fleming was the first to suggest that a Penicillium mold must secrete an antibacterial substance" (Wikipedia) That suggests to me that just as how work has been done regarding the balance of different micro-organisms in the soil being desirable for different plants/trees, the same sort of work will need doing to help tweak compost heaps that are being used to digest human waste containing pharmaceuticals. It makes "sense" to me, (but I could easily be wrong) that the presence of a high enough concentration of an antibiotic in excrement would in fact encourage a microbe that was tolerant of +/- used that drug to its own benefit and would discourage a microbe that was bothered by it. This might be exactly what we don't want happening. Just as we try using inputs or specific plants to shift the microbe balance, we may need to try to get similar results through motivated home scientists! Trying to test something as complex as this in a "lab" setting may lead us further astray.

S Benji wrote further:

It seems like similar to heavy metals we can use plants and charcoal to filter out these toxins but where do we now dump these toxic filter?

I have read in the case of brown fields, some work was done to 1. grow "absorbing" plants, 2. compost those plants in a contained space, 3. use this "concentrated toxin" to grow more of the target plants, 4. send the super-contaminated plants to a company that would actually "harvest" the chemical for re-use in industry. Unfortunately, or hopefully, most permies won't be working at that scale, but this might apply to the comment elsewhere about getting hospitals to treat their waste water before it enters the general city waste stream?
 
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If you look up a medication on drugs.com, you'll get a "professional" tab that you can click on. That gives you info on how the drug is metabolized and excreted. It tells you how much of the unchanged drug is excreted in urine  or whatever, but you'd have to look up the metabolites elsewhere to see if there was a concern with them in excretions.
 
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Hmmm...looking up metformin I see they don't actually say how much of the drug is excreted in urine, just that 90% of it is unchanged. Atorvastatin entry has more details. So I guess that website is an only partially helpful resource.
 
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I am thinking that if a commercial dialysis filter only requires 1% bleach to disinfect, realistically there is less to be concerned with than sad authorities claim.



My thoughts are that the filter manufacturer uses the term disinfect to indicate that harmful biologicals are made safe with bleach. I think that does not mean that chemicals & medications would be eliminated or possibly even affected. Any of those things trapped by the filter would still be present. Purification & disinfection are two different things.
 
Catherine Windrose
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Mike Barkley wrote:My thoughts are that the filter manufacturer uses the term disinfect to indicate that harmful biologicals are made safe with bleach. I think that does not mean that chemicals & medications would be eliminated or possibly even affected. Any of those things trapped by the filter would still be present. Purification & disinfection are two different things.


Posted here again, the Nanoguard filter referenced above is reusable and claims:

NANOGUARD-C
  Ideal for any application requiring ultrafiltration
  Reduces Total Suspended Solids and traps particulates as small as 5nm in size
  Expected life up to 10,000 gallons per 10” of ultrafilter, depending on water quality
  Attains and maintains high flow rate (up to 3 GPM @ 20 psi per 10” segment)
  Meets ASTM F838-05 standard on bacterial retention


What is happening inside the filter then, that allows reuse of that same filter for dialysis?  The claim by the manufacturer seems to be the filter is reusable after disinfection.  If this is not so, and it may not be, how do dialysis patients survive regular dialysis?  Maybe they aren't and it hasn't been caught yet?  

Previously, the concern stated by an NIH study, was pathogens had been discovered at 15nm.  So I looked for lower and found the Nanoguard C that is claimed to filter down to 5nm.  If commercial filters cannot do better than 5nm, is the concern more about potential unknowns?  

If 5nm is the golden standard for a commercial dialysis filter, and if 1% bleach disinfects the filter sufficiently for reuse, what is left to consider?  I don't know how to gauge suspended solids.  Maybe someone else does?  On the other hand, again the same filter can be reused after being disinfected.

I do have a feeling there is a missing detail that might more clearly explain away concerns.  Or maybe it really does work as stated and I am a doubting Thomas? :)

The brochure is attached here again, in case someone is able to comprehend and explain more completely in lay terms, how this particular filter functions.
Filename: NanoGuard-C-Brochure-NEW.pdf
File size: 261 Kbytes
 
S Bengi
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While filter/strainers will separate sand/hair/granules/pulp and such most times they will not filter out the sugar molecules in say juice or salt in salty water.

And even the filters like say reverse osmosis that do separate salt/sugar/pharmaceuticals still produce two outputs one that is extra concentrated/brine/syrup and another that is 'clean'. The question still remains what do we do with the concentrated stuff.

A nano-filter is cleaned with bleach to kill infectious microbes/bacteria. They do not use the bleach to react with sugar/urea/pharmaceutical and turn it into harmless water.

I know that alot of these pharmaceutical look like creosote (carbon rings), so my personal plan is to find fungi that can use creosote as food and enlist them to breakdown my pharmaceutical metabolites and turn it into harmless CO2. Oyster Mushroom seems to fit the bill but I am sure alot more exist out there. https://www.researchgate.net/publication/231180793_Use_of_Edible_and_Medicinal_Oyster_Mushroom_Pleurotus_ostreatus_Jacq_Fr_Kumm_Spent_Compost_in_Remediation_of_Chemically_Polluted_Soils  
 
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Pearl......I have two compost toilets.  One for me, one for visitors.  As I basically eat only fruits, grains and a small amount of veggies....I dump mine at the back of my property, and something always eats it - LOL.  The visitors "gifts" go to the dump.

Pearl Sutton said: "The question I want to be able to answer is whether is if we should treat someone's humanure as nuclear waste when/if they are taking various medications.
I personally default to "it's nuclear waste." although I also consider things like eating at McDonald's a source of nuclear waste. I'm still building, and having a hard time with the idea that I don't want some people using my bathroom, since it goes to good uses. I don't think I can socially have a handle to flip for "if you eat or take anything horrifying, move the lever to the right  so your output gets extra processing." Maybe if I just have an unlabeled one that I can switch before company comes over...

 
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To answer the first question of what is a reliable source to know how a drug is metabolized you simply have to look up the drug in a PDR (Physician's Desk Reference).  This is a gigantic book available for purchase at a hefty price or check on-line at www.pdr.net.  E-mail for info to: < customer.service@medec.com>.  You might also check at the local library or a medical library if you live near one.  Many doctor's offices, clinics, and all pharmacies and hospitals have them for use by the staff in various departments. In this reference book you'll find info on pharmacokinetics, metabolism, elimination of drug and route of elimination, half life and other detailed info about drug interactions, uses, warnings, etc.  There are also PDR's for other things like Nutritional Supplements, Herbal Medicines and Nonprescription Drugs.  You might even ask a medical professional or library if they would give you their old/retired copy when they update to a new edition.  
 
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Denise Cares wrote:To answer the first question of what is a reliable source to know how a drug is metabolized you simply have to look up the drug in a PDR (Physician's Desk Reference).  This is a gigantic book available for purchase at a hefty price or check on-line at www.pdr.net.  E-mail for info to: < customer.service@medec.com>.  You might also check at the local library or a medical library if you live near one.  Many doctor's offices, clinics, and all pharmacies and hospitals have them for use by the staff in various departments. In this reference book you'll find info on pharmacokinetics, metabolism, elimination of drug and route of elimination, half life and other detailed info about drug interactions, uses, warnings, etc.  There are also PDR's for other things like Nutritional Supplements, Herbal Medicines and Nonprescription Drugs.  You might even ask a medical professional or library if they would give you their old/retired copy when they update to a new edition.  



Thank you Denise.  This ended up telling me exactly what we were looking to find out.   Not being medical, I tried to hunt for urine or feces, stool, etc.   Search for the word "excreted" after looking up the drug to find out how and it what form it is eliminated.

It also told me something that has me upset with my mother-in-law's doctor.   We found out that she should not be taking Tylenol with Metformin, which she takes for her mild diabetes.   This should have been told to us as I could have given this to her for a headache not knowing it would harm her.   So I am twice grateful for this link.
 
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