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{{short description|Medication legally requiring a medical prescription before it can be dispensed}}
[[File:PLcodes.jpg|thumb|Photo of the packaging of four medicines registered in the UK, showing their [[Product Licence Number]]s and symbols denoting if they are Prescription Only Medicine (POM) or Pharmacy Medicine (P)]]

A '''prescription drug''' (also '''prescription medication''' or '''prescription medicine''') is a [[pharmaceutical drug]] that legally requires a [[medical prescription]] to be dispensed. In contrast, [[over-the-counter drug]]s can be obtained without a prescription. The reason for this difference in [[controlled substance|substance control]] is the potential scope of misuse, from [[drug abuse]] to [[practicing without a license|practicing medicine without a license]] and without sufficient education. Different jurisdictions have different definitions of what constitutes a prescription drug.

In North America, '''℞''', usually printed as "Rx", is used as an abbreviation of the word "prescription". It is a contraction of the Latin word "''recipe''" (an imperative form of "recipere") meaning "take".<ref>{{Cite encyclopedia |title=Rx |encyclopedia=Merriam Webster Dictionary |url=https://www.merriam-webster.com/dictionary/Rx |access-date=16 April 2021}}</ref> Prescription drugs are often dispensed together with a [[Medication package insert|monograph]] (in Europe, a Patient Information Leaflet or PIL) that gives detailed information about the drug.

The use of prescription drugs has been increasing since the 1960s.

==Regulation==
{{more medical citations needed|section|date=July 2020}}

===Australia===
In [[Australia]], the [[Standard for the Uniform Scheduling of Medicines and Poisons]] (SUSMP) governs the manufacture and supply of drugs with several categories:<ref name="Home Office Poisons">{{Cite web |title=The Poisons Standard (the SUSMP) |url=http://www.tga.gov.au/industry/scheduling-poisons-standard.htm |access-date=17 September 2011 |publisher=[[Therapeutic Goods Administration]]}}</ref>
* Schedule 1 – Defunct Drug.
* Schedule 2 – Pharmacy Medicine
* Schedule 3 – Pharmacist-Only Medicine
* Schedule 4 – Prescription-Only Medicine/Prescription Animal Remedy
* Schedule 5 – Caution/Poison.
* Schedule 6 – Poison
* Schedule 7 – Dangerous Poison
* Schedule 8 – Controlled Drug (Possession without authority illegal)
* Schedule 9 – Prohibited Substance (Possession illegal without a license legal only for research purposes)
* Schedule 10 – Controlled Poison.
* Unscheduled Substances.

As in other developed countries, the person requiring a prescription drug attends the clinic of a qualified [[health practitioner]], such as a [[physician]], who may write the prescription for the required drug.

Many prescriptions issued by health practitioners in Australia are covered by the [[Pharmaceutical Benefits Scheme]], a scheme that provides subsidised prescription drugs to residents of Australia to ensure that all Australians have affordable and reliable access to a wide range of necessary medicines. When purchasing a drug under the PBS, the consumer pays no more than the patient co-payment contribution, which, as of January 1, 2022, is [[Australian dollar|A$]]42.50 for general patients. Those covered by government entitlements (low-income earners, welfare recipients, Health Care Card holders, etc.) and or under the [[Repatriation Pharmaceutical Benefits Scheme]] (RPBS) have a reduced co-payment, which is [[Australian dollar|A$]]6.80 in 2022.<ref name="About the PBS">{{Cite web |title=About the PBS |url=https://www.pbs.gov.au/info/about-the-pbs |access-date=26 September 2022 |publisher=[[Pharmaceutical Benefits Scheme]]}}</ref> The co-payments are compulsory and can be discounted by pharmacies up to a maximum of [[Australian dollar|A$]]1.00 at cost to the pharmacy.

=== United Kingdom ===

In the [[United Kingdom]], the [[Medicines Act 1968]] and the [http://www.legislation.gov.uk/uksi/1997/1830/made Prescription Only Medicines (Human Use) Order 1997] contain regulations that cover the supply of sale, use, prescribing and production of medicines. There are three categories of medicine:<ref name="HPC ">{{Cite web |title=About Registration: Medicines and Prescribing |url=http://www.hpc-uk.org/aboutregistration/medicinesandprescribing/ |url-status=dead |archive-url=https://web.archive.org/web/20160113121019/http://www.hpc-uk.org/aboutregistration/medicinesandprescribing/ |archive-date=13 January 2016 |access-date=15 February 2015 |publisher=[[Health and Care Professions Council]]}}</ref>
* Prescription-only medicines (POM), which may be dispensed (sold in the case of a private prescription) by a pharmacist only to those to whom they have been prescribed
* Pharmacy medicines (P), which may be sold by a pharmacist without a prescription
* General sales list (GSL) medicines, which may be sold without a prescription in any shop

The possession of a prescription-only medicine without a prescription is legal unless it is covered by the [[Misuse of Drugs Act 1971]].<ref name="Home Office Laws">{{Cite web |title=Other drug laws |url=http://drugs.homeoffice.gov.uk/drugs-laws/other-laws/ |archive-url=http://webarchive.nationalarchives.gov.uk/20100419081707/http://drugs.homeoffice.gov.uk/drugs-laws/other-laws/ |archive-date=19 April 2010 |publisher=[[Home Office]]}}</ref>

A patient visits a [[physician|medical practitioner]] or [[dentist]], who may prescribe drugs and certain other medical items, such as blood glucose-testing equipment for [[diabetic]]s. Also, qualified and experienced nurses and pharmacists may be independent prescribers. Both may prescribe all POMs (including controlled drugs), but may not prescribe Schedule 1 controlled drugs, and 3 listed controlled drugs for the treatment of addiction; which is similar to doctors, who require a special license from the Home Office to prescribe schedule 1 drugs. Schedule 1 drugs have little or no medical benefit, hence their limitations on prescribing. [[District nurse]]s and [[health visitor]]s have had limited prescribing rights since the mid-1990s; until then, prescriptions for dressings and simple medicines had to be signed by a doctor. Once issued, a prescription is taken by the patient to a pharmacy, which dispenses the medicine.

Most prescriptions are [[NHS prescription]]s, subject to a standard charge that is unrelated to what is dispensed. The [[NHS]] prescription fee was increased to £9.35 per item in [[National Health Service (England)|England]] on 1 April 2021;<ref>{{Cite web |title=How Much is the NHS Prescription Charge? |url=https://www.nhs.uk/common-health-questions/nhs-services-and-treatments/how-much-nhs-prescription-charge/ |access-date=15 June 2020 |publisher=NHS Choices}}</ref> prescriptions are free of charge if prescribed and dispensed in [[NHS Scotland|Scotland]],<ref>{{Cite news |date=5 December 2007 |title=Staged end to prescription charge |work=[[BBC News]] |url=http://news.bbc.co.uk/1/hi/scotland/7127997.stm}}</ref> [[NHS Wales|Wales]] and [[Health and Social Care in Northern Ireland|Northern Ireland]],<ref>{{Cite web |title=[NI] Prescription charges |url=http://www.nidirect.gov.uk/index/information-and-services/health-and-well-being/health-services/doctors-dentists-and-other-health-services/prescription-charges.htm |url-status=dead |archive-url=https://web.archive.org/web/20110829090132/http://www.nidirect.gov.uk/index/information-and-services/health-and-well-being/health-services/doctors-dentists-and-other-health-services/prescription-charges.htm |archive-date=29 August 2011 |access-date=12 July 2011 |publisher=NI Direct}}</ref> and for some patients in England, such as inpatients, children, those over 60s or with certain medical conditions, and claimants of certain benefits.<ref name="NHS Choices help">{{Cite web |title=NHS in England - help with health costs |url=http://www.nhs.uk/NHSEngland/Healthcosts/Pages/Prescriptioncosts.aspx |access-date=15 February 2017 |website=nhs.uk |publisher=NHS |id=NHS Choices}}</ref> The pharmacy charges the NHS the actual cost of the medicine, which may vary from a few pence to hundreds of pounds.<ref name="BMA">{{Cite web |date=23 March 2006 |title=Patients and prescribing: rights and responsibilities |url=http://www.bma.org.uk/ap.nsf/Content/InfoOnPrescrib0904~Pats&Prescrib |url-status=dead |archive-url=https://web.archive.org/web/20090109185952/http://www.bma.org.uk/ap.nsf/Content/InfoOnPrescrib0904~Pats%26Prescrib |archive-date=9 January 2009 |access-date=18 April 2010 |publisher=British Medical Association}}</ref><ref name="BMA 2">{{Cite web |date=September 2004 |title=Information and guidance on prescribing in general practice |url=http://www.bma.org.uk/images/Infoprescribingp0904_tcm41-20363.pdf |url-status=dead |archive-url=https://web.archive.org/web/20120607102134/http://www.bma.org.uk/images/Infoprescribingp0904_tcm41-20363.pdf |archive-date=2012-06-07 |publisher=British Medical Association}}</ref> A patient can consolidate prescription charges by using a prescription payment certificate (informally a "season ticket"), effectively capping costs at £30.25 per quarter or £108.10 per year.<ref name="NHS Choices help" />

Outside the NHS, [[private prescription]]s are issued by private medical practitioner and sometimes under the NHS for medicines that are not covered by the NHS.<ref name="BMA" /><ref name="BMA 2" /> A patient pays the pharmacy the normal price for medicine prescribed outside the NHS.

Survey results published by [[Ipsos MORI]] in 2008 found that around 800,000 people in England were not collecting prescriptions or getting them dispensed because of the cost, the same as in 2001.<ref>[http://www.ipsos-mori.com/researchpublications/researcharchive/151/Prescription-Costs-A-Barrier-To-Healthcare.aspx Ipsos MORI:Prescription Costs A Barrier To Healthcare, 27 February 2008]</ref>

===United States===
{{Regulation of therapeutic goods in the United States}}
In the United States, the [[Federal Food, Drug, and Cosmetic Act]] defines what substances require a prescription for them to be dispensed by a pharmacy. The federal government authorizes physicians (of any specialty), [[physician assistant]]s, [[nurse practitioner]]s and other [[advanced practice nurse]]s, veterinarians, dentists, and optometrists to prescribe any controlled substance. They are then issued unique [[DEA number]]s;<ref name="DEA Diversion Control Division 2017">{{Cite web |date=2017-07-14 |title=Registration |url=https://www.deadiversion.usdoj.gov/drugreg/index.html |access-date=2021-09-14 |website=DEA Diversion Control Division}}</ref> many other mental and physical health technicians, including basic-level [[registered nurse]]s, [[medical assistant]]s, emergency medical technicians, most psychologists, and social workers, for example, do not have the authority to prescribe any legend drugs or controlled drugs. Legend drugs are another name for drugs requiring a prescription.<ref>{{Cite web |date=2 November 2010 |title=US Nurse Practitioner Prescribing Law: A State-by-State Summary |url=http://www.medscape.com/viewarticle/440315 |access-date=26 November 2010 |publisher=Medscape Nurses}}</ref>

The [[Controlled Substances Act]] (CSA) was enacted into law by the [[US Congress]] of the United States in 1970. It is the federal drug law that regulates manufacture, importation, possession, use, and distribution of ''controlled'' substances. The legislation classes these substances into five schedules, with varying qualifications for each schedule. The schedules are designated [[List of Schedule I drugs (US)|schedule I]], [[List of Schedule II drugs (US)|schedule II]], [[List of Schedule III drugs (US)|schedule III]], [[List of Schedule IV drugs (US)|schedule IV]], and [[List of Schedule V drugs (US)|schedule V]]. Many drugs require a prescription, even though they are not a controlled substance.

The safety and the effectiveness of prescription drugs in the US are regulated by the 1987 [[Prescription Drug Marketing Act]] (PDMA). The [[Food and Drug Administration]] (FDA) is charged with implementing the law.

Misuse or abuse of prescription drugs can lead to adverse drug events, including those due to dangerous drug interactions.

The package insert for a prescription drug contains information about the intended effect of the drug and how it works in the body. It also contains information about side effects, how a patient should take the drug, and cautions for its use, including warnings about allergies.

As a general rule, ''[[over-the-counter drug]]s'' (OTC) are used to treat a condition that does not need care from a healthcare professional if have been proven to meet higher safety standards for self-medication by patients. Often, a lower strength of a drug will be approved for OTC use, but higher strengths require a prescription to be obtained; a notable case is [[ibuprofen]], which has been widely available as an OTC [[analgesic|pain killer]] since the mid-1980s, but it is available by prescription in doses up to four times the OTC dose for severe pain that is not adequately controlled by the OTC strength.

[[Herbal medicine|Herbal preparations]], [[amino acid]]s, [[vitamin]]s, [[Mineral (nutrient)|minerals]], and other [[food supplement]]s are regulated by the FDA as [[dietary supplements]]. Because specific health claims cannot be made, the consumer must make informed decisions when purchasing such products.<ref>{{Cite journal |last1=Alexander |first1=GC |last2=O'Connor |first2=AB |last3=Stafford |first3=RS |year=2011 |title=Enhancing prescription drug innovation and adoption |journal=Annals of Internal Medicine |volume=154 |issue=12 |pages=833–837 |doi=10.7326/0003-4819-154-12-201106210-00012 |pmc=4049188 |pmid=21690598}}</ref>

By law, American pharmacies operated by "membership clubs" such as [[Costco]] and [[Sam's Club]] must allow non-members to use their pharmacy services and may not charge more for these services than they charge as their members.<ref name="SavingAdvice">{{Cite web |last=Strain |first=Jeffrey |date=2 February 2015 |title=Can I Use the Costco Pharmacy Without a Membership? |url=https://www.savingadvice.com/articles/2015/02/02/1032625_can-i-use-the-costco-pharmacy-without-a-membership.html |archive-url=https://web.archive.org/web/20160403090900/http://www.savingadvice.com/articles/2015/02/02/1032625_can-i-use-the-costco-pharmacy-without-a-membership.html |archive-date=3 April 2016 |access-date=28 May 2016 |website=SavingAdvice.com}}</ref>

Physicians may legally prescribe drugs for uses other than those specified in the FDA approval, known as [[off-label use]]. Drug companies, however, are prohibited from marketing their drugs for off-label uses.

Large US retailers that operate pharmacies and pharmacy chains use inexpensive generic drugs as a way to attract customers into stores. Several chains, including Walmart, Kroger (including subsidiaries such as Dillons), Target, and others, offer $4 monthly prescriptions on select generic drugs as a customer draw.<ref>{{Cite web |title=$4 Generic Prescription Drugs |url=http://www.healthharbor.com/saving-money-on-prescriptions/4-generic-prescriptions |url-status=dead |archive-url=https://web.archive.org/web/20100210090514/http://www.healthharbor.com/saving-money-on-prescriptions/4-generic-prescriptions |archive-date=10 February 2010 |access-date=19 January 2010 |publisher=HealthHarbor}}</ref> Publix Supermarkets, which has pharmacies in many of their stores, offered free prescriptions on a few older but still effective medications to their customers, the program ended in 2022.<ref>{{cite news |title=Publix stops offering free prescription medications |url=https://health.wusf.usf.edu/health-news-florida/2022-06-03/publix-stops-offering-free-prescription-medications |access-date=2 October 2022 |work=Health News Florida |date=3 June 2022 |language=en}}</ref> The maximum supply is for 30 days.

Some prescription drugs are commonly abused, particularly those marketed as [[analgesic]]s, including [[fentanyl]] (Duragesic), [[hydrocodone]] (Vicodin), [[oxycodone]] (OxyContin), [[oxymorphone]] (Opana), [[propoxyphene]] (Darvon), [[hydromorphone]] (Dilaudid), [[meperidine]] (Demerol), and [[diphenoxylate]] (Lomotil).<ref>{{Cite web |title=Prescription Drugs & Cold Medicines |url=http://www.drugabuse.gov/drugs-abuse/prescription-drugs-cold-medicines |access-date=12 September 2015 |website=www.drugabuse.gov |publisher=National Institute of Health}}</ref>

Some prescription painkillers have been found to be addictive, and unintentional poisoning deaths in the United States have skyrocketed since the 1990s according to the [[National Safety Council]].<ref>{{Cite book |title=Injury Facts |publisher=National Safety Council |year=2017 |isbn=978-0-87912-357-4 |pages=161}}</ref> Prescriber education guidelines as well as patient education, [[prescription drug monitoring program]]s and regulation of pain clinics are regulatory tactics which have been used to curtail opioid use and misuse.<ref>National Safety Council (2017). The State of Safety - A State-by-State Report. Itasca, IL. Pg. 30-31. accessed at: http://www.nsc.org/NSCDocuments_Advocacy/State-of-Safety/State-Report.pdf {{Webarchive|url=https://web.archive.org/web/20170728171306/http://www.nsc.org/NSCDocuments_Advocacy/State-of-Safety/State-Report.pdf |date=2017-07-28 }}</ref>

==Expiration date==
The expiration date, required in several countries, specifies the date up to which the manufacturer guarantees the full potency and safety of a drug. In the United States, expiration dates are determined by regulations established by the FDA.<ref>{{Cite web |date=8 February 2019 |title=Questions and Answers on Current Good Manufacturing Practices, Good Guidance Practices, Level 2 Guidance - Records and Reports |url=https://www.fda.gov/Drugs/GuidanceComplianceRegulatoryInformation/Guidances/ucm124787.htm |publisher=[[United States Food and Drug Administration]]}}</ref> The FDA advises consumers not to use products after their expiration dates.<ref>{{Cite web |date=14 July 2015 |title=Expiration Dates Matter |url=https://www.fda.gov/ForConsumers/ConsumerUpdates/ucm251658.htm |access-date=12 September 2015 |publisher=[[United States Food and Drug Administration]]}}</ref>

A study conducted by the U.S. Food and Drug Administration covered over 100 drugs, prescription and over-the-counter. The results showed that about 90% of them were safe and effective far past their original expiration date. At least one drug worked 15 years after its expiration date.<ref>{{Cite journal |title=Proceedings |journal=Baylor Univ. Medical CTR. |volume=13 |page=309}}</ref> Joel Davis, a former FDA expiration-date compliance chief, said that with a handful of exceptions—notably [[Glyceryl trinitrate (pharmacology)|nitroglycerin]], [[insulin]], some liquid antibiotics; outdated [[tetracyclines]] can cause [[Fanconi syndrome]]—most expired drugs are probably effective.<ref>{{Cite news |last=Cohen |first=Laurie P. |date=2000-03-28 |title=Many Medicines Prove Potent for Years Past Their Expiration Dates |volume=235 |pages=A1 |work=[[The Wall Street Journal]] |issue=62}}</ref>

The [[American Medical Association]] (AMA) issued a report and statement on Pharmaceutical Expiration Dates.<ref>{{Cite web |date=June 2001 |title=Report 1 of the Council on Scientific Affairs (A-01) Full text: Pharmaceutical Expiration Dates |url=http://www.ama-assn.org/ama/no-index/about-ama/13652.shtml |publisher=[[American Medical Association]]}}</ref> The [[Harvard Medical School]] Family Health Guide notes that, with rare exceptions, "it's true the effectiveness of a drug may decrease over time, but much of the original potency still remains even a decade after the expiration date".<ref name="HHPExpiration">[http://www.health.harvard.edu/fhg/updates/update1103a.shtml Drug Expiration Dates - Do They Mean Anything?]. [[Harvard Medical School|Harvard]] Health Publications. Retrieved on February 15, 2011.</ref>

The expiration date is the final day that the manufacturer guarantees the full potency and safety of a medication. Drug expiration dates exist on most medication labels, including prescription, over-the-counter (OTC) and dietary (herbal) supplements. U.S. pharmaceutical manufacturers are required by law to place expiration dates on prescription products prior to marketing. For legal and liability reasons, manufacturers will not make recommendations about the stability of drugs past the original expiration date.<ref>{{Cite web |date=10 February 2014 |title=Drug Expiration Dates - Are They Still Safe to Take? |url=https://www.drugs.com/article/drug-expiration-dates.html |access-date=12 September 2015 |publisher=drugs.com}}</ref>

==Cost==
[[Prices of prescription drugs|Prices for prescription drugs]] vary widely around the world.<ref name="HHPCosts">https://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/themes/drug.html . Frontline. Posted April 15, 2008.</ref> [[Prescription costs]] for [[biosimilar]] and [[generic drugs]] are usually less than brand names, but the cost is different from one pharmacy to another.<ref name="HHP">http://www.healthtalk.umn.edu/2013/03/29/new-report-prescription-drug-prices-can-vary-widely/ . University of Minnesota. March 29, 2013.</ref>

Prescription drug prices including generic prices are rising faster than the average rate of inflation. To lower prescription drug costs, some [[United_States |U.S.]] patients buy medicine in [[Canada]] or online.<ref name="WZZM13">{{cite web | url=https://www.wzzm13.com/article/news/investigations/13-on-your-side/the-canadian-remedy-how-to-save-hundreds-on-prescription-drugs/69-407942367 | title=The Canadian Remedy: How to save hundreds on prescription drugs }}</ref>

Generics undergo strict scrutiny to meet the equal efficacy, safety, dosage, strength, stability, and quality of brand name drugs.<ref name=":1">{{Cite web |last=Research |first=Center for Drug Evaluation and |title=Questions & Answers - Generic Drugs: Questions & Answers |url=https://www.fda.gov/drugs/resourcesforyou/consumers/questionsanswers/ucm100100.htm |access-date=2017-10-31 |website=www.fda.gov}}</ref> Generics are developed after the brand name has already been established, and so generic drug approval in many aspects has a shortened approval process because it replicates the brand name drug.<ref name=":1" />

Brand name drugs cost more due to time, money, and resources that drug companies invest in in order to repeat research clinical trials that the FDA requires for the drug to remain in the market.<ref name=":2">{{Cite web |last=Research |first=Center for Drug Evaluation and |title=Generic Drugs - Generic Drug Facts |url=https://www.fda.gov/Drugs/ResourcesForYou/Consumers/BuyingUsingMedicineSafely/GenericDrugs/ucm167991.htm |access-date=2017-10-31 |website=www.fda.gov}}</ref> Because drug companies have to invest more in research costs to do this, brand name drug prices are much higher when sold to consumers.<ref name=":2" />

When the patent expires for a brand name drug, generic versions of that drug are produced by other companies and are sold for lower price. By switching to generic prescription drugs, patients can save significant amounts of money: e.g. one study by the [[FDA]] showed an example with more than 50% savings of a patient's overall costs of their prescription drugs.<ref>{{Cite web |last=Research |first=Center for Drug Evaluation and |title=Resources for You - Savings From Generic Drugs Purchased at Retail Pharmacies |url=https://www.fda.gov/drugs/resourcesforyou/ucm134205.htm |access-date=2017-10-31 |website=www.fda.gov}}</ref>

== Drug cost containment strategies in the US ==
In the United States there are many resources available to patients to lower the costs of medication. These include copayments, coinsurance, and deductibles. The [[Medicaid Drug Rebate Program]] is another example.<ref>{{Cite web |title=Cost Sharing Out of Pocket Costs |url=https://www.medicaid.gov/medicaid/cost-sharing/out-of-pocket-costs/index.html |access-date=12 June 2018 |website=Medicaid.gov}}</ref>

Generic drug programs lower the amount of money patients have to pay when picking up their prescription at the pharmacy. As their name implies, they only cover generic drugs.<ref>{{Cite web |title=Generic Drug Facts |url=https://www.fda.gov/Drugs/ResourcesForYou/Consumers/BuyingUsingMedicineSafely/GenericDrugs/ucm167991.htm |access-date=12 June 2018 |website=FDA}}</ref>

Co-pay assistance programs are programs that help patients lower the costs of specialty medications; i.e., medications that are on restricted formularies, have limited distribution, and/or have no generic version available. These medications can include drugs for HIV, hepatitis C, and multiple sclerosis. Patient Assistance Program Center ([http://www.rxassist.org/providers/resources RxAssist]) has a list of foundations that provide co-pay assistance programs. It is important to note that co-pay assistance programs are for under-insured patients. Patients without insurance are not eligible for this resource; however, they may be eligible for patient assistance programs.

Patient assistance programs are funded by the manufacturer of the medication. Patients can often apply to these programs through the manufacturer's website. This type of assistance program is one of the few options available to uninsured patients.

The out-of-pocket cost for patients enrolled in co-pay assistance or patient assistance programs is $0. It is a major resource to help lower costs of medications – however, many providers and patients are not aware of these resources.

== Environment ==
Traces of prescription drugs — including [[antibiotics]], [[Anticonvulsant|anti-convulsants]], [[mood stabilizer]]s and [[Sex steroid|sex hormones]] — have been detected in drinking water.<ref>{{Cite news |last1=Jeff Donn |last2=Martha Mendoza |last3=Justin Pritchard |date=2008-03-10 |title=Drugs found in drinking water |work=[[USA Today]] |agency=[[Associated Press]] |url=https://www.usatoday.com/news/nation/2008-03-10-drugs-tap-water_N.htm |url-status=dead |access-date=2011-02-15 |archive-url=https://web.archive.org/web/20080313232557/http://www.usatoday.com/news/nation/2008-03-10-drugs-tap-water_N.htm |archive-date=2008-03-13}}</ref><ref>{{Cite news |last=Gray |first=Richard |date=2008-01-13 |title=Cancer drugs found in tap water |work=[[The Sunday Telegraph]] |url=https://www.telegraph.co.uk/earth/earthnews/3321519/Cancer-drugs-found-in-tap-water.html |url-status=dead |access-date=2010-01-19 |archive-url=https://web.archive.org/web/20090317094640/http://www.telegraph.co.uk/earth/earthnews/3321519/Cancer-drugs-found-in-tap-water.html |archive-date=2009-03-17}}</ref> Pharmaceutically active compounds (PhACs) discarded from human therapy and their metabolites have been found to not be eliminated by sewage treatment plants and have been found at low concentrations in surface waters downstream from those plants.<ref name=":7">{{Cite journal |last=Li |first=W. C. |date=2014-04-01 |title=Occurrence, sources, and fate of pharmaceuticals in aquatic environment and soil |journal=Environmental Pollution |volume=187 |issue=Supplement C |pages=193–201 |doi=10.1016/j.envpol.2014.01.015 |pmid=24521932}}</ref> The continuous discarding of incompletely treated water may interact with other environmental chemicals and lead to uncertain ecological effects.<ref>{{Cite journal |last=Heberer |first=Thomas |date=2002-05-10 |title=Occurrence, fate, and removal of pharmaceutical residues in the aquatic environment: a review of recent research data |journal=Toxicology Letters |volume=131 |issue=1 |pages=5–17 |doi=10.1016/S0378-4274(02)00041-3 |pmid=11988354}}</ref> Due to most pharmaceuticals being highly soluble, fish and other aquatic organisms are susceptible to their effects.<ref name=":7" /> The long term effects of pharmaceuticals in the environment may affect survival and reproduction of such organisms.<ref name=":7" /> However, levels of medical drug waste in the water is at a low enough level that it is not a direct concern to human health. However, processes, such as [[biomagnification]], are potential human health concerns.<ref>{{Cite journal |last=Boxall |first=Alistair B.A. |date=December 2004 |title=The environmental side effects of medication |journal=EMBO Reports |volume=5 |issue=12 |pages=1110–1116 |doi=10.1038/sj.embor.7400307 |issn=1469-221X |pmc=1299201 |pmid=15577922}}</ref>

On the other hand, there is clear evidence of harm to aquatic animals and fauna. Recent advancements in technology have allowed scientists to detect smaller, trace quantities of pharmaceuticals in the ng/ml range.<ref name=":8">{{Cite journal |last=Fabbri |first=Elena |date=March 2015 |title=Pharmaceuticals in the environment: expected and unexpected effects on aquatic fauna |journal=Annals of the New York Academy of Sciences |volume=1340 |issue=1 |pages=20–28 |bibcode=2015NYASA1340...20F |doi=10.1111/nyas.12605 |issn=1749-6632 |pmid=25557669 |hdl=11585/556827 |s2cid=2567919}}</ref> Despite being found such low concentrations, female hormonal contraceptives have been documented to cause feminizing effects on male vertebrate species, such as fish, frogs and crocodiles.<ref name=":8" /> A promising model has been developed to further study the effects on the aquatic environment. The ''biological read across model'' combines the concepts of the mechanism of action (MoA) and adverse outcomes pathway (AOP).<ref name=":8" /> In other words, the species being studied needs to have similar mechanisms by which the pharmaceutical acts on the species and reach similar concentrations that would be enough to cause an effect in humans.<ref name=":8" /> Studying these relations may give us more quantifiable information on the effects of pharmaceuticals in the environment.

Currently, research is being done on various methods of reducing chemical waste in the environment. In addition, FDA established guidelines in 2007 to inform consumers should dispose of prescription drugs.<ref>{{Cite news |title=External Medicine: Discarded Drugs May Contaminate 40 Million Americans' Drinking Water |work=Scientific American |url=https://www.scientificamerican.com/article/pharmaceuticals-in-the-water/ |access-date=2017-11-15}}</ref> When medications do not include specific disposal instructions, patients should not flush medications in the toilet, but instead use medication take-back programs. This aims to reduce the amount of pharmaceutical waste that gets into sewage and landfills.<ref name=":6">{{Cite journal |last=Lubick |first=Naomi |date=May 2010 |title=Drugs in the Environment: Do Pharmaceutical Take-Back Programs Make a Difference? |journal=Environmental Health Perspectives |volume=118 |issue=5 |pages=A210–A214 |doi=10.1289/ehp.118-a210 |issn=0091-6765 |pmc=2866706 |pmid=20435558}}</ref> If no take-back programs are available, prescription drugs can be discarded in household trash after they are crushed and/or dissolved and then mixed in a separate container or sealable bag with undesirable substances like cat litter or other unappealing material (to discourage consumption).<ref name=":6" />

== See also ==
{{Div col}}
* [[Controlled Substances Act|U.S. Controlled Substances Act]]
* [[Co-pay card]]
* [[Classification of Pharmaco-Therapeutic Referrals]]
* [[Drug policy]] – policy regulating drugs considered dangerous, rather than only medicinal
* [[Inverse benefit law]]
* [[List of pharmaceutical companies]]
* [[Package insert]]
* [[Pharmacy (shop)]]
* [[Pharmacy automation]]
* [[Pill splitting]]
* [[Prescription drug prices in the United States]]
* [[Regulation of therapeutic goods]]
{{Div col end}}

==References==
{{Reflist|30em}}

==Further reading==
{{refbegin}}
* [https://web.archive.org/web/20130122030301/http://www.yaleeconomicreview.com/spring2005/optimallevelofregulation.php The Optimal Level of Regulation in the Pharmaceutical Industry (Yale Economic Review)]
* Jerry Avorn, ''Powerful Medicines: The Benefits, Risks, and Costs of Prescription Drugs'', Random House (2004), hardcover, 448 pages, {{ISBN|0-375-41483-5}}
* {{Cite news |last=Donna Leinwand |date=June 13, 2006 |title=Prescription drugs find place in teen culture |work=[[USA Today]] |url=https://www.usatoday.com/news/health/2006-06-12-teens-pharm-drugs_x.htm}}
{{refend}}

{{Pharmacy}}

{{二次利用|date=27 December 2022}}
{{DEFAULTSORT:Prescription Drug}}
[[Category:Clinical pharmacology]]
[[Category:Pharmaceuticals policy]]
[[Category:Drugs]]
[[Category:Pharmacy]]

[[es:Medicamento]]

Prescription drug - Revision history