...............................................................................................................................................................
Protect
the Water Supply,.............
Pharmaceuticals
and Personal Care Products in Water
What Is
the Bottom Line for Consumers?
Rose
Ann Gould Soloway
The Bottom Line
Federal guidelines
for safe disposal of medicines aim to prevent unintentional poisonings, misuse
and diversion of discarded drugs, and to keep drugs within engineered
landfills, instead of in the water supply.
The Full Story
There are many ways
for pharmaceuticals and personal care products to enter ground water and
surface water.
These include water
that we drink and that we use for recreation such as swimming, fishing, and
boating. Of course, water also is home to a multitude of aquatic animals.
There are no
studies to date documenting human harm from the trace amounts of
pharmaceuticals and personal care products measured in water, but there are
studies in animals which indicate possible concerns.
Even though
substantive measures would require major resources and cooperation by a number
of government and private entities, there are steps that individuals can take
to limit the amount of pharmaceuticals and personal care products that they
introduce into ground and surface water.
How and why should
consumers be concerned about drug disposal?
The federal
government offered consumers the first-ever nationwide guidelines for disposing
of household drugs in 2007.
The goals were to
prevent unintentional poisonings from unused and/or expired drugs in the home,
prevent misuse and diversion of discarded drugs, and to keep drugs within
engineered landfills, instead of in the water supply.
The means suggested
were simple:
· Mix unused drugs with old coffee grounds or kitty litter, or
something else that no one would be tempted to swallow.
· Place this material in a container or zip-top plastic bag.
· Discard the container with household trash.
The old
recommendation of flushing drugs down the toilet or drain is no longer advised.
Exceptions are for
extremely toxic drugs and controlled substances which may be exceptionally
unsafe if swallowed unintentionally, taken in overdose, or abused; the most
common example is narcotic drugs.
How do drugs and
personal care products enter the water supply?
Even if all
consumers followed these recommendations, there are many ways for drugs and
personal care products to enter the water supply.
Examples include:
· Drugs and their breakdown products that are eliminated in urine
and feces and flushed down the toilet, thus entering the water supply through
sewage systems or as leachate from inadequate or leaking septic fields.
· Drugs that are eliminated through the skin and personal care
products applied to the skin, that then are washed down the drain.
· Drugs and personal care products that spread onto clothing; when
the clothing is washed, the chemicals go down the drain.
· Drugs from health care facilities that may not be legally
required to discard drugs as hazardous materials, for example, long-term care
facilities, medical and dental offices, and veterinarians.
· Sewage/waste water from hospitals and other health care
facilities, from which human waste is flushed or washed down the drain, just as
it is at home.
· Drugs from animal feeding operations and ranches.
· Domestic animal waste.
· Illicit drugs.
· Waste water treatment plants that do not filter all drugs,
potentially releasing drugs into the drinking water, water used for irrigation, and/or
into the sludge that may be used to fertilize food crops.
· Storm water overflow, during which water bypasses waste water
treatment plants.
· "Straight-piping", i.e. direct release of untreated
sewage into bodies of water.
What drugs are
found in drinking water?
The Associated
Press compiled a list of pharmaceuticals found in tap water in several areas
around the country.
These compounds
were identified in tests conducted by federal government agencies and
individual water providers.
Among the drugs
that were found in tap water were acetaminophen, caffeine, antibiotics,
antidepressants, anticonvulsants, antihistamines, non-steroidal
anti-inflammatory drugs, steroids, and female sex hormones.
The study notes
that water companies are not required by the federal government to test their
water for pharmaceuticals, many water companies do not routinely test tap water
for these compounds, and most companies do not make test results generally
available.
The U.S.
Environmental Protection Agency (EPA) reported that, in addition to steroids
and antibiotics, more than one hundred pharmaceuticals and personal care
products have been identified in drinking water and other environmental
samples.
In a pilot study of
fish from five sites near wastewater treatment sites and a control site in a
non-polluted area, seventeen pharmaceutical compounds were found in fish from
the five streams, including antidepressants and an antihistamine, but not in
fish from the control site.
The U.S. Geological
Survey collected drinking water samples from ground-water and surface-water
sites in half the U.S. states.
Chemicals found
included metabolites of nicotine and caffeine, bisphenol-A, fire
retardants, and a number of pharmaceuticals.
In an earlier study
by the U.S. Geological Survey of 139 streams in 30 states, researchers assessed
the water for the presence or absence of 95 chemicals.
One or more was
detected in 80 percent of the streams. Eighty-two of the 95 chemicals tested
for were found at least once.
In addition to
pharmaceuticals, researchers found triclosan, used as an
antimicrobial/disinfectant in consumer products; DEET, used in insect
repellants; fire retardants; detergents; and plasticizers.
Government and
industry researchers note, though, that the chemicals are found in minute
amounts.
For as long as
humans have ingested, injected, inhaled, or applied drugs and chemicals, these
substances and/or their metabolites most likely have been entering the
environment.
Many or most of
them are being identified now because testing has become increasingly
sensitive. In other words, an unknown number of substances may have been
present in water for some time, but it's only recently that technology existed
to measure such small quantities.
Some question whether
drugs found in amounts as low as parts per billion, or parts per trillion, are
even capable of causing harm, as these amounts are far lower than therapeutic
doses.
Is aquatic life
affected?
A number of
pharmaceuticals and personal care products have been measured in tissue of
aquatic species in the U.S.
For example, fish
exposed to wastewater from a metropolitan area sewage treatment plant exhibited
endocrine disruption, i.e. male fish produced female egg-yolk proteins.
In a widely
reported study of smallmouth bass from the Potomac River, male fish were found
to have female ovarian tissue within their testes.
Studies of
pharmaceuticals and other contaminants have been conducted in many countries
and have included insect and aquatic life as targets, with many types of
alterations found in structure and function.
No one believes
that the presence of human drugs and other products is desirable in water and
wildlife.
Even so, it can be
a challenge to ascribe some changes in aquatic life and other wildlife to the
presence of drugs, personal care products, and other substances in the water if
the baseline incidence of a particular abnormality is not known for comparison.
Are there
implications for human health?
To date, no studies
implicate chemicals in water with human health problems. There are concerns for
a number of reasons, however.
· As testing becomes more sensitive, we may learn that even more
drugs, personal care products, and other contaminants are in the water that we
use for drinking and recreation.
· It is not known if exposure to chemicals in drinking water poses
a hazard for pregnant women and their fetuses. It is theoretically possible
that a woman may be ingesting drugs that are contraindicated in pregnancy.
Also, it is not known if continual exposure to low or trace levels of these
substances has an effect on the woman or developing infant.
· It is theoretically possible for someone to ingest a drug to
which he or she is allergic.
· Drug resistance is a theoretical issue, if someone is regularly
ingesting measurable, even though tiny, amounts of a drug over a period of
time.
· Studies of potential health risks are typically carried out with
one drug or substance at a time. It is not known what, if any, problems may
occur with life-long ingestion of ever-changing combinations of drugs and
chemicals.
Even with these
potential concerns, the U.S. water supply is considered safe, based on current
knowledge.
EPA asserts that
U.S. drinking water is among the safest in the world.
(EPA notes that
there are more than 155,000 public suppliers of drinking water in the U.S. and
provides information for researching the quality of water in individual
communities.)
What is being done
to monitor for and eliminate pharmaceuticals and personal care products from water?
Existing research
regarding environmental pollutants is voluminous. Research is ongoing in
several areas, for example:
· Determining how various health care facilities manage unused
pharmaceuticals.
· Measuring substances in water and
elsewhere in the environment.
· Assessing the potential toxicity of pharmaceuticals and other
substances to aquatic life, wildlife, humans, and the environment.
· Determining the environmental fate of pharmaceuticals, personal
care products, and other chemicals as they enter the waste stream.
· Preventing such substances from entering the environment.
· Determining how best to strengthen the infrastructure of the
nation's water system, including upgrading water treatment plants to prevent
contaminants from entering the drinking water supply; eliminating failing
septic systems; and preventing contaminants from reaching aquifers from
landfills.
What is being done
now to eliminate drugs and personal care products from the water supply?
The EPA is
considering more than 100 chemicals, including pharmaceuticals, for inclusion
in regulations under the Safe Water Drinking Act. Also, the U.S. Department of
the Interior is funding water infrastructure improvements.
There are
requirements that pharmaceutical companies and other industries discharge only
treated water.
Depending on the
geographic area, there may be local regulations for agricultural and animal
management that address environmentally sound disposal of animal waste and
pesticides.
Many health care
facilities contract with disposal firms to discard unused pharmaceuticals in an
environmentally sound manner.
Community
pharmacies and law-enforcement organizations sometimes sponsor community
"drug take-back" programs, allowing consumers to turn in drugs that
then will be disposed of safely, according to relevant hazardous materials
guidelines.
Water
infrastructure improvements to limit or eliminate the number of substances
released into drinking water are desirable but would be very expensive.
What can consumers
do?
It would be ideal
if drugs and personal care products, along with pesticides and other chemicals,
never reached the water supply.
Realistically,
achieving this goal would require massive resources and cooperation among
academic, private, and government entities.
No one is advising
consumers to stop taking needed medicines, using sunscreen and insect
repellants, or medicating their pets as needed.
Every consumer,
though, can take individual steps to limit introduction of drugs and personal
care products into the water supply.
· Buy only drugs and products that are needed.
· Buy the minimum quantity needed. Purchasing a "giant
size" bottle of medication that cannot be used up before expiring is
wasteful; unused drug can enter the water supply when discarded.
· Take only the prescribed or recommended amount of needed drugs.
· Apply skin care products according to label instructions.
· Ask your physician for drug samples, if they are available and
appropriate for your condition, before filling a prescription that might not
work for you. (Be sure all drug samples are stored safely, out of sight and
reach of children.)
· If you have unused prescription medicines, ask your pharmacy if
they will take them back for disposal. If not, find out if they know of drug
take-back programs in your community.
· If drug take-back programs are not available to you, carefully
follow federal guidelines for disposal of unneeded and expired drugs.
· If you have a septic tank/field, be sure that it is maintained
properly to eliminate leakage of pharmaceutical and personal care product waste
into groundwater.
· Clean up pet waste promptly.
Prevention Tips
There are a number of ways that human and
veterinary drugs can enter the drinking water supply.
It would be ideal if drugs and personal care
products, along with pesticides and other chemicals, never reached the water
supply.
Every consumer, though, can take individual
steps to limit introduction of drugs and personal care products into the water
supply. Among them are safe disposal of medicines.
Mix unused drugs with old coffee grounds or
kitty litter, or something else that no one would be tempted to swallow.
Place this material in a closed container or
zip-top bag.
Discard the container with household trash.
Rose Ann Gould Soloway, RN, BSN, MSEd,
DABAT emerita
Clinical Toxicologist
Clinical Toxicologist
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