[Pharmwaste] Popular Science, C&E News articles

[Tenace, Laurie]

Sewage is more than just filth. It’s evidence of our worst habits, everything
from caffeine to cocaine, all ingested and flushed down the toilet. Now
scientists are using wastewater to drug-test entire cities, and the results
are sobering 
By Eric Hagerman Posted 02.21.2008 at 3:51 pm 0 Comments
http://www.popsci.com/scitech/article/2008-02/your-sewer-drugs - LONG
article, this is the first of 7 pages
  
Jörg Rieckermann snaps on a pair of purple rubber gloves, picks up a crowbar,
and levers a manhole cover out of the way. “Here’s my access to the
underworld,” Rieckermann, who speaks with a faint German accent, says as he
hoists up a barrel-shaped robot suspended above a stream of raw sewage.
Rieckermann’s protective gloves and orange jumpsuit are a sharp contrast to
the parched brown backdrop of San Diego. But there’s no guarding against the
stench. I can almost see the vapor, a rank blend of excrement and vomit that
hits me like nuclear-strength smelling salts. If hell has a smell, it has
found its way to this suburban portal, sandwiched between train tracks and a
highway just outside the city limits. 

Rieckermann seems unfazed. Moving with hunched urgency, the athletic
34-year-old pops open the top on the corrugated-plastic robot. The
contraption uses a vacuum pump and a long hose to siphon samples from the
sewage and then fill a carousel of plastic flasks with a mechanical arm.
Apparently the battery has died, because half the flasks are empty. “At least
it didn’t malfunction and overflow, like last time,” Rieckermann says,
adjusting his rimless eyeglasses. He punches a keypad to recalibrate the
draw. The robot beeps and gurgles and then spits up 100 millimeters of brown
water. “Now, that’s a nice sample,” he says, holding up a plastic test tube
full of sewage to the morning sun. “Liquid, plus particles—toilet paper,
feces, sludge, slime.” Not to mention traces of cocaine, methamphetamine,
marijuana, heroin and any number of other illicit substances ingested,
digested, and then flushed down the toilet. This spiked refuse is why we’re
here.

Rieckermann, a Swiss-trained environmental engineer, is one of a handful of
scientists in the world pioneering a controversial new field known as sewer
epidemiology, whose goal is to provide the first truly objective estimate of
illegal-drug consumption. He’s now visiting San Diego State University on a
research fellowship from the Swiss National Science Foundation to develop a
mathematical model of community drug use based on the amount of illicit
by-products that wind up in the sewers. 

The approach is, in essence, a community drug test. By analyzing wastewater
at treatment plants or at strategic spots throughout sewer systems,
scientists can run extraordinarily accurate and anonymous tests on an entire
population without ever asking anyone to hand over a cup of urine. (Everyone
has to use the toilet, after all.) If, say, Philadelphia implements an ad
campaign against methamphetamine, officials could gauge levels of the drug in
the wastewater to instantly see if it’s working. Maybe San Francisco is
considering building methadone clinics—does the data suggest they’re worth
it? And if law enforcement wants to know whether drug busts are reducing
consumption in certain neighborhoods, it could get an immediate answer.

Supporters say that wastewater testing provides objective data that links the
hard science of chemical analysis and the social science of epidemiology.
Conducting a urinalysis of an entire city, they argue, could be far less
expensive and time-consuming than surveys, which can take up to a year to
process. It would give officials the ability to study drug use in cities and
towns in nearly real time.

*****


Side Effects
Pharmaceuticals have been finding their way into our environment for a long
time, but just what are they doing there?
Bethany Halford
http://pubs.acs.org/cen/coverstory/86/8608cover.html

NO ONE EVER planned for fish to take birth control pills. But they are. As
treated wastewater flows into rivers and streams every day, fish all over the
world get a tiny dose of 17α-ethinylestradiol, a synthetic steroidal estrogen
that's used in birth control pills. They also get a little sip of the
anticonvulsant carbamazepine, a nip of the antidepressant fluoxetine, and a
taste of hundreds of other drugs that we take to make our lives better.

Every drug begins its life as a promise—a promise to fight disease or improve
our quality of life. It wends its way through the discovery process and
clinical trials until it ends up in our bodies, ready to do its job.

 
EPA
 
A Complex System Fish, plants, and other aquatic life are feeling the effects
of pharmaceuticals in the environment.But that's not the end of the story. A
drug doesn't simply disappear once it has served its purpose. People and
animals excrete pharmaceuticals and their metabolites, which then find their
way into the environment through a variety of routes—treated wastewater,
agricultural runoff, and biosolids and manure that are used as fertilizers.
Pharmaceuticals also enter the environment when people dispose of medications
by flushing them down the toilet or pouring them down the drain.

Concentration-wise, pharmaceuticals represent just a small fraction of the
thousands of man-made chemicals in the environment, including everything from
pesticides to personal care products. Even though medications have been in
the environment for as long as people have been taking them, it's only
through the advent of advanced analytical instrumentation and techniques that
scientists have been able to detect them in the wild.

The small concentrations, however, belie the potentially powerful effects of
these compounds. Pharmaceuticals are specifically designed to elicit a
biological response at very low levels, and scientists are increasingly
becoming aware of how medications let loose on the environment may have
effects no one ever anticipated.

By far, the most dramatic example of this kind of pharmaceutical pollution
has been the effect of estrogenic compounds on fish. In the 1990s, scientists
working in the U.K. noted that male fish living downstream from wastewater
treatment plants were becoming feminized. They were making proteins
associated with egg production in female fish, and they were developing
early-stage eggs in their testes. Feminized male fish have now been observed
in rivers and streams in the U.S. and Europe.

Research led by John Sumpter, an ecotoxicologist at England's Brunel
University, linked the feminizing phenomenon to the presence of estrogenic
compounds, such as the synthetic birth control compound 17α-ethinylestradiol
and the natural hormone 17β-estradiol, in the water (Environ. Sci. Technol.
1998, 32, 1549). Municipal wastewater treatment plants don't completely break
down these estrogenic compounds or their metabolites. For example,
17α-ethinylestradiol is excreted in the form of glucuronide and sulfate
conjugates. Bacteria in the wastewater treatment process cleave these
conjugate groups, regenerating the original estrogenic compound.

"It doesn't take a lot of estrogen to feminize male fish," says Karen A.
Kidd, a biology professor at the Canadian Rivers Institute, University of New
Brunswick. "If you can measure the estrogen in the water, then that's enough
to cause an effect, and we can measure it at very low parts-per-trillion
concentrations."

Kidd recently spearheaded a research project to study the overall impact of
estrogenic compounds on fish (Proc. Natl. Acad. Sci. USA 2007, 104, 8897).
"No one knew what feminization meant for the fish population," Kidd explains.
"Can feminized males still successfully reproduce, or is there going to be an
impact on the number of fish in the rivers? That's the big question we set
out to address."

FOR THREE SUMMERS, Kidd and her colleagues spiked a lake in Canada's
Experimental Lakes Area with 17α-ethinylestradiol at a concentration of 5
ppt—a concentration that has been measured in municipal wastewaters and in
river waters downstream of discharges. During the autumn that followed the
first addition of the estrogenic compound, the researchers observed delayed
sperm cell development in male fathead minnows—the freshwater equivalent of a
canary in a coal mine. A year later, the male fathead minnows were producing
eggs and had largely stopped reproducing. The minnow population began to
plummet. The decline continued for an additional three years until the fish
had all but disappeared from the lake.

The fathead minnow wasn't the only fish to feel the effects of the trace
amounts of birth control. The population of lake trout, which feed on smaller
fish, fell by about 30%. "The numbers of lake trout dropped not because of
direct exposure to the estrogens but because they lost their food supply,"
Kidd says.

But Kidd's story is not all doom and gloom. In 2006, three years after her
team stopped adding 17α-ethinylestradiol to the lake, the fathead minnow
population rebounded. "So given enough time, once you remove the estrogens
from a system, the fish can recover to their original population size," Kidd
notes.

Although estrogenic compounds may have the most dramatic effect on fish, they
aren't the only pharmaceuticals that have been implicated in the pollution of
aquatic environments. Laboratory studies have shown that the antidepressant
fluoxetine, or Prozac, can slow the development of fish and frogs. The
anticonvulsant carbamazepine affects the emergence of mosquito-like insects
that are a popular food source for certain fish.

"The challenge is that we don't have a good understanding of" a lot of drugs
that are being used, Kidd says. "We've looked at only a handful of the drugs
that are actually used and discharged into our waters. There are just a lot
of unknowns in this field right now."

And it's not just aquatic organisms that are feeling the effects of
pharmaceutical pollution. One study traced massive die-offs of vultures in
Asia to the veterinary use of diclofenac, a nonsteroidal, anti-inflammatory
(Nature 2004, 427, 630).

Diclofenac is frequently used to treat domestic livestock in India and
Pakistan. When these animals die from disease or injury, they're typically
left for scavengers. An international team of scientists, led by J. Lindsay
Oaks of Washington State University, found that the vultures were consuming
these carcasses and dying from renal failure and visceral gout caused by
diclofenac poisoning.

Scientists also worry that the massive amounts of antibiotics used to treat
livestock may be creating antibiotic-resistant microbes. "There's a whole
other source of pharmaceutical pollution that really needs attention, and
that's livestock use, which generates an estimated 500 million tons of waste
each year," says Dana W. Kolpin, a research hydrologist at U.S. Geological
Survey (USGS) who studies emerging contaminants in the environment.

Kolpin points out that livestock manure is full of antibiotics, synthetic and
biogenic hormones, and other veterinary medicines. Farmers use sludge
generated by sewage treatment plants as a fertilizer and a source of
nutrients for crops, but this material also contains excreted medications.

SCIENTISTS KNOW that these pharmaceuticals can travel into the environment as
agricultural runoff and soil contaminants. A new report from chemistry
professor Chad A. Kinney of Colorado State University, Pueblo, shows that
earthworms living in the contaminated soil can take up some of these
pharmaceuticals, notably the antibiotic trimethoprim, albeit in small amounts
(Environ. Sci. Technol., DOI: 10.1021/es702304c). "It shows there is uptake
into earthworms that leads to a potential pathway up the food chain, as
earthworms are a major food source for many higher organisms," says Kolpin,
who was a coauthor of the report. Studies have also shown that
pharmaceuticals can be taken up into crop plants (J. Agric. Food Chem. 2006,
54, 2288).


drug flow Pharmaceuticals and their metabolites enter municipal sewage
systems and aquifers from homes, health care facilities, and
farms.Researchers continue to suss out the subtle effects of pharmaceuticals
on the environment, such as antibiotic resistance and changes in feeding and
mating behaviors. But getting a handle on the whole problem is a huge task.
Not only do researchers need to consider the parent compounds in their
analyses, but they also have to look at metabolites and at the transformation
products that are formed either during treatment or from natural processes
taking place in the environment, such as microbial degradation and
photolysis.

"If you just look at the parent compound, that's only giving you a piece of
the story," Kolpin explains. "Each compound can break down and form new
environmental contaminants, which can become much more mobile and much more
persistent."

"Sometimes there are cases for which the biodegradation product is more toxic
than the parent compound," adds Diana Aga, an analytical chemist at State
University of New York, Buffalo, who is developing tools to detect trace
levels of pharmaceuticals.

Scientists also have to keep in mind that pharmaceuticals aren't isolated in
the environment, Kolpin notes. They could be acting in concert with a
surfactant, another pharmaceutical, or some other environmental contaminant.

The Food & Drug Administration requires pharmaceuticals to undergo an
environmental risk assessment before they can go on the market. These tests
are performed on both terrestrial and aquatic organisms, but they're usually
short-term tests that measure how much of a compound is required to kill an
organism outright or stunt its growth within a matter of days.

"If we're going to identify the compounds that are going to be problematic,
we need to be looking for the right things," says Bryan Brooks, an
environmental science professor at Baylor University. For example, he
explains, it takes a lot of 17α-ethinylestradiol to kill an aquatic organism,
so by current testing standards, the compound would appear to have a very low
potential risk. But feminization of male fish—something those short-term
tests would have never detected—occurs at very low concentrations of the
drug.

THE BIG QUESTION is whether pharmaceutical pollution has any impact on human
health. While trace amounts of pharmaceuticals do find their way into
drinking water, studies indicate that the concentrations are far too small to
elicit any appreciable effect.


Fetal exposure to certain pharmaceuticals is also a cause for concern. An
extreme example would be exposure to thalidomide or to a chemotherapeutic
drug, says Christian G. Daughton, chief of the environmental chemistry branch
at the Environmental Protection Agency's National Exposure Research
Laboratory. He adds, however, that "the doses that a fetus would get from its
mother ingesting several liters of water a day are still orders of magnitude
below the dosages that are known to cause effects."

Daughton says that toxicologists are now trying to understand the effects of
continual sustained exposure to multiple chemicals, each present at a very
low level. "It could be that the chemical stress that's put on any organism
is the result of minute stresses of a multitude of chemicals," whether
they're synthetic or naturally occurring compounds, he says.

Francesco Pomati, a toxicologist at Australia's University of New South
Wales, and colleagues at Italy's University of Insubria recently discovered
that a low-concentration mixture of 13 drugs—including a chemotherapeutic
agent and several antibiotics—can inhibit the growth of human embryonic
kidney cells in vitro (Environ. Sci. Technol. 2006, 40, 2442). It's important
to note, however, that the concentrations used were those found in the
environment, not in drinking water.

"Studies conducted to date suggest that it is highly unlikely that the
quantities of pharmaceuticals detected in the environment would be harmful to
human health," says Ken Johnson, senior vice president with Pharmaceutical
Research & Manufacturers of America.

"I think it's unambiguous that the trace pharmaceuticals we're seeing in
drinking water have no human health problems so far," adds Shane Snyder, an
environmental toxicologist at the Southern Nevada Water Authority. A few
months ago, Snyder published an analysis of water from 20 drinking water
utilities across the U.S. These utilities were treating water known to
contain wastewater that had come from a sewage treatment plant upstream.

Notably, Snyder's team did not detect any of the estrogenic compounds that
have been implicated in the feminization of fish in either the source water
or the treated drinking water. They did find that drinking water from at
least half of the treatment facilities contained ibuprofen, carbamazepine,
the antiepileptic dilantin, and the antianxiety drug meprobamate, but each
occurred in extremely low concentrations—in the parts-per-trillion range.

 
Pharmaceutical Pollutants Medications that scientists think may have negative
effects on the environment."The treatment processes we have are highly
effective," Snyder concludes. He points out that we're seeing more
pharmaceuticals in our environment because we're getting better at detecting
them, not necessarily because there are more of them. It's therefore
important, he says, to develop toxicologically based limits for
pharmaceuticals in our water. "If we ignore concentration and say presence or
absence is our litmus test, then there will be no end to that," Snyder says.
"Detection does not infer health risk and nondetection does not ensure
safety."

Snyder's study also assessed the removal of pharmaceuticals from drinking
water, using both conventional and advanced drinking water treatment
processes. Conventional treatments, such as coagulation, flocculation, and
filtration, were basically ineffective. Chlorination proved to be better,
removing about half of the compounds considered in the study. Advanced
treatments, such as ozonation, activated carbon, and reverse osmosis and
nanofiltration membranes, worked well, but these methods are expensive, and
they're generally used to treat drinking water, not wastewater.

"YOU HAVE TO keep in mind that sewage treatment plants were originally
designed a long time ago to improve the aesthetic quality of treated sewage
and to reduce the incidence of disease—to reduce odor and make the water look
better and get rid of bacteria and viruses," EPA's Daughton says. "They were
never engineered to remove synthetic substances."

Whether or not sewage treatment plants should be equipped to remove
pharmaceuticals is a matter of some controversy. "There's this huge
risk-benefit equation that's very difficult to address," Daughton explains.

"I think for a lot of drugs out there, we are probably more concerned than we
should be," says Alistair Boxall, an environmental chemist at the University
of York, in England. "I think there are examples of substances that perhaps
we do need to look at a bit further, but I'm not convinced we should be
putting advanced treatment mechanisms on every sewage treatment plant just to
get rid of pharmaceuticals."

Snyder agrees. "I would be very cautious about building energy-intensive
wastewater treatment plants," he tells C&EN.

"With regard to pharmaceuticals in the environment, I do believe that we have
the treatment technologies available to address these problems," says Nancy
G. Love, a professor of civil and environmental engineering at Michigan
University. "The challenge comes in improving the engineering implementation
of the technologies" to make them more cost-effective, she adds.

Even though pharmaceutical pollution is a problem we are equipped to deal
with, the solution may not be so simple if the contaminants are causing
antibiotic resistance, Love says. "We do not necessarily have the technology
to design antibiotics that are not vulnerable to generating
antibiotic-resistant characteristics in microbes. And if pollution is an
inducer of antibiotic resistance, then we have a larger problem on our hands
than we realize."

Scientists working in this area agree that more research needs to be done on
all aspects of pharmaceuticals' effects in the environment. "We need to
determine which compounds or sets of compounds are the worst players, and
then we need to make the decision whether these things need to be removed
before they get into the environment," USGS's Kolpin says. "There's more
information needed before any sort of policy or regulatory decision can be
made. Otherwise, I'm afraid it will be ineffective or unnecessary." 

****

What To Do With Your Unused Pharmaceuticals

http://pubs.acs.org/cen/coverstory/86/8608coverbox.html

Bethany Halford
Open up any medicine cabinet and you'll probably see shelves crammed with
expired and unused medications. The average American received more than 11
prescriptions in 2006, according to the Kaiser Family Foundation, adding up
to 3.3 billion prescriptions total. And that doesn't even take into
consideration all the nonprescription drugs we've got stockpiled in our
cupboards.

No one knows just how many of those unwanted meds get flushed away each year,
only to reemerge as trace contaminants in the environment. To get a handle on
just how many unused pharmaceuticals go down the drain, scientists at the
Environmental Protection Agency surveyed the drug inventory maintained by the
Clark County coroner's office in Las Vegas.

"When coroners investigate a death, they take a detailed inventory of all the
medications that are present, and then, as standard industry practice, they
often dispose of them down the toilet," explains Christian G. Daughton, chief
of the environmental chemistry branch at EPA's National Exposure Research
Laboratory, who led the study for EPA. "We know exactly what active
pharmaceutical ingredients were present and exactly what amounts were
disposed of during a particular period of time. So we're able to calculate
the minimum amounts that are being introduced to sewage and some very rough
extrapolations can be made to the general population."

Daughton and collaborator Ilene S. Ruhoy found that during a 13-month period,
the Clark County coroners flushed more than 325,000 doses of a wide array of
drugs, representing roughly 225 lb of active pharmaceutical ingredients
(APIs). Extrapolating from that data, Daughton and Ruhoy estimate that
orphaned medications from the deceased population alone account for as many
as 19.7 tons of APIs disposed into U.S. sewage systems annually (Sci. Total.
Environ. 2007, 388, 137).

Getting people to stop flushing away their unwanted medication is one easy
way to cut down on pharmaceutical pollution. So last year, the Office of
National Drug Control Policy (ONDCP) issued new federal guidelines for the
proper disposal of prescription drugs. According to the guidelines, unused,
unneeded, or expired prescription drugs should be removed from their original
containers and thrown in the trash.

To prevent accidental poisonings or potential drug abuse, ONDCP recommends
mixing meds with an undesirable substance, such as coffee grounds or kitty
litter. The mix should be placed into impermeable, nondescript containers,
such as empty cans or sealable plastic bags, before being tossed in the
trash.

In some cases, the risk of poisoning or abuse outweighs the potential
environmental impact. The Food & Drug Administration recommends that certain
controlled substances, such as the painkillers OxyContin and Percocet, are
best disposed of down the drain. A full list is available at ONDCP's website
(whitehousedrugpolicy.gov/drugfact/factsht/proper_disposal.html).

Pharmaceuticals sent to landfills, however, can end up at wastewater
treatment plants as part of the muck that leaches out of the landfill. To
ensure that drugs are disposed of in the most environmentally friendly
manner, individual communities are developing pharmaceutical take-back
programs that collect unwanted medications and then incinerate them.

"There are pilot programs going on all around the country," says Susan
Boehme, a coastal sediment specialist with Illinois-Indiana Sea Grant (IISG),
an organization that is educating communities in the Great Lakes region about
the environmental effects of unwanted medicines. Although there's currently
no national registry of pharmaceutical take-back programs, Boehme says that
IISG is working with the website earth911.org to set up such a database. In
the meantime, Boehme suggests that people interested in pharmaceutical
take-backs contact their local household and hazardous waste office to find
out if there's a program nearby.

Although it's not comprehensive, the Berkeley, Calif.-based Teleosis
Institute also lists a number of pharmaceutical take-back programs on its
website (www.teleosis.org). The institute launched its own take-back program
in May 2007 and has already collected and incinerated more than 800 lb of
unwanted medicines from people living in the San Francisco Bay area. The
program uses local pharmacies, doctor and dental offices, and other heath
care facilities as take-back sites.

The Teleosis Institute documents all of the returned medication and sends the
data to the Unused & Expired Medicine Registry, which compiles national
statistics on medicines returned and the reason for their disposal.
Currently, the institute is picking up the tab for the take-back program,
which costs about $4,000 annually for each of the program's 13 sites. The
program may be more costly than other take-back programs that don't do the
labor-intensive documentation or data analysis.

"By deepening our understanding of the quantities of medicines discarded, we
can better comprehend the effectiveness of our current pharmacological
approaches to illness, presenting a case for sustainable health care," says
Joel Kreisberg, the institute's executive director.




Laurie J. Tenace
Environmental Specialist
Florida Department of Environmental Protection
2600 Blair Stone Road, MS 4555
Tallahassee, Florida 32399-2400
PH: (850) 245-8759
FAX: (850) 245-8811
Laurie.Tenace at dep.state.fl.us 

Mercury web pages:
http://www.dep.state.fl.us/waste/categories/mercury/default.htm

Unwanted Medications web pages:
http://www.dep.state.fl.us/waste/categories/medications/default.htm




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