[Pharmwaste] PPCPs' Double Life

DeBiasi,Deborah dldebiasi at deq.virginia.gov
Fri Sep 15 15:23:31 EDT 2006


PPCPs' Double Life

Experts are concerned about the potential health and environmental
impacts of contaminants from pharmaceuticals and personal care products
that survive municipal wastewater treatment
By Sherleen H. Mahoney

Each and every one of us contribute to water pollution. "Not I," you
say? Well, if you use personal care products, such as shampoos, lotions,
or antiperspirants, you do. If you take any kind of medication,
over-the-counter or prescription, you do. Each year, thousands of tons
of chemicals from pharmaceuticals and personal care products (PPCPs)
infiltrate our environment with little or no resistance. PPCPs include
all drugs, over-the-counter and prescription, and any products used for
personal care, such as fragrances, cosmetics, sunscreens, antiseptics,
and soaps. In the United States, the top prescribed drug in 2005 was
hydrocodone with more than 100 million prescriptions, and according to
the American Academy of Dermatology, and the average adult uses at least
seven different skin-care products each day. And many households dispose
of expired or unwanted medication by simply flushing them down the

A Big Dose of Reality
PPCPs live a double life. We need many of them to stay hygienic and
healthy, but they are believed to adversely affect the environment.
Whenever we pop a pill, its effects continue long after the ailment is
alleviated. In fact, up to 90 percent of oral medications pass through
our bodies unchanged, and those compounds end up at water treatment
facilities that are not equipped to remove them. The same is true for
chemicals from personal care products. Aside from the aesthetic results,
chemicals from products that are applied topically are easily washed off
and end up in the environment. Researchers at the Johns Hopkins
Bloomberg School of Public Health found 75 percent of triclocarban, an
ingredient found in antibacterial hand soap, which is toxic when
ingested, remained intact after treatment in a wastewater facility. It
accumulates in wastewater sludge, which is then used to fertilize citrus
fruit, soy bean and carrot crops. 

"Typical wastewater treatment facilities, secondary, and tertiary
treatment plants are not designed to remove PPCPs from wastewater," said
Karin North, associate engineer with the City of Palo Alto's
Environmental Compliance Group. PPCPs are currently unregulated, and
with no means of specific removal, municipal wastewater, health, and
environmental professionals are concerned. PPCPs are constantly flowing
into the environment with unknown cumulative and synergistic effects.
They are designed to produce biological effects, even at therapeutic
doses, which means that even at low concentrations, they remain active
and may deviate from their original intent and cause different reactions
in the environment. 

Mounting Evidence
Recent monitoring studies have found low trace levels of PPCPs in the
parts-per-trillion and -billion, comparable to one drop in an
Olympic-sized swimming pool, in soils, sewage treated effluent, surface
water, groundwater, and even drinking water around the world. In Canada,
researchers at Edmonton's Enviro-Test Labs, found carbamazepine, an
epileptic drug, and emfibrozil, a cholesterol reducing drug in the
drinking water of four cities. Germany has been studying PPCPs for the
past decade. Thirty-one different PPCPs were found in 40 German rivers
and streams. The antidepressant, fluoxetine, better known as Prozac, was
found in trace amounts in groundwater in England. The most notable
state-side study was conducted by the U.S. Geological Survey (USGS) in
1999-2000, where 139 rivers in 30 states were tested and found that 80
percent of streams contained 31 different drugs. U.S. studies have also
confirmed the presence of PPCPs, such as naproxen, estrone, and
clofibric acid in drinking water. Thanks to new technology capable of
detecting low concentrations, it is no longer a question of if these
compounds are in our waters -- they are. A flood of new questions has
emerged with no answers; most importantly, what are their effects?

Side Effects
We are ingesting low traces of medication we don't need or want.
Sensitive populations, particularly pregnant women and children, are
believed to be most susceptible to any negative effects, but studies
have not shown any impacts on human health as of yet. The
Biogeochemistry Research Group at Harvard School of Public Health is
currently studying PPCPs to develop a ranking system to identify which
compounds pose the most significant threat to humans and the

To date, most of the research has been focused on aquatic environments.
There's a lot we don't know yet, but what we do know is that PPCPs are
blamed for various negative effects on marine life. Populations of male
fish are being feminized when exposed to wastewater containing low
concentrations of estrogen from oral contraceptives. They are growing
ovaries, suffering from low sperm count, producing egg proteins usually
found only in females, and in some cases, trying to lay eggs.

Antidepressants, including Prozac, Zoloft, and Paxil have been linked to
significantly delayed metamorphosis in amphibians, which may seriously
impact their survival rate. Fish and amphibians are sensitive to subtle
environmental changes and serve as biological indicators that may
predict future effects on other species. 

Increased use of antibiotics has created antibiotic-resistant pathogens,
and trace compounds from antibiotics may exacerbate the problem. USGS
found ampicillin-resistant bacteria in every U.S. river tested in 1999.
Combating drug-resistant bacterial strains will require more expensive
and more toxic alternatives, which, without PPCP removal, will only
cause a cyclical, snowballing effect.

What Works and What Doesn't
Municipal wastewater treatment facilities are not always successful in
removing PPCPs from wastewater. "There are thousands of PPCPs, each
chemical with different characteristics, some are water soluble, some
tend to sorb into solids, and some are a little of both. Therefore, some
PPCPs are removed or degraded during the normal treatment process and
some are not," North said. "Many PPCPs sorb into solids which are often
land applied. The sheer volume and constant input of PPCPs to the
wastewater treatment plant results in a constant discharge of PPCPs to
the environment, which results in a pseudo-persistence." 

The EU project, POSEIDON, was formed to assess technologies for PPCP
removal. Participants in this project included researchers from various
European countries, such as Germany's Federal Institute of Hydrology and
ECT Ecotoxicology Gmbh; Eawag; the Swiss Federal Institute of Aquatic
Science and Technology; France's Suez Environment and universities from
Finland, Austria, Spain, and Poland. The final results were published in
June 2005. They indicate:

Biological degradation and sorption are the main mechanisms for PPCP
removal during municipal wastewater treatment. 

Ozonation of treated effluent substantially reduces PPCP content.

Some PPCPs are degraded significantly during anaerobic sludge digestion.

Removal by sorption onto suspended solids is an important mechanism for
hydrophobic and positively charged compounds. 

Stripping is not relevant for PPCP removal in state-of-the-art municipal
wastewater treatment. 

A rough estimate of PPCP concentration in raw wastewater is directly
proportional to the amount of PPCPs sold. 

During irrigation and soil passage, most of the PPCPs (more than 80
percent) are sorbed or degraded. However, the irrigation can lead to a
pollution of groundwater with iodinated contrast media (ICM).

Ozonation or advanced oxidation processes (AOPs) are able to
substantially reduce the contamination of groundwater prior to
irrigation of treated wastewater. 

Acidic drugs, such as diclofenac, bezafibrate, and ibuprofen that are
removed easily during wastewater treatment are subject to additional
removal during post- treatment steps like polishing lagoons, gravel
filters, or infiltration ponds. Conversely, neutral substances, such as
diazepam and carbamazepine, that show poor removal rates during
wastewater treatment, remain stable during post-treatment steps as well
as in the groundwater. The polycyclic musks tonalide and galaxolide were
significantly removed during wastewater treatment and post-treatment
steps, but showed no significant further reduction during groundwater

With few exceptions, coagulation and flocculation are inappropriate to
remove PPCPs. 

Ozonation is a very effective treatment process to oxidize PPCPs.
Currently, there is no indication that the formed oxidation products are

Disinfection with chlorine and chlorine dioxide does not lead to a
general oxidation/removal of PPCPs. Only a few PPCPs were transformed. 

Activated carbon is a powerful process to remove PPCPs. Only a limited
number of PPCPs, such as iodinated contrast media and the antibiotic,
sulfamethoxazole show insufficient affinity to activated carbon. 

Nanofiltration and ultrafiltration/powdered activated carbon (PAC) are
powerful processes to remove PPCPs. 
What Can We Do Today?
Most wastewater professionals agree that the first step is source
control. One way to accomplish this is by educating the public about how
to properly disposal of medication. "We must first look at the
low-hanging fruit, which is the unwanted or expired medication that
people have historically and traditionally been told to flush down the
toilet as poison control measures, North said. "Now, we would rather
people bring them to their health hazard waste site or to a collection

Currently, pharmacies in the United States are not allowed to accept
unwanted or expired medication, but in May 2006 the Bay Area Pollution
Prevention Group (BAPPG) held Safe Medicine Collection Events at 32
locations throughout the San Francisco Bay area. More than 3,500 pounds
of unused or expired medications were collected at senior centers, city
hall, and pharmacies, mostly Walgreen's. "The goal is to provide
residents with an easy disposal option and to increase public
awareness," North said.

As the United States is still in the pilot-program stage, Europe,
Australia, and Canada are leading the way in instituting permanent
medication-return programs at pharmacies. The National Return and
Disposal of Unwanted Medicines, known as the RUM program in Australia,
allows the return of unwanted or expired medication to any pharmacy, at
any time. The medicines are then incinerated. The government pays for
disposal and advertising. The RUM program started in 1998 and collected
696,241 pounds of unwanted or expired medication in 2005. Canada has a
similar program that collected 52,800 pounds in 2004. 

Unknown Fate
The U.S. Environmental Protection Agency (EPA) began formally tracking
pharmaceuticals and PPCPs in 2002 and is conducting research to
determine potential negative effects. 

"The EPA formed the Federal Inter-Agency Task Group on Pharmaceuticals
in the Environment in January 2006, with a goal is develop research
strategies by 2007," said EPA spokesperson Enesta Jones. "PPCP research
has also been identified as one of the top 14 short-term, cross-regional
priorities." PPCPs are on the map, but it will be years until we learn
the results of all these studies. As we wait, the use of PPCPs will
certainly continue, if not increase, only adding to a larger problem to
clean up years from now.

Is My Water Safe to Drink?
With the public becoming more aware of PPCPs, municipal utilities will
be receiving calls from concerned residents. Though there are not a lot
of answers yet, utilities have a responsibility to calm their concerned
customers. Here are some suggestions, courtesy of Southern Nevada Water
Authority, for representatives of municipal drinking water and
wastewater treatment plants when communicating with the public:

Keep in mind, to the average person "parts per billion/trillion" means
contaminants are present, and that causes concern. They feel as though
water should be contaminant-free. This is impossible, so if a
contaminant doesn't warrant removal, the reason must be explained.

Due to the lack of answers, the public needs to feel that utilities are
taking a serious, proactive approach. Use lay terms and everyday
language instead of technical jargon to describe current measures. For
example, "We're working hard to find out whether or not these compounds
are harmful at low levels, and if they are, we will try to figure out
the best way to remove them." 

Give them real-world examples of other sources of exposure. For example,
soy products such as tofu, soy milk, and soy sauce contain millions of
times more estrogen than drinking water containing trace concentrations,
or stress how someone would need to drink hundreds of thousands of
gallons of water every day to match one Advil tablet. 

Never use cost as a reason to avoid implementing new or additional
treatment options.

Assign a primary contact who is knowledgeable and friendly to discuss
the issue with the public.

Develop and maintain a Web site on the topic and include articles from
agency publications. Customers will feel their utility is staying
current and wishes to serve as a source of information. 


U.S. Universities Involved in PPCP Studies
Harvard University
Columbia University
Duke University
Johns Hopkins University
Tulane University
Villanova University
Carnegie Mellon University
State University of New York at Stony Brook
Washington State University
Baylor University
University of Cincinnati
University of Washington
University of Delaware
University of North Carolina
University of Alaska Anchorage
University of Kansas
University of Arizona
University of Hawaii
University of Georgia
University of Tennessee
University of New Mexico
University of Minnesota
University of Oklahoma 

This article originally appeared in the September/October 2006 issue of
Water & Wastewater Products, Vol. 6, No. 5.

Sherleen H. Mahoney is associate editor of Water and Wastewater Products

Deborah L. DeBiasi
Email:   dldebiasi at deq.virginia.gov
WEB site address:  www.deq.virginia.gov
Virginia Department of Environmental Quality
Office of Water Permit Programs
Industrial Pretreatment/Toxics Management Program
Mail:          P.O. Box 10009, Richmond, VA  23240-0009 
Location:  629 E. Main Street, Richmond, VA  23219
PH:         804-698-4028
FAX:      804-698-4032

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