[Pharmwaste] Drugging Our Waters - long article

Tenace, Laurie Laurie.Tenace at dep.state.fl.us
Fri Sep 29 16:04:04 EDT 2006

by Elizabeth Royte

How An Aging Population And Our Growing Addiction To Pharmaceuticals May Be
Poisoning Our Rivers 

Norman Leonard moved to Heritage Village, a sprawling retirement community in
western Connecticut, 11 years ago. Its green-gabled condominiums and Capes
were well maintained, and the landscapers hadn't skimped on the
rhododendrons. A retired CPA, Leonard considers himself, at age 80, to be in
pretty decent shape: He plays platform tennis on the grounds and hikes often
in nearby forests and reserves. But still, he takes five different drugs a
day to manage his blood pressure, acid reflux, and high cholesterol. Heritage
Village is home to about 4,000 residents with similar medical profiles, who
take an average of six drugs a day. 

And that's a healthy population. In a convalescent home a few miles away,
Patricia Reilly, age 88, wheels herself each morning toward a low shelf. With
a glass of water and small cups of applesauce at the ready, she prepares to
take her morning medicines: nine different types that treat heart disease,
acid reflux, renal stones, a chronic urinary-tract infection, chronic
constipation, migraine headaches, depression, allergic rhinitis, degenerative
arthritis, and intermittent vertigo. The 120 residents of River Glen Health
Care Center, where the average age is 90, take an average of eight drugs a
day; the most common among them target high cholesterol, high blood pressure,
depression, and diabetes. Once swallowed, Reilly's medications will bring her
some relief, but their biological activity won't stop once they leave her

When residents of Heritage Village and two other nearby retirement
communities flush their toilets, wastewater laced with traces of prescription
drugs rushes through a series of pipes into the Heritage Village treatment
plant. This flushing is the main pathway by which pharmaceuticals enter the
environment. Hospitals and nursing homes routinely dump unused or expired
pills down the toilet, and consumers have been advised to do the same;
effluent from pharmaceutical manufacturers also ends up at municipal
wastewater treatment plants. Through a process of settling and aeration, the
Heritage Village plant separates liquids from solids, treats the liquid
portion with disinfectant, and then discharges this effluent into a
mini-creek that meanders between the third green and the seventh tee of the
Heritage Village golf course. Making its way through a riparian band of oaks
and maples, the creek fans out into the Pomperaug River, which loops without
further interruption through the town of Southbury. 

The Pomperaug looks no different upstream or down, but studies by the U.S.
Geological Survey (USGS) on other rivers suggest that the Pomperaug below the
effluent creek carries the signatures of drugs consumed by anyone plumbed
into the Heritage Village system. The effect of those drugs on the
environment, and possibly on those who drink water pumped from those streams,
is only beginning to be understood.

We are a nation obsessed with pharmaceuticals. We spend vast sums to manage
our health, and we pop pills to address every conceivable symptom. Some
elderly Americans take as many as 30 drugs a day, some of them merely to
counteract the effects of others. Prescription drug sales rose by an annual
average of 11 percent between 2000 and 2005. Americans now fill more than
three billion prescriptions a year; nationwide, more than 10 million women
take birth-control pills, and about the same number are on
hormone-replacement therapy. 

The rate at which prescriptions are dispensed is only going up as the
population ages. Already, those over 65 fill twice as many prescriptions per
year as do younger Americans. Inevitably, more drugs will be headed into
waterways like the Pomperaug. Our rivers -- already stressed by pollutants,
groundwater pumping, reduced flows, and overburdened wastewater treatment
plants that dump raw sewage -- will be ever less able to cope. 

Alarmed by data that showed trace levels of pharmaceuticals in European
streams, researchers in the United States have begun to survey our nation's
waterways. In 2002, the USGS published the results of its first-ever
reconnaissance of man-made contaminants. Using highly sensitive assays, the
agency found traces of 82 different organic contaminants -- fertilizers and
flame retardants as well as pharmaceuticals -- in surface waters across the
nation. These drugs included natural and synthetic hormones, antibiotics,
antihypertensives, painkillers, and antidepressants. 

Now that science has documented the presence of free-flowing pharmaceuticals,
researchers are faced with another, far more difficult, pair of questions:
What does this mean for the environment, and what does it mean for us? Early
evidence of harm to aquatic organisms is giving researchers grounds for real

On a dull November morning, two graduate students from the University of
Connecticut shiver on the steep banks of the Pomperaug. Monotonously,
repetitively, they plunge plastic jars two feet down into the beer-colored
water. Five-minute intervals tick away on a stopwatch. "Is it here yet?" asks
Dan Seremet. He's now midstream, his fleece cuffs dripping onto his chest
waders. Raquel Figueroa, squatting in a drift of crisp oak leaves, slips a
vial of water into a portable fluorometer, closes the gizmo's cover, taps a
button, and answers, "Point one nine."

So, no. It isn't here yet. 

Five minutes pass, Raquel shouts in her tiny voice, "Go!" and Dan,
maneuvering over slippery rocks, dips his jar again. Two hours pass, in
five-minute chunks, and the fluorometer, which detects and measures specific
particles in the water, rises only to 0.65 parts per billion (ppb). 

"Maybe we're in the wrong river," Dan sighs. Raquel doesn't bother to answer.
She logs the time and the concentrations. She dumps out samples. She
painstakingly removes a bittersweet vine holding her leg prisoner. "Next time
we should bring pruners," she says to no one in particular. Then, "Go!" Dan

In 30 minutes, the fluorometer rises to 2.45. Nothing to get excited about:
When the half cup of fluorescent magenta dye -- poured into the Pomperaug two
miles upstream and two hours earlier -- flowed past the previous monitoring
station, the reading peaked at just over 4 ppb. "Uh-oh," says Raquel when she
takes the next reading. "We're down to 2.301." In another five minutes it is

"I guess that was the peak," says Dan, his voice the opposite of a peak, as
he clambers out of the streambed. He and Raquel pack up their bottles and log
books, the fluorometer, a tape measure, and a flow meter (basically a pair of
spinning blades on a stick, used to measure the water's velocity), then drive
downstream to do it all again with the boss, at the last of four monitoring

The boss is Allison MacKay, an environmental engineer who specializes in
aquatic chemistry at the University of Connecticut. MacKay had risen at four
o'clock in the morning and loaded her car with gear, plus the sleepy Dan and
Raquel, then drove west to Southbury. By eight, she had poured her dye into
the Pomperaug at the point where it receives the Heritage Village effluent.
(Invisible to the naked eye, the dye is nontoxic and will degrade in sunlight
over three days.) With her grad students MacKay is tracking the dye's
progress down a six-mile stretch. The concentration of the dye, read by the
fluorometer, will tell her both the rate at which the Pomperaug flows and the
rate at which a particular contaminant is diluted as it flows downstream --
two useful bits of information when you're studying the movement of
contaminants from a single source. MacKay and her helpers are also taking
water samples that will later be analyzed for the presence of the same 82
organic contaminants originally assayed by the USGS.

In a turquoise parka and insulated pants, MacKay kneels on the sandy bank.
Her cheeks are pink in the cold air. If there is any fun to be had along a
New England river in November, this crew refuses to acknowledge it. There are
no observations on flora or fauna, no chitchat, no stone skipping or stick
building. MacKay is all business, and her students follow her lead. For eight
hours (no lunch break) they collect water and measure the river's depth,
width, and velocity. 

"The USGS does grab samples," says MacKay, rapidly punching a series of
numbers into her calculator and plotting points on a hand-drawn graph. Grab
samples are like snapshots, a single moment in a single place in a stream.
"Their studies established the presence of drugs in our waterways, but no one
in this country has looked at the temporal and spatial distribution or the
environmental degradation rates of pharmaceuticals in surface water. That's
what I'm doing." Among the factors that influence the compounds' fate are
sunlight, temperature, flow rate, microorganisms in the sediment, minerals,
and other chemicals in the water. If concentrations of any particular
contaminant decrease, MacKay explains, she'll set up controlled lab
experiments to see where, when, and how it happened: Was it the sun degrading
the compound, a change in temperature, or an organism that might have
consumed it? If aquatic life is suffering, she continues, researchers will
need to know what concentrations they're being exposed to at different points
in the stream.

This stretch of the Pomperaug makes an ideal laboratory for MacKay's study:
It is wadeable, and it has only one significant input of both water and
prescription compounds -- the Heritage Village treatment plant. The river is
also a paradigm of the nation's threatened waterways, of the large- and
small-scale changes that our growing population has wrought. Still, to drive
the country roads of Southbury and its neighboring villages is to marvel at
what hasn't changed in the past 200 years. Well-kept colonial houses still
flank water mills; nineteenth-century farm fences decorously sag. The stream
banks are, for the most part, intact. Trout congregate in deep pools. Though
some of its meanders and oxbows were mechanically straightened more than half
a century ago, the river still flows past horse farms and hemlock glades and
rolling hills. 

One can't help thinking the Pomperaug is privileged to run through a
stronghold of the well-to-do. All American rivers are, at some level,
endangered, but this one's remaining virtues are particularly obvious. Not
only is there plenty worth saving here, there are also plenty of stakeholders
eager to do the saving, among them a mild-mannered, semiretired internist
named Marc Taylor, who happens to live just a few miles downstream from
MacKay's sampling sites. 

Taylor is the medical director of the River Glen Health Care Center, where
Patricia Reilly lives, but he spends an inordinate amount of time fretting --
in public meetings and in private telephone calls with scientists,
politicians, city planners, and conservation groups -- about the health of
his river. "I'm concerned about pharmaceuticals in the river because I am a
doctor," says Taylor, who speaks in precisely measured sentences, "and
because I know these drugs are bioactive." That is, they can enter the
bioprocesses of aquatic organisms. 

As chairman of the Pomperaug River Watershed Coalition, Taylor has watched
with increasing concern as developers cut streets into nearby hillsides,
shopping centers supplant farms and orchards, and waves of the elderly flock
to four planned communities within the town limits. "As the population of the
watershed goes up," says Taylor, sitting in his basement office surrounded by
maps of the region, "more groundwater is being pumped. We've got three public
water companies drawing water from wells sunk near the Pomperaug." With a few
computer keystrokes, Taylor pulls up real-time data from a gauging station on
the river. This afternoon's flow is 250 cubic feet per second. Last summer it
dropped to 8 cubic feet per second -- one of the lowest flow rates in the
river's recorded history. Some small streams in the Pomperaug watershed now
completely disappear in the summer. 

The Pomperaug's peril is not unique. "Across the nation rivers are stressed,"
says Katherine Baer, advocacy director for American Rivers, which is based in
Washington, D.C. "As drought becomes more common, there is less water in
streams for aquatic life. Everywhere we see more development, sprawl, and
increased population. So we get higher pollution loads. Pharmaceuticals,
which become more concentrated with low water, are only increasing the

At the present time, in a project unrelated to its study of contaminants, the
USGS is making hydrologic models of how water enters, moves through, and
leaves the Pomperaug watershed. The Pomperaug River Watershed Coalition is
studying water quality, the dilution of treated wastewater, and, with the
help of Allison MacKay, the environmental fate of compounds left behind after
drugs have been metabolized by our bodies, as well as that portion of the
drugs that passes through us without being absorbed.

According to the Environmental Protection Agency, which is putting together a
database of literature on so-called emerging contaminants, those metabolites
are virtually everywhere, from the iconically dirty Chicago River to the
iconically pristine headwaters of Boulder Creek in Colorado. They're in the
intakes and outflows of water facilities in both urban and rural areas, in
groundwater, mountain streams, surface water, and domestic wells. And while
levels of pharmaceuticals are sometimes infinitesimally low, their supplies
are continually replenished. As a result, organisms that constantly bathe in
a chemical broth are beginning to reveal some alarming abnormalities.

In Boulder Creek, David Norris, an environmental endocrinologist at the
University of Colorado at Boulder, found that female white suckers,
bottom-feeding fish that grow up to a foot long, outnumber males by more than
five to one, and that 50 percent of males have female sex tissue. Similar
intersex changes have been found in flat-head chubs and smallmouth bass. The
cause, Norris suspects, is exposure to estrogen. Like most pharmaceuticals,
hormones aren't designed to break down easily. They're supposed to have an
effect at low dosages with chronic use, and they only partly dissolve in

"I'm worried for fish populations, and I'm worried for human populations,"
says Norris. "The levels found in Boulder Creek are low in absolute terms,
but they aren't low on the biological level. You could have six chemicals
below the no-effect level, but all together they are above the no-effect
level." In lab tests, frogs and rats have developed infections and
deformities after being exposed to multiple pollutants at extremely low
levels. Since exposure to only one compound is rare in the modern world,
sorting out "mixture effects" is a daunting but critical research area. The
estrogenic compounds in drinking water, Norris says, are "adding to the
general exposure of the human population to environmental estrogens in our
foods, and in containers that hold our foods. They all work through the same
mechanisms." In the United Kingdom, hormones in the environment have been
linked with lowered sperm counts and gynecomastia -- the development of
breasts in men. 

A Baylor University researcher found tiny amounts of Prozac in liver and
brain tissue of channel catfish and black crappie captured in a creek near
Dallas that receives almost all of its flow from a wastewater treatment
plant. The creek also connects to a drinking water supply. A University of
Georgia scientist found that tadpoles exposed to Prozac morphed into
undersize frogs, which are vulnerable to predation and environmental stress.
The EPA reports that antidepressants can have a profound effect on spawning
and other behaviors in shellfish and that calcium-channel blockers (used to
relieve chest pain and hypertension) can dramatically inhibit sperm activity
in some aquatic organisms. Even at extremely low levels, ibuprofen, steroids,
and antifibrotics -- a class of drugs that helps reduce the development of
scar tissue -- block fin regeneration in fish. According to a report by the
Scientific Committee on Problems of the Environment, a worldwide network of
scientists and scientific institutions, and the International Union of Pure
and Applied Chemistry, more than 200 species -- aquatic and terrestrial --
are known or suspected to have experienced adverse reactions to such
endocrine disruptors as estrogen and its synthetic mimics. (See "Hundreds of
Man-Made Chemicals Are Interfering With Our Hormones and Threatening Our
Children's Future" by Gay Daly, OnEarth, Winter 2006.)

Experts say pharmaceuticals have probably been in the environment for as long
as we've been using them. We're discovering them now because analytical
methods sensitive at the parts-per-trillion level and lower were only
recently developed. Surely the technology is a boon to society, but it opens
a Pandora's box of questions. We know that low concentrations of some
pharmaceuticals are affecting aquatic organisms, but what are they doing to
humans? What happens when organisms are exposed to multiple chemicals at the
same time? What happens when they bioconcentrate in living creatures or
accumulate in sediment? 

Traditionally, toxicologists have assessed environmental and health risks one
chemical at a time, focusing on such end points as birth defects or cancer.
More recently, scientists have begun to examine effects from combinations of
chemicals, an approach that more closely mimics the way organisms are exposed
to chemicals in the environment. Looking at end points that include immune
and reproductive system dysfunctions and neurological, cognitive, and
behavioral effects, researchers are finding that mixtures of chemicals can
lead to effects at much lower levels than do single chemicals, and that
low-level exposure can often induce results not seen at higher levels. Nearly
every week, results of new studies on emerging contaminants appear in
toxicology and environmental health journals.

"It may seem impossible to figure out what's happening," says Christian
Daughton, chief of the environmental chemistry branch of the EPA's National
Exposure Research Laboratory in Las Vegas, "but technology has a way of
leapfrogging. Less than a decade ago no one thought you could map the human
genome. Analytical chemistry progresses at a fast rate. Remember, we're only
talking about this now because we developed the technology to find these

Parsing the downstream effects of pharmaceutical compounds is an exceedingly
complicated task. For one thing, more than 100 new drugs -- both prescription
and over-the-counter -- are introduced each year. Researchers are confronted
with long latency periods for some human diseases, making it difficult to
connect an illness or disorder with long-ago exposures. Some of the drugs in
our waterways act upon more than one hormonal pathway; some may end up in
humans through multiple exposures (for example, antibiotics from both food
and water); and exposure to mixtures of contaminants may lead to an adverse
effect using one particular recipe, but produce a dif-ferent effect when the
ratio of those same ingredients is changed. "For many of these drugs, the
mechanism of action for humans is unknown," says Daughton. "So it's difficult
to anticipate what's going to happen to them after they've entered the
environment. There isn't even a database for all published work to show their
presence, their location, and their concentration."

This fall, when water flows are at their lowest, Allison MacKay, accompanied
by Raquel and another grad student, hopes to inch down the riverbanks once
again to capture small pieces of the Pomperaug. MacKay knows her study is
just the beginning of a very long process, but it is fundamental to an
understanding of drugs in our waterways. "The power of knowing about the fate
of these compounds is to use it in a predictive way," MacKay says. "Once we
know what's happening, we can say, 'I'm going to release this, and this is
when it will degrade.' I don't know about drugs, but pesticides have been
reformulated to degrade faster and be less bioaccumulative in water-ways." 

Could manufacturers reformulate pharmaceuticals in a similar way? "There's a
trade-off in terms of having molecules break down readily versus having a
stable molecule that does its work as a medicine and has a reasonable shelf
life," says Thomas White, a technical consultant to the Pharmaceutical
Research and Manufacturers of America (PhRMA), which represents brand-name
drug manufacturers and accounts for 80 percent of all drug sales in the
United States. "We've looked at studies of 26 compounds and there doesn't
appear to be any human health risk." Because there is no accepted methodology
for evaluating interactions among active pharmaceutical ingredients, the
studies that PhRMA reviewed, which came from a variety of sources, considered
drugs singly, not in combination. The PhRMA review included antibiotics,
cardiovascular drugs, and antidepressants, but not estrogen or steroids.
"Hormones," White concedes, "are a class of drug that would be a problem:
They're designed to affect the human endocrine system. Their fate effects are
under study now." 

Marc Taylor, like many health-care professionals, thinks a good first step
for getting drugs out of waterways is to persuade hospitals and nursing homes
to abandon their policy of flushing unused drugs down the toilet. A handful
of states and municipalities have launched pharmaceutical take-back programs,
in which consumers bring unwanted or expired medications to an official
collection site. Drugs are then either returned to manufacturers or disposed
of by incineration. But creating a national return policy is more complex
than it sounds. "You've got federal and state regulations, the governing
boards of pharmacies, and the Drug Enforcement Agency," says Daughton.
"Everyone has to get together." 

Even if the federal government did devise such a policy, it would deal only
with unused drugs, not with those actually swallowed and then flushed, which
is the primary pathway to the environment. If redesigning drugs to break down
sooner in the environment is a non-starter, then what about improving
wastewater treatment? "We already have the tools and technology to take out
everything," says Lynn Orphan, former president of the Water Environment
Federation, which represents operators of municipal wastewater treatment
plants. "We can use activated carbon or membrane filters, which have tiny
pores. There's reverse-osmosis filtration [which removes organic
contaminants] and exposure to ozone or to ultraviolet light. Sometimes it's
just a matter of extra retention time in holding tanks."

But Hugh Kaufman, a senior policy analyst on waste issues at the EPA, says,
"Some of those technologies have been demonstrated to work in a laboratory,
but they haven't been scaled up for day-to-day use. The cost of putting them
in place, plus their operation, is astronomical -- hundreds of millions over
the lifetime of a plant." 

Standing in his backyard, Marc Taylor can, with little effort, toss a stone
into the riffles of the Pomperaug. The water is so clear that he could, if he
wanted, easily retrieve it. He continues to swim in the river and to drink
from it -- his well water comes from the Pomperaug aquifer. 

As he awaits the results of MacKay's study, Taylor says, "I'll keep
prescribing the medications that Patricia Reilly and my other patients need."
In a philosophical mode, he continues, "The public will have to get used to
the reality that the drugs and chemicals we use all go somewhere and have
potential effects. The environmental fate of all consequential drugs and
chemicals should be known. It's worth studying because this problem is only
going to get worse as the population ages." For now, he says, "we'll have to
rely on the health of the fauna in our rivers to get hints about the
consequences to people. The fish and the amphibians are our canaries." 

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  
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