[Pharmwaste] pharmwaste

matthew mireles mirelesmc at earthlink.net
Sun Mar 9 21:57:22 EDT 2008

While we are curious about the method and scientific inquiry of AP in
conducting environmental risk assessment, specifically water quality and
identification of certain compounds, the results very consistent with other
findings from more scientific groups.  Additionally, we may have clues to
the type of drugs found in the water samples.  Data from samples of drug
take-back and disposal programs have indicated that psychotherapeutic drugs
are the most common unused and expired drugs that are returned, or otherwise
flushed down the toilet or sink.  We also estimated from actual pill (tablet
and capsule) count that about 40% of prescription drugs are never used by
the patient/consumer, and these drugs would eventually end in the water
supply.  For more info, contact us or visit the Maine Benzodiazepine Study
Group (www.mainebenzo.org).  There is an upcoming conference in Oct 2008 to
continue this discussion, and sponsors and underwriters are invited.  If you
are involved in this area or are concerned about drugs in the water supply,
join us in October.


Matthew C. Mireles, PhD, MPH

President and CEO

Community Medical Foundation for Patient Safety




From: pharmwaste-bounces at lists.dep.state.fl.us
[mailto:pharmwaste-bounces at lists.dep.state.fl.us] On Behalf Of Michele
Sent: Sunday, March 09, 2008 12:55 PM
To: pharmwaste at lists.dep.state.fl.us
Subject: [Pharmwaste] pharmwaste


AP news on drugs in the water Sunday morning 3/9/08






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AP probe finds drugs in drinking water 

54 minutes ago 

A vast array of pharmaceuticals - including antibiotics, anti-convulsants,
mood stabilizers and sex hormones - have been found in the drinking water
supplies of at least 41 million Americans, an Associated Press investigation

To be sure, the concentrations of these pharmaceuticals are tiny, measured
in quantities of parts per billion or trillion, far below the levels of a
medical dose. Also, utilities insist their water is safe.

But the presence of so many prescription drugs - and over-the-counter
medicines like acetaminophen and ibuprofen - in so much of our drinking
water is heightening worries among scientists of long-term consequences to
human health.

In the course of a five-month inquiry, the AP discovered that drugs have
been detected in the drinking water supplies of 24 major metropolitan areas
- from Southern California to Northern New Jersey, from Detroit to
Louisville, Ky.

Water providers rarely disclose results of pharmaceutical screenings, unless
pressed, the AP found. For example, the head of a group representing major
California suppliers said the public "doesn't know how to interpret the
information" and might be unduly alarmed.

How do the drugs get into the water?

People take pills. Their bodies absorb some of the medication, but the rest
of it passes through and is flushed down the toilet. The wastewater is
treated before it is discharged into reservoirs, rivers or lakes. Then, some
of the water is cleansed again at drinking water treatment plants and piped
to consumers. But most treatments do not remove all drug residue.

And while researchers do not yet understand the exact risks from decades of
persistent exposure to random combinations of low levels of pharmaceuticals,
recent studies - which have gone virtually unnoticed by the general public -
have found alarming effects on human cells and wildlife.

"We recognize it is a growing concern and we're taking it very seriously,"
said Benjamin H. Grumbles, assistant administrator for water at the U.S.
Environmental Protection Agency.

Members of the AP National Investigative Team reviewed hundreds of
scientific reports, analyzed federal drinking water databases, visited
environmental study sites and treatment plants and interviewed more than 230
officials, academics and scientists. They also surveyed the nation's 50
largest cities and a dozen other major water providers, as well as smaller
community water providers in all 50 states.

Here are some of the key test results obtained by the AP:

_Officials in Philadelphia said testing there discovered 56 pharmaceuticals
or byproducts in treated drinking water, including medicines for pain,
infection, high cholesterol, asthma, epilepsy, mental illness and heart
problems. Sixty-three pharmaceuticals or byproducts were found in the city's

_Anti-epileptic and anti-anxiety medications were detected in a portion of
the treated drinking water for 18.5 million people in Southern California.

_Researchers at the U.S. Geological Survey analyzed a Passaic Valley Water
Commission drinking water treatment plant, which serves 850,000 people in
Northern New Jersey, and found a metabolized angina medicine and the
mood-stabilizing carbamazepine in drinking water.

_A sex hormone was detected in San Francisco's drinking water.

_The drinking water for Washington, D.C., and surrounding areas tested
positive for six pharmaceuticals.

_Three medications, including an antibiotic, were found in drinking water
supplied to Tucson, Ariz.

The situation is undoubtedly worse than suggested by the positive test
results in the major population centers documented by the AP. 

The federal government doesn't require any testing and hasn't set safety
limits for drugs in water. Of the 62 major water providers contacted, the
drinking water for only 28 was tested. Among the 34 that haven't: Houston,
Chicago, Miami, Baltimore, Phoenix, Boston and New York City's Department of
Environmental Protection, which delivers water to 9 million people. 

Some providers screen only for one or two pharmaceuticals, leaving open the
possibility that others are present. 

The AP's investigation also indicates that watersheds, the natural sources
of most of the nation's water supply, also are contaminated. Tests were
conducted in the watersheds of 35 of the 62 major providers surveyed by the
AP, and pharmaceuticals were detected in 28. 

Yet officials in six of those 28 metropolitan areas said they did not go on
to test their drinking water - Fairfax, Va.; Montgomery County in Maryland;
Omaha, Neb.; Oklahoma City; Santa Clara, Calif., and New York City. 

The New York state health department and the USGS tested the source of the
city's water, upstate. They found trace concentrations of heart medicine,
infection fighters, estrogen, anti-convulsants, a mood stabilizer and a

City water officials declined repeated requests for an interview. In a
statement, they insisted that "New York City's drinking water continues to
meet all federal and state regulations regarding drinking water quality in
the watershed and the distribution system" - regulations that do not address
trace pharmaceuticals. 

In several cases, officials at municipal or regional water providers told
the AP that pharmaceuticals had not been detected, but the AP obtained the
results of tests conducted by independent researchers that showed otherwise.
For example, water department officials in New Orleans said their water had
not been tested for pharmaceuticals, but a Tulane University researcher and
his students have published a study that found the pain reliever naproxen,
the sex hormone estrone and the anti-cholesterol drug byproduct clofibric
acid in treated drinking water. 

Of the 28 major metropolitan areas where tests were performed on drinking
water supplies, only Albuquerque; Austin, Texas; and Virginia Beach, Va.;
said tests were negative. The drinking water in Dallas has been tested, but
officials are awaiting results. Arlington, Texas, acknowledged that traces
of a pharmaceutical were detected in its drinking water but cited post-9/11
security concerns in refusing to identify the drug. 

The AP also contacted 52 small water providers - one in each state, and two
each in Missouri and Texas - that serve communities with populations around
25,000. All but one said their drinking water had not been screened for
pharmaceuticals; officials in Emporia, Kan., refused to answer AP's
questions, also citing post-9/11 issues. 

Rural consumers who draw water from their own wells aren't in the clear
either, experts say. 

The Stroud Water Research Center, in Avondale, Pa., has measured water
samples from New York City's upstate watershed for caffeine, a common
contaminant that scientists often look for as a possible signal for the
presence of other pharmaceuticals. Though more caffeine was detected at
suburban sites, researcher Anthony Aufdenkampe was struck by the relatively
high levels even in less populated areas. 

He suspects it escapes from failed septic tanks, maybe with other drugs.
"Septic systems are essentially small treatment plants that are essentially
unmanaged and therefore tend to fail," Aufdenkampe said. 

Even users of bottled water and home filtration systems don't necessarily
avoid exposure. Bottlers, some of which simply repackage tap water, do not
typically treat or test for pharmaceuticals, according to the industry's
main trade group. The same goes for the makers of home filtration systems. 

Contamination is not confined to the United States. More than 100 different
pharmaceuticals have been detected in lakes, rivers, reservoirs and streams
throughout the world. Studies have detected pharmaceuticals in waters
throughout Asia, Australia, Canada and Europe - even in Swiss lakes and the
North Sea. 

For example, in Canada, a study of 20 Ontario drinking water treatment
plants by a national research institute found nine different drugs in water
samples. Japanese health officials in December called for human health
impact studies after detecting prescription drugs in drinking water at seven
different sites. 

In the United States, the problem isn't confined to surface waters.
Pharmaceuticals also permeate aquifers deep underground, source of 40
percent of the nation's water supply. Federal scientists who drew water in
24 states from aquifers near contaminant sources such as landfills and
animal feed lots found minuscule levels of hormones, antibiotics and other

Perhaps it's because Americans have been taking drugs - and flushing them
unmetabolized or unused - in growing amounts. Over the past five years, the
number of U.S. prescriptions rose 12 percent to a record 3.7 billion, while
nonprescription drug purchases held steady around 3.3 billion, according to
IMS Health and The Nielsen Co. 

"People think that if they take a medication, their body absorbs it and it
disappears, but of course that's not the case," said EPA scientist Christian
Daughton, one of the first to draw attention to the issue of pharmaceuticals
in water in the United States. 

Some drugs, including widely used cholesterol fighters, tranquilizers and
anti-epileptic medications, resist modern drinking water and wastewater
treatment processes. Plus, the EPA says there are no sewage treatment
systems specifically engineered to remove pharmaceuticals. 

One technology, reverse osmosis, removes virtually all pharmaceutical
contaminants but is very expensive for large-scale use and leaves several
gallons of polluted water for every one that is made drinkable. 

Another issue: There's evidence that adding chlorine, a common process in
conventional drinking water treatment plants, makes some pharmaceuticals
more toxic. 

Human waste isn't the only source of contamination. Cattle, for example, are
given ear implants that provide a slow release of trenbolone, an anabolic
steroid used by some bodybuilders, which causes cattle to bulk up. But not
all the trenbolone circulating in a steer is metabolized. A German study
showed 10 percent of the steroid passed right through the animals. 

Water sampled downstream of a Nebraska feedlot had steroid levels four times
as high as the water taken upstream. Male fathead minnows living in that
downstream area had low testosterone levels and small heads. 

Other veterinary drugs also play a role. Pets are now treated for arthritis,
cancer, heart disease, diabetes, allergies, dementia, and even obesity -
sometimes with the same drugs as humans. The inflation-adjusted value of
veterinary drugs rose by 8 percent, to $5.2 billion, over the past five
years, according to an analysis of data from the Animal Health Institute. 

Ask the pharmaceutical industry whether the contamination of water supplies
is a problem, and officials will tell you no. "Based on what we now know, I
would say we find there's little or no risk from pharmaceuticals in the
environment to human health," said microbiologist Thomas White, a consultant
for the Pharmaceutical Research and Manufacturers of America. 

But at a conference last summer, Mary Buzby - director of environmental
technology for drug maker Merck & Co. Inc. - said: "There's no doubt about
it, pharmaceuticals are being detected in the environment and there is
genuine concern that these compounds, in the small concentrations that
they're at, could be causing impacts to human health or to aquatic

Recent laboratory research has found that small amounts of medication have
affected human embryonic kidney cells, human blood cells and human breast
cancer cells. The cancer cells proliferated too quickly; the kidney cells
grew too slowly; and the blood cells showed biological activity associated
with inflammation. 

Also, pharmaceuticals in waterways are damaging wildlife across the nation
and around the globe, research shows. Notably, male fish are being
feminized, creating egg yolk proteins, a process usually restricted to
females. Pharmaceuticals also are affecting sentinel species at the
foundation of the pyramid of life - such as earth worms in the wild and
zooplankton in the laboratory, studies show. 

Some scientists stress that the research is extremely limited, and there are
too many unknowns. They say, though, that the documented health problems in
wildlife are disconcerting. 

"It brings a question to people's minds that if the fish were affected ...
might there be a potential problem for humans?" EPA research biologist
Vickie Wilson told the AP. "It could be that the fish are just exquisitely
sensitive because of their physiology or something. We haven't gotten far
enough along." 

With limited research funds, said Shane Snyder, research and development
project manager at the Southern Nevada Water Authority, a greater emphasis
should be put on studying the effects of drugs in water. 

"I think it's a shame that so much money is going into monitoring to figure
out if these things are out there, and so little is being spent on human
health," said Snyder. "They need to just accept that these things are
everywhere - every chemical and pharmaceutical could be there. It's time for
the EPA to step up to the plate and make a statement about the need to study
effects, both human and environmental." 

To the degree that the EPA is focused on the issue, it appears to be looking
at detection. Grumbles acknowledged that just late last year the agency
developed three new methods to "detect and quantify pharmaceuticals" in
wastewater. "We realize that we have a limited amount of data on the
concentrations," he said. "We're going to be able to learn a lot more." 

While Grumbles said the EPA had analyzed 287 pharmaceuticals for possible
inclusion on a draft list of candidates for regulation under the Safe
Drinking Water Act, he said only one, nitroglycerin, was on the list.
Nitroglycerin can be used as a drug for heart problems, but the key reason
it's being considered is its widespread use in making explosives. 

So much is unknown. Many independent scientists are skeptical that trace
concentrations will ultimately prove to be harmful to humans. Confidence
about human safety is based largely on studies that poison lab animals with
much higher amounts. 

There's growing concern in the scientific community, meanwhile, that certain
drugs - or combinations of drugs - may harm humans over decades because
water, unlike most specific foods, is consumed in sizable amounts every day.

Our bodies may shrug off a relatively big one-time dose, yet suffer from a
smaller amount delivered continuously over a half century, perhaps subtly
stirring allergies or nerve damage. Pregnant women, the elderly and the very
ill might be more sensitive. 

Many concerns about chronic low-level exposure focus on certain drug
classes: chemotherapy that can act as a powerful poison; hormones that can
hamper reproduction or development; medicines for depression and epilepsy
that can damage the brain or change behavior; antibiotics that can allow
human germs to mutate into more dangerous forms; pain relievers and
blood-pressure diuretics. 

For several decades, federal environmental officials and nonprofit watchdog
environmental groups have focused on regulated contaminants - pesticides,
lead, PCBs - which are present in higher concentrations and clearly pose a
health risk. 

However, some experts say medications may pose a unique danger because,
unlike most pollutants, they were crafted to act on the human body. 

"These are chemicals that are designed to have very specific effects at very
low concentrations. That's what pharmaceuticals do. So when they get out to
the environment, it should not be a shock to people that they have effects,"
says zoologist John Sumpter at Brunel University in London, who has studied
trace hormones, heart medicine and other drugs. 

And while drugs are tested to be safe for humans, the timeframe is usually
over a matter of months, not a lifetime. Pharmaceuticals also can produce
side effects and interact with other drugs at normal medical doses. That's
why - aside from therapeutic doses of fluoride injected into potable water
supplies - pharmaceuticals are prescribed to people who need them, not
delivered to everyone in their drinking water. 

"We know we are being exposed to other people's drugs through our drinking
water, and that can't be good," says Dr. David Carpenter, who directs the
Institute for Health and the Environment of the State University of New York
at Albany. 


The AP National Investigative Team can be reached at investigate (at) ap.org

Copyright C 2008 The Associated Press. All rights reserved. The information
contained in the AP News report may not be published, broadcast, rewritten
or redistributed without the prior written authority of The Associated

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