[Pharmwaste] third AP story

Tenace, Laurie Laurie.Tenace at dep.state.fl.us
Wed Mar 12 11:08:48 EDT 2008


again, lots of other stories. Check out
Our local paper ran this in a much abridged version.
Thanks for all the great comments on this series!

Little done to test, limit contaminated water 

Here's the list of metropolitan areas, with the number of pharmaceuticals
detected and some examples of specific drugs that were found, or where tests
were negative, not conducted or awaiting results:

Albuquerque, N.M.: tests negative

Arlington, Texas: 1 (unspecified pharmaceutical)

Atlanta: 3 (acetaminophen, caffeine and cotinine)

Austin, Texas: tests negative

Baltimore: no testing

Birmingham, Ala.: no testing

Boston: no testing

Charlotte, N.C.: no testing

Chicago: no testing

Cincinnati: 1 (caffeine)

Cleveland: no testing

Colorado Springs, Colo.: no testing

Columbus, Ohio: 5 (azithromycin, roxithromycin, tylosin, virginiamycin and

Concord, Calif.: 2 (meprobamate and sulfamethoxazole)

Dallas: results pending

Denver: (unspecified antibiotics)

Detroit: (unspecified drugs)

El Paso, Texas: no testing

Fairfax, Va.: no testing

Fort Worth, Texas: no testing

Fresno, Calif.: no testing

Honolulu: no testing

Houston: no testing

Indianapolis: 1 (caffeine)

Jacksonville, Fla.: no testing

Kansas City, Mo.: no testing

Las Vegas: 3 (carbamazepine, meprobamate and phenytoin)

Long Beach, Calif.: 2 (meprobamate and phenytoin)

Los Angeles: 2 (meprobamate and phenytoin)

Louisville, Ky.: 3 (caffeine, carbamazepine and phenytoin)

Memphis, Tenn.: no testing

Mesa, Ariz.: no testing

Miami: no testing

Milwaukee: 1 (cotinine)

Minneapolis: 1 (caffeine)

Nashville, Tenn.: no testing

New Orleans: 3 (clofibric acid, estrone and naproxen)

New York City: no testing

Northern New Jersey: 7 (caffeine, carbamazepine, codeine, cotinine,
dehydronifedipine, diphenhydramine and sulfathiazole)

Oakland, Calif.: no testing

Oklahoma City: no testing

Omaha, Neb.: no testing

Orlando, Fla.: no testing

Philadelphia: 56 (including amoxicillin, azithromycin, carbamazepine,
diclofenac, prednisone and tetracycline)

Phoenix: no testing

Portland, Ore.: 4 (acetaminophen, caffeine, ibuprofen and sulfamethoxazole)

Prince George's and Montgomery counties, Md.: no testing

Riverside County, Calif.: 2 (meprobamate and phenytoin)

Sacramento, Calif.: no testing

San Antonio: no testing

San Diego: 3 (ibuprofen, meprobamate and phenytoin)

San Francisco: 1 (estradiol)

San Jose, Calif.: no testing

Santa Clara, Calif.: no testing

Seattle: no testing

Southern California: 2 (meprobamate and phenytoin)

Suffolk County, N.Y.: no testing

Tucson, Ariz.: 3 (carbamazepine, dehydronifedipine and sulfamethoxazole)

Tulsa, Okla.: no testing

Virginia Beach, Va.: tests negative

Washington, D.C.: 6 (carbamazepine, caffeine, ibuprofen, monensin, naproxen
and sulfamethoxazole)

Wichita, Kan.: no testing.

About the study: 

At least one pharmaceutical was detected in tests of treated drinking water
supplies for 24 major metropolitan areas, according to an Associated Press
survey of 62 major water providers and data obtained from independent

Only 28 tested drinking water. Three of those said results were negative;
Dallas says tests were conducted but results are not yet available.
Thirty-four locations said no testing was conducted. 

Test protocols varied widely. Some researchers looked only for one
pharmaceutical or two; others looked for many.

Some water systems said tests had been negative, but the AP found independent
research showing otherwise. Both prescription and non-prescription drugs were

Because coffee and tobacco are so widely used, researchers say their
byproducts are good indicators of the presence of pharmaceuticals. Thus, they
routinely test for, and often find, both caffeine and nicotine's metabolite
cotinine more frequently than other drugs.

By Jeff Donn, Martha Mendoza And Justin Pritchard, Associated Press Writers
PHILADELPHIA - Just a century ago, this historic city notched by the Delaware
and Schuylkill treated these rivers as public sewers, but few cared until the
waters ran black with stinking filth that spread cholera and typhoid. Today,
municipal drinking water is cleansed of germs - but not drugs.

AP PROBE: Drugs found in drinking water nationwide
WATER DEPARTMENTS: Reports rarely released to public
BOTTLED WATER: Is it any safer?
RELATED: Problems in fish blamed on contamination

Traces of 56 human and veterinary pharmaceuticals or their byproducts - like
the active ingredients in medicines for pain, infection, high cholesterol,
asthma, epilepsy, mental illness and heart problems - have been detected in
Philadelphia's drinking water. Starting their winding journey in medicine
cabinets and feed bins, they are what's left of drugs excreted or discarded
from homes and washed from farms upriver.

Is Philadelphia worried? Not so far. Tens of millions of Americans here and
elsewhere drink water that has tested positive for minute concentrations of
pharmaceuticals, and they don't even realize it, The Associated Press learned
during a five-month investigation.

Though U.S. waterways coast to coast are contaminated with residues of
prescription and over-the-counter drugs, there's no national strategy to deal
with them - no effective mandates to test, treat, limit or even advise the

FIND MORE STORIES IN: Philadelphia | Drug Administration | Food | Delaware |
National Center for Environmental Health | Office of Water | Schuylkill 
Benjamin H. Grumbles, the U.S. Environmental Protection Agency's assistant
administrator for water, told the AP the agency recognizes that this
contamination in water supplies is a growing concern and that government has
some catching up to do: "Our position is there needs to be more searching,
more analysis."

He said the EPA has launched a four-pronged approach: to identify the extent
of the problem, to "identify what we don't know and close the gap," to take
steps using existing science and regulatory tools, and finally, to increase
dialogue and awareness with water providers and state and local agencies.

But none of those goals has any regulatory firepower.

Some researchers, environmentalists, health professionals, water managers and
bureaucrats say it's time for government to do more.

"The onus has been on the scientific community to provide the research, but
at this point the evidence is conclusive," says U.S. Geological Survey
scientist Steven Goodbred, who has studied carp in drug-tainted waters. "Now
it's up to the public and policymakers to decide what they want to do about

Yet water regulators are barely budging:

_The government has set no national standards for how much of any
pharmaceutical is too much in waterways or taps. Drugs in the environment are
"not currently a priority" of the National Center for Environmental Health,
says spokesman Charles L. Green, at its parent U.S. Centers for Disease

_Though the Food and Drug Administration can review the environmental impact
of new drugs, it has never rejected one on this basis, according to Raanan
Bloom, an FDA environmental officer. Most pharmaceuticals are excluded from
environmental review on the basis of their presumed low concentrations in

_Even though residues of many types of prescription and over-the-counter
drugs have been discovered in scores of watersheds and drinking water systems
nationwide, the EPA says it awaits more survey data before considering
action. The agency has little information "that goes into whether these
substances are occurring in the environment ... and at what level," says
Suzanne Rudzinski, a manager at EPA's Office of Water.

But even when the EPA says it's taking action, little is accomplished. The
agency analyzed 287 pharmaceuticals for inclusion on a draft list of
contaminants to be considered for regulation. Only one, nitroglycerin, which
can be used as a drug for heart problems, has been nominated. Asked to
explain, an EPA spokesman acknowledged the primary reason for inclusion was
its use in making explosives.

_Though pharmaceutical sales are rising, plants that cleanse sewage or
drinking water are not required to remove drugs. They aren't even required to
monitor for them.

When contacted directly by the AP, many water utilities confirmed whether
they had tested for the presence of pharmaceuticals in their water. But
federal agencies and industry groups declined to identify the cities and
treatment plants where traces of pharmaceuticals had been found during
independent studies, citing confidentiality concerns.

Philadelphia has found more pharmaceuticals in its source and drinking waters
than any of the other 61 big water providers surveyed by the AP. It tested
for more drugs and byproducts than other utilities - a total of 72 - and it
found 56, or three-quarters of those checked, in its drinking water. It found
63 - almost 90% of those checked - in its source waters. More study is

However, water managers detected scant concentrations similar to other
places, suggesting they found so much largely because they tested for a
larger list of pharmaceuticals - not necessarily because their watersheds are
more contaminated. David A. Katz, a deputy water commissioner for the city,
said the water was tested so heavily out of vigilance: "We choose to know; we
choose to look."

Under no obligation to tell, Philadelphia keeps it quiet when tests show that
drugs have reached its drinking water, the AP found. Philadelphia Water
Department spokeswoman Laura Copeland provided the findings for an AP survey
but added: "We don't want to create any perception where people would be

John Muldowney, who oversees the city's three drinking water treatment
plants, said no immediate upgrades are planned to filter out pharmaceuticals.
"Based just on the data that's available now ... we would be risking spending
a lot of money, a lot of public funds, for very little health benefit," he

Government leaders seem largely to share that attitude. "We're not really
doing anything on this right now," says a spokesman for U.S. Sen. Harry Reid,
D-Nev., though he has earmarked funds in the past to study environmental
drugs in his state.

Congress held hearings in 2006 on endocrine-disrupting compounds after
researchers discovered that the Potomac River, dotted with sewage treatment
plants, contains feminized male bass which create egg yolk proteins, a
process usually restricted to females. But the hearings produced no new

In Boston, drug makers, state representatives and water managers have been
grinding through their third year trying to craft a compromise approach to
dealing with the problem on a national scale. Scott Cassel, director of the
Product Stewardship Institute, which is hosting the dialogue, says
controlling waterborne pharmaceuticals will make the disposal of old
computers "seem simple by comparison."

"There's definitely a growing movement and a growing concern, but at this
point there isn't a lot of direction from the federal government," adds Susan
Frechette, a policy expert at the institute.

Grumbles, the EPA's top water pollution official, said the agency has
embarked on four studies specific to the presence of pharmaceuticals and
personal care products in wastewater and fish tissue. One "national study,"
expected to be completed next year, will look at the inflow and outflow at
nine sewage plants; another will study sludge from 74 randomly selected
sewage treatment plants.

The fish tissue study will focus on five streams where the flow primarily
originates at a sewage treatment plant.

Just two months ago the agency developed three new methods to detect and
quantify about 160 different pharmaceuticals and personal care products,
including steroids and hormones, in wastewater and sewage sludge, Grumbles

A year ago, the federal government put out its first consumer guidelines for
discarding leftover or expired medicines. The goal was to slow the flow of
drugs flushed down the toilet. Though Grumbles acknowledged that human
excretions are the major factor in spreading pharmaceuticals through the
waste stream, he said it is important for all Americans to realize "the
toilet is not a trash can."

But the guidelines immediately drew criticism from some environmentalists,
water treatment experts and pharmaceutical researchers who say they are
contradictory, confusing, and don't solve the problem.

The guidelines say that about a dozen specific drugs should still be flushed
down the toilet to keep others from finding and abusing them. The rest should
be mixed with something unsavory like coffee grounds and tossed into the
trash. That just moves the problem, though: The drugs end up at landfills,
where they can slowly seep into the groundwater.

The EPA is also engaged in a national study - expected to be completed by the
end of the summer - to examine how long-term health care facilities and
nursing homes dispose of pharmaceuticals.

"We don't really know what to do with waste pharmaceuticals," acknowledges
Laura Brannen, executive director of the professional group Hospitals for a
Healthy Environment.

The government barely oversees drugs spilled or tossed by hospitals and drug
makers. Discharge limits for drug makers concentrate on chemicals used in
manufacturing, not the drugs themselves; Virginia Cunningham, an
environmental executive at drug maker GlaxoSmithKline PLC, says the industry
spills very little of the drugs that turn up in waterways.

At hospitals, the EPA flags about three dozen specific drugs as hazardous
waste. Though their dangers are acknowledged, the rules for special disposal
have been casually observed, according to environmental specialists in the
industry. They say many hospitals still dump some of those hazardous
pharmaceuticals into their other garbage.

Also, the list hasn't been updated for years and ignores scores of
troublesome newer drugs, including toxic chemotherapy agents.

"It has not been practical or economical to keep pace with the large number
of pharmaceuticals developed, approved ... and marketed each year," explains
EPA spokeswoman Roxanne Smith.

And what of the drug waste generated by millions of U.S. households? It's
exempt from these rules. The EPA again says it would be impractical to act.

In fairness, even those pressing for action realize that regulators must
strike a hard balance between potential benefits and costs. Several recent
studies indicate that even very dilute pharmaceuticals can harm human cells,
but scientists are still unsure if there's a significant health risk from
drinking water with trace drugs.

Environmental standards focus on better-understood contaminants from
disease-causing germs to manmade dioxins. The government also is pondering a
raft of newly identified water contaminants in many products from cosmetics
to vitamins - not just in pharmaceuticals.

The government has tried to narrow the focus of much of its drugs-in-water
research to powerful hormones that orchestrate reproduction and development
and omnipresent antibiotics that strengthen the very germs in the environment
that they're meant to kill in the body.

"This is a complex issue because each and every one of us is a part of this
problem. But there's no doubt we need a new standard of wastewater treatment.
If the limits were there, believe me when I say it could be done," argues
environmental toxicologist Greg Moller, at the University of Idaho.

As with global warming, some cities and states have tried to forge ahead,
even without strong federal direction. Small pilot programs and one-day
pickups of unused drugs have popped up in the Northeast, California,
Washington state, Florida, and elsewhere.

Maine is preparing to accept unwanted pharmaceuticals on a grander scale. The
federal and state governments have split the $300,000 cost to launch a
four-county trial in coming months. Pharmaceutical buyers will take home
prepaid mailers to send drug leftovers to a way station, where most will be
picked up for transport to incinerators. Organizers intend eventually to roll
out the program statewide.

Drug pollution stirs more anxiety in Europe, Canada and Australia, and
officials in those places have acted more aggressively to reclaim unused
drugs. A French program recaptured about 6,500 tons at drugstores in 2005,
managers estimate. Two-thirds of the French say they participate, according
to one poll.

That program is run by Jacques Aumonier, an environmental officer for
Cephalon, Inc., a Pennsylvania-based biopharmaceuticals firm. He said
pharmaceutical levels in water may be modest now, "but with more and more
drug use, it can become more important."

Some researchers and activists want to catch and stop drugs from entering
waterways at both types of water treatment plants - those for sewage and for
drinking water. Standard techniques allow many to slip through, research
shows. It seems possible to remove virtually all detectable pharmaceutical
traces with an advanced treatment known as reverse osmosis, and hotter
incinerators also could burn more drugs.

But all that is viewed as too expensive and maybe unnecessary, at least until
the threat is better understood.

"When there's no regulation or limit, and no evidence of human health
impacts, it's very hard to justify putting in energy and money to test for
it," said Shane Snyder, research and development project manager at the
Southern Nevada Water Authority in Las Vegas. Never mind spending much more
to remove it.

Some critics want drug companies to design medicines that break down more
easily into safer byproducts. "In the long run ... we can at least make some
of the compounds greener," says chemist Klaus Kuemmerer, at the University of
Freiburg Medical Center in Germany.

However, that would come "a distant third" after designing drugs for
effectiveness and safety, says Cunningham of GlaxoSmithKline.

In coming years, public pressure is likely to grow, as more pharmaceuticals
find their way into less water. Drug use is expanding in many countries, and
more communities will need to recycle treated wastewater for drinking to cope
with increased demand, drought, and global warming.

At the same time, today's chemical tests that reveal pollutants in parts per
trillion will no doubt be able to detect even finer levels in the future. The
added knowledge may not equal bliss, though.

"There isn't such a thing as 100% pure water," said EPA scientist Christian
Daughton, one of the first to sound warnings over pharmaceutical pollution.
"Yet people have a tough time with the idea that water contains all kinds of

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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