http://www.citizenscampaign.org/campaigns/pharmaceutical-disposal.asp
http://www.fda.gov/downloads/Drugs/ResourcesForYou/Consumers/BuyingUsingMedicineSafely/UnderstandingOver-the-CounterMedicines/ucm107163.pdf
https://www.scientificamerican.com/article.cfm?id=pharmaceuticals-in-the-water
http://ap.google.com/article/ALeqM5hGsoyElv4ZL879LW6z2aZS0Pix7AD8VA14500
AP probe finds drugs in drinking water
by Jeff Donn, Martha Mendoza & Justin Pritchard  /  Mar 9, 2008

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 shows. 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 watersheds.

-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 tranquilizer. 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 drugs. 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 organisms.” 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.

NEW YORK
http://www.washingtonpost.com/wp-dyn/content/article/2008/03/09/AR2008030900952_pf.html
NYC: Traces of Sedatives in NYC Water
by Jeff Donn  /  March 9, 2008

Locals say this city makes the world’s best bagels from the best water, piped in from rustic reservoirs up to 150 miles north. Yet few know of a secret ingredient in their source water: a dash of pharmaceuticals. Research studies have turned up minute amounts of more than 15 drugs or their byproducts in several pristine-looking rivers, a reservoir, and aqueducts feeding the country’s biggest water system. Though barely measurable, these pharmaceuticals are present in a variety worthy of a medicine cabinet: drugs for aches, infections, seizures and high blood pressure; hormones for menopause; the active ingredient in a popular sedative; and caffeine _ all bound for the city that never sleeps. How did they reach waterways? The vast watershed, while mainly rural, stretches almost from Pennsylvania to Connecticut and encompasses lots of human activity. Human and veterinary medicines are excreted or discarded, and eventually enter source waters mostly through residential sewage or farm runoff. And while these waters are processed at wastewater treatment plants upstate, much of the pharmaceutical residue passes right through, studies show. It’s unknown how much lingers each day by the time 1.1 billion gallons reach the faucets of more than 9 million people in the city and northern suburbs via a century-old network of aqueducts and tunnels. The New York City Department of Environmental Protection, which runs the city’s water system, responded to an Associated Press survey of water utilities, saying it has not tested its drinking water for pharmaceuticals, despite the findings in its watershed. The tests that detected pharmaceuticals in the upstate source waters were conducted by the U.S. Geological Survey and New York State Department of Health.

City water officials declined repeated requests for an interview and issued only a brief general statement: “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 pharmaceuticals in trace amounts. As in other cities, human health risks from trace pharmaceuticals are uncertain, since concentrations in New York source waters are way below medical doses and undergo dilution as they mix with fresh water en route to the city. Already, though, troubling studies indicate that traces of pharmaceuticals may be harming fish in New York City’s Jamaica Bay, within sight of Manhattan’s skyscrapers. Researcher Anne McElroy at Stony Brook University has found feminized male flounder there, and she links them to high levels of the female hormone estrone or other estrogenic chemicals discovered in the waterway.

Estrogen also has been found in the city’s watershed in recent years. Upstate, the geological survey and state health agency also detected the heart medicine atenolol; anti-seizure drugs carbamazepine and primidone; relaxers diazepam and carisoprodol; infection fighters trimethoprim, clindamycin, and sulfamethoxazole; pain relievers ibuprofen, acetaminophen and codeine; and remains of caffeine and nicotine. Despite all that, the federal government considers the New York City system to be so clean that it need not filter most of its water, as most big cities are required to do. When the filtering waiver was extended last year, Mayor Michael R. Bloomberg exulted: “I’ve always thought that New York City has some of the best water around, and now we’ve got confirmation from Washington.” However, filtration is meant mainly to remove germs, and the federal government hasn’t required any testing of pharmaceuticals in source or drinking water. Though it lacks conventional treatment plants with filtering processes, New York City does disinfect and add chemicals to its drinking water. Plus, it is building a filtration plant for water from its Croton watershed _ its smallest and closest source. Patrick Phillips, a geological survey hydrologist who has studied drugs in the city’s watershed, says recent sewage treatment upgrades probably catch some, though the systems aren’t designed to. The city also is building a plant to disinfect with ultraviolet radiation the water taken from the major, upstate sectors of the watershed. Research shows that ultraviolet can degrade some pharmaceuticals. “I think both the state and the city are aware that these things could be an issue and you could be proactive about it,” Phillips says. Few New Yorkers seem aware of their possible presence. The AP contacted more than two dozen water-testing companies across the metropolitan area, and none had ever been asked to check for pharmaceuticals. Douglas LeVangie, a sales executive at Simpltek, says even the company’s home water tests for disease-causing germs sell modestly in New York City, with its global reputation for wholesome water.

WASHINGTON DC
http://www.washingtonpost.com/wp-dyn/content/article/2008/03/09/AR2008030901739.html?sid=ST2008030901877
The Drugs in the Area’s Water  /  March 10, 2008

Tests revealed that some of the Washington area’s drinking water contained trace amounts of these drugs:

Caffeine: a stimulant found in food and drinks.
Carbamazepine: an anti-convulsive to reduce epileptic seizures and a mood stabilizer for treating bipolar disorders.
Ibuprofen: an over-the-counter anti-inflammatory medication.
Monensin: an antibiotic administered to cattle.
Naproxen: an anti-inflammatory drug commonly found in Aleve.
Sulfamethoxazole: an antibiotic that can be used to treat infections in humans and animals.
Triclocarban: a disinfectant found in antibacterial soaps.

{Source: Washington Aqueduct}

http://www.washingtonpost.com/wp-dyn/content/story/2008/03/09/ST2008030901877.html?sid=ST2008030901877
Area Tap Water Has Traces of Medicines
Tests Find 6 Drugs, Caffeine in D.C., Va.
by Carol D. Leonnig  /  March 10, 2008

The Washington area’s drinking water contains trace amounts of six commonly used drugs that typically turn up in wastewater and cannot be filtered out by most treatment systems. The pharmaceuticals – an anti-seizure medication, two anti-inflammatory drugs, two kinds of antibiotics and a common disinfectant – were found in very small concentrations in the water supply that serves more than 1 million people in the District, Arlington County, Falls Church and parts of Fairfax County. But scientists say the health effects of long-term exposure to such drugs are not known. Pharmaceuticals, along with trace amounts of caffeine, were found in the drinking water supplies of 24 of 28 U.S. metropolitan areas tested. The findings were revealed as part of the first federal research on pharmaceuticals in water supplies, and those results are detailed in an investigative report by the Associated Press set to be published today.

In addition to caffeine, the drugs found in water treated by the Washington Aqueduct include the well-known pain medications ibuprofen and naproxen, commonly found in Aleve. But there were also some lesser-known drugs: carbamazepine, an anti-convulsive to reduce epileptic seizures and a mood stabilizer for treating bipolar disorders; sulfamethoxazole, an antibiotic that can be used for humans and animals in treating urinary tract and other infections; and monensin, an antibiotic typically given to cattle. In addition, the study uncovered traces of triclocarban, a disinfectant used in antibacterial soaps. That the drugs were found so commonly nationwide highlights an emerging water dilemma that the public rarely considers. The drugs we use for ourselves and animals are being flushed directly into wastewater, which then becomes a drinking water source downstream. However, most wastewater and drinking water treatment systems, including Washington’s, are incapable of removing those drugs. And although the chemicals pose no immediate health threat in the water, the health effects of drinking these drug compounds over a long period is largely unstudied. Some scientists said there is probably little human health risk; others fear chronic exposure could alter immune responses or interfere with adolescents’ developing hormone systems.

Washington’s water regulators and utility officials say they are not alarmed by the findings because the drugs are found at such low levels – parts per trillion, a tiny fraction of the amount in a medical dose. But they do view these “emerging contaminants” with concern. “What concerns me is we’re finding pharmaceuticals in the river that we rely upon for drinking water,” said Thomas P. Jacobus, general manager of the Washington Aqueduct. “If we can’t get them out, we have to find a way to neutralize them if we find there’s a health effect from them.” Jacobus said the aqueduct leadership will recommend in the next few months likely upgrades for water treatment to deal with an array of newly identified and increasing contaminants in the water. The aqueduct uses chlorine, which kills a wide group of bacteria and breaks down some chemicals but cannot disrupt pharmaceuticals. Studies show ozone water treatment is the most effective in zapping such drugs. The U.S. Geological Survey and the U.S. Department of Agriculture have been screening Washington’s and other cities’ water supplies for pharmaceuticals in the first research project on pharmaceuticals in the water. The Washington Aqueduct, an arm of the U.S. Army Corps of Engineers, does not regularly screen for caffeine or pharmaceuticals, nor do most water utilities.

The drugs discovered in testing over the past two years typically get into the water supply because they pass through a user’s body and are flushed downstream. The U.S. Environmental Protection Agency is studying some pharmaceuticals for their impact on public health but has not set safety standards for any of the drugs. “We recognize it is a growing concern, and we’re taking it very seriously,” Benjamin H. Grumbles, the EPA’s assistant administrator for water, said of the drugs’ presence. There is no clear evidence of a human health threat from such low levels of pharmaceuticals. But scientists warn that, because there has been very little study of the long-term or synergistic effects of this kind of drug exposure, water providers and regulators need to exercise caution. Although experts agree that aquatic life are most at risk from exposure to the drugs in rivers and streams, researchers are concerned about what they don’t know about human health effects.

In other findings from its reporting, the AP said officials in Montgomery County and Fairfax have found numerous pharmaceuticals in their environmental watersheds but do not test their drinking water supplies for the same chemical compounds. Nationwide, the AP reported that researchers found anti-depressants, antacids, synthetic hormones from birth control pills, and many other human and animal medicines in the water. In San Francisco, tests found a sex hormone. In New York, the water tested positive for heart medicines and a prescription tranquilizer.

CALIFORNIA
http://www.dailynews.com/news/ci_8516128

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 researchers. 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. Here’s the list of California metropolitan areas, grouped by categories – those with positive test results, including the number of pharmaceuticals detected and some examples of specific drugs found, locations where tests were negative, locations where tests were not conducted and a location with pending results:

TESTED POSITIVE
Concord: 2 (meprobamate and sulfamethoxazole)
Long Beach: 2 (meprobamate and phenytoin)
Los Angeles: 2 (meprobamate and phenytoin)
Riverside County: 2 (meprobamate and phenytoin)
San Diego: 3 (ibuprofen, meprobamate and phenytoin)
San Francisco: 1 (estradiol)
Southern California: 2 (meprobamate and phenytoin)

DID NOT TEST
Fresno: no testing
Oakland: no testing
Sacramento: no testing
San Jose: no testing
Santa Clara: no testing

At least one pharmaceutical or byproduct was detected in testing within the watersheds of 28 major metropolitan areas, according to an AP survey of 62 major water providers and data obtained from independent researchers. Test protocols varied widely. Some researchers tested for more drugs than others. Thirty-five areas said they tested. Four said tests were negative, and three said they were awaiting results. Twenty-seven locations said they had not tested watershed supplies. Here’s the list of the California areas where pharmaceuticals were detected, with the number found and some examples.

Concord: (unspecified drugs)
Long Beach: 9 (unspecified drugs)
Los Angeles: 9 (unspecified drugs)
Riverside County: 9 (unspecified drugs)
San Diego: 12 (clofibrate, clofibric acid, ibuprofen and nine unspecified)
San Francisco: 1 (estrone)
Santa Clara: (unspecified drugs)
Southern California: 9 (unspecified drugs)