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Hormone Therapy and Other Drug Regimens...In Your Drinking Water

Apr 19, 2011

A few media outlets have called Americans the most medicated people in the world, and they may have a point. Almost half of all Americans take at least one prescription drug, according to the U.S. Department of Health and Human Services and one in six people take three medications or more.

But even if you're one of the lucky half who takes no prescriptions, chances are, you're sharing your fellow Americans' drugs. Why? Because you drink water.

According to a U.S. Geological Survey done in 2002, so-called "pharmaceutical waste" (traces of prescription drugs) was found in 80 percent of U.S. streams sampled. The drugs in these streams contaminate ground water, in turn, and ultimately end up in drinking water. The study, which was the first of its kind, found not only drugs, but natural and synthetic hormones, detergent metabolites, plasticizers, insecticides, fire retardants and a host of other exciting chemicals. Half of the streams contained seven or more of these chemicals, and about one-third of the streams contained 10 or more of these chemicals.

So how active are these drugs and what can they do to us? Nobody's really sure. Of the 95 chemicals and pharmaceuticals found to be common in rivers and streams, ecological health criteria had only been established for 14 of them. Thirty-three of them are known (or suspected to be) hormonally active, and 46 of them are pharmaceutically active.

Of particular concern to scientists is how often pharmaceutical hormones show up in groundwater, particularly estrogen from birth control pills. Many scientists have expressed concern that estrogen in waterways is resulting in the "feminization" of fish and wildlife, leading to breeding problems. While at least one study has suggested that artificial hormones in streams and groundwater biodegrade quite well and will pose little threat to humans, there is still concern that widespread use of hormones and the subsequent trace amounts in water tables will result in fish undergoing involuntary sex changes (well, we presume they are involuntary, anyway). And this is a problem, of course, because two girl fish can't make little fish.

OK, so we're all getting hormones, but what else? Another U.S. Geological study published in Environmental Science and Technology found a number of different antidepressants in waste water discharged into streams by municipal waste water treatment plants. The drugs have been found in the bodies of fish living as far as five miles downstream of these plants.

So, we may have terrible water contamination problems, but thank goodness our fish are getting treated for depression, I say.

So why are our waterways contaminated with pharmaceuticals? For a number of reasons, actually, most of them theoretically fixable. First, we dump them down the toilet and flush. A Drug Enforcement Administration study conducted in 2010 showed that nearly 70 percent of unused prescription medications are eventually flushed down the toilet. (The rest are misused by prescription drug abusers, many of them teenagers, but that's a different story.) Once upon a time, government officials advised Americans to flush old prescriptions. The message that this is no longer a good practice doesn't seem to have caught on yet.

The toilet is also responsible for another method of groundwater contamination, but this one is harder to solve. What goes in must come out, and the urine of anyone taking a prescription drug will usually contain traces of that pharmaceutical -- some more than others. Flushed down the toilet, the waste is treated at waste water plants, but only by chlorine, which kills a wide spectrum of bacteria, but does nothing to eliminate the drugs. A process called reverse osmosis can remove the drug traces - the filtering is so effective it removes salt from sea water - but it's expensive and considered impractical for widespread drinking water use. Bottled water isn't a solution. Not to burst the bubble of enthusiastic drinkers of bottled water, but the stuff is actually filtered tap water in expensive and high energy-consumptive packaging...complete with the same traces of pharmaceuticals as the water that pours out of your kitchen faucet.

Of course, people flushing or urinating pharmaceuticals are not the only methods by which drugs end up in ground water. Substances can end up in the water system during the pharmaceutical manufacturing process, particularly if the company isn't following accepted manufacturing protocols. The U.S.G.S. tested discharged water from two waste water treatment plants that received discharge from pharmaceutical manufacturing facilities. The study found the water contained 10 to 1,000 times higher concentrations of pharmaceuticals than water from 24 other treatment facilities in the U.S. that don't have pharmaceutical plants nearby. It's not a local problem, either: water from these two facilities flows into streams, and traces of the measured pharmaceuticals were found in water over 18 miles downstream.

Drugs can also wind up in the ground from veterinary use (particularly from cattle and horses) and from other agricultural uses. Hospitals and clinics are another significant source of pharmaceutical contamination of groundwater. Though medical facilities have distinct rules they must follow for disposing of medicine, not all choose to do the right thing and follow proper hazardous waste material handling rules. U.S. hospitals buy more than four billion vials, bottles and ampoules containing hazardous materials and generate more than 84,000 tons of hazardous pharmaceutical waste annually, according to medical technology company CareFusion.

The EPA has been toughening its stance on health care facilities that cut corners in disposing of pharmaceuticals. Hospitals can now be fined up to $37,500 per infraction, per day, for mismanaging the disposal of pharmaceutical waste. Recently, one government-owned hospital was fined $51,501 and ordered to spend a half a million dollars to develop a program for pharmaceutical waste management. A prominent cancer hospital was slapped with a fine of $372,254 for improper handling and storage of pharmaceutical waste.

As for what can be done with drugs in the home medicine cabinet, the White House Office of National Drug Control Policy (plus a host of other anti-drug agencies and groups) is backing the second-annual "National Prescription Drug Take Back Day"  to encourage municipalities to set up stations to accept unused prescriptions for Americans, and to encourage individuals to turn in drugs that are no loner needed. This year, the event will take place on Saturday, April 30. Locations that will be accepting leftover drugs include police stations, churches, pharmacies and fire departments. (You can find a site close to you here.

So...we know they are there, but do they really present any danger?

Though the concentrations of drugs showing up in rivers and treated water are low, said University of Pittsburgh Professor James Pschirer in an interview with the Pittsburgh Tribune Review, the risks may be real. "The amount is very minute, but it's detectable," even in treated water, Pschirer said, because water treatment processes aren't designed to deal with pharmaceuticals. Some studies have demonstrated that estrogen and even some heart medicines are not only showing up in fish, but causing distinct changes. Sure, fish aren't humans, but they are still biologically complex.

Several years ago, tests in the Washington DC area of drinking water discovered small (parts per trillion) but nonetheless measurable levels of six pharmaceuticals - an anti-seizure medication, two anti-inflammatory drugs, two kinds of antibiotics and a common disinfectant. Though the drugs were found in very small concentrations, the water it's in serves more than one million people in and around Washington DC. A federal research project done around the same time discovered that pharmaceuticals (along with caffeine) were found in the drinking water supplies of 24 of 28 U.S. metropolitan areas tested - areas that serve 41 million Americans.

The experts are mixed in their opinion on the effect on human health."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," wrote the Washington Post. "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."

One glass of water with parts per trillion of nasty substances isn't going to harm, of course, but this isn't an occasional tipple: it's water. "The question is, how much damage is being done to human beings?" asked Professor Pschirer. "We drink water every day. What is the effect of lifetime exposure?"

Good question. Perhaps we should ask those non-depressed, sex changed fish. So what can you do to make sure that you're not indirectly imbibing your next-door neighbor's cholesterol drugs? Drink distilled water, which contains nothing but water...if you can stand the taste.