An Unholy Residue—Pharmaceuticals and Nature

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With the US Supreme Court’s final decision not to hear the challenge by the drug industry to the Alameda County Safe Drug Disposal Ordinance, the final chapter of this current discussion comes to a close.   “People hold on to drugs and they don’t know what to do with them,” said Supervisor Nat Miley, key motivator for this law. The responsibility to dispose of them should be on business. “Taxpayers should not have to pay for this.”

Listen To KQED’s California Report for a brief summary.

Pharmaceuticals are disposed or discharged into the environment on a continual basis via industrial and household sewage and waste (many individuals dispose of unwanted and expired drugs directly into the domestic sewage system or garbage). Further complicating the issue—and unique to pharmacueticals—once ingested, they are subjected to the metabolism of the user, after which excreted metabolites plus some unaltered parent compounds are released into sewage water.

landfillGarbage disposal is a major problem as it leads to wet weather runoff as a leachate from landfills, sending drugs compounds into ground and water systems. In addition, landfills accept sewage sludge that can produce leachates carrying high concentrations of drugs. Over a 45-year period, researchers Holm 1 et al found high concentrations of antibiotics and barbiturates in a Danish landfill. Through these processes, drugs enter the environment, where they are deemed “pseudo-persistent” because their rate of transformation and removal from the environment is overwhelmed by their replacement rate—a direct result both of long-term use of higher quantities of medicines by consumers and of improper disposal. A take-back event for unused medicine in 20062  in the San Francisco Bay area found that 45% of unused or expired medicines were flushed down the toilet and 28% were disposed directly into the trash.

Persistence also arises from the natural resistance of medicines to degradation. One study in Germany3 showed that barbiturate concentrations were still found in the environment, even though their use had been virtually eliminated 30 years ago. Since drugs in the environment have not captured as much attention as pesticides, documentation of quantities released and environmental impacts are limited. Studies that quantify drugs in the environment originate primarily in Europe. In sharp contrast, pesticide use is clearly documented and controlled in the United States, Canada, and the European Union. And yet, pharmaceuticals may be released directly anywhere humans exist worldwide—for example, through human excretion in rural or wilderness areas that have limited capacity for sewage treatment4.

Pharmaceuticals have been detected in domestic drinking water. In the United States, a recent study5,6,7 identified more than 100 kinds of medications in significant concentrations in sampled waterways, the most common being aspirin, statins, hypertension medications, and hormones taken by women. Drinking-water regulations historically have been designed to protect consumers from threats of pathogens and industrial chemicals. Precaution is necessary to stave off future problems.

Hormones, specifically estrogen compounds, made the first headlines about medicines adulterating sewage, and since then they have been found in significant concentrations. Synthetic oral contraceptive medications, combined with steroidal estrogens, cause male fish to feminize. Screening for endocrine disruption is complex. Significant numbers of xenoestrogens— estrogen mimics—exist8,9,10,11  water cupA considerable amount of research concerns the environmental effects of antibiotics, due to the extensive use of antibiotics in aquaculture, veterinarian medicine, animal husbandry, and human medicine. Antibiotics enjoy widespread use, but, according to studies, up to 95% of antibiotic compounds are released unaltered into the sewage system.12 This phenomenon has been shown to accelerate resistance of bacterial pathogens to antibiotics. High concentrations of antibiotics can produce alterations in microbial community structure and affect entire food chains. Because of its use in cattle in the Indian subcontinent, the anti-inflammatory diclofenac proved fatal to vultures, decimating several species in India before its recent ban13.

The most frequently reported drugs documented in the public waters of Europe are blood lipid regulators. Buser3 et al reported concentrations in remote lakes with no apparent atmospheric distribution. The researchers concluded that the route of introduction must be medicinal use and excretion by visitors and local inhabitants. Other substances found in surface water throughout Europe include beta-blockers, antidepressants, antiepileptics, antineoplastics, diagnostic contrast media, synthetic musks, disinfectants, sunscreens, and nutritional supplements.

What We Can Do
Obviously, the increasing amount of drugs in the environment is a source of great concern. Equally as obvious, something needs to be done to curb their impact. Fortunately, numerous ways are available to us consumers.  The most effective method is to implement “cradle-to-grave product stewardship.” Med_disp_BANNER_PROOF-LOGOThis is exactly what is happening in counties throughout the US.  Beginning in Alameda County, CA, a program is up and running designed by the drug companies to set up 22 take –back stations in law enforcement agencies throughout the county.  In year two and three, 100 pharmacies will have take-back bins in place.  Kings County, WA, San Francisco, San Mateo County and Marin County all have similar systems developing. In these locations, you can bring your unused medicines to a site and dispose of them properly.  A take-back bin is very similar to a mailbox!   You can also bring your drugs back to your physician and ask that he or she take them back for disposal.  This will increase physician’s awareness of the need for proper stewardship for medicine.   Imagine a patient receiving a phone call from your medical office reminding her not only about her next appointment, but also to bring along her expired and unused medicines!

Evidence that medicines and supplements are remaining in our waterways and in our drinking water continues to mount.  Healthy product stewardship requires everyone’s participation. In addition to drug producer involvement in take-back programs, increasing your own healthy bTeleosis logoehavior enables optimal health thus reducing the need for drugs entering the environment and water supply.  Each one of us can contribute to a healthier home for all of us on planet Earth—just by making a better choice Taking simple but effective action to reduce the potential impact of this problem on personal and environmental health.  Dispose of your meds safely!

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References:

  1. Holm JV, Rügge K, Bjerg PL, Christensen TH. Occurrence and distribution of pharmaceutical organic compounds in the groundwater downgradient of a landfill (Grindsted, Denmark). Environ Sci Technol. 1995;29(5):1415-1420.
  1. Bay Area Pollution Prevention Group. Report on San Francisco Bay Area’s Safe Medicine Disposal Days. August 2006.
  1. Buser HR, Müller MD, Theobald N. Occurrence of the pharmaceutical drug clofibric acid and the herbicide mecoprop in various Swiss lakes and in the North Sea. Environ Sci Technol. 1998;32(1):188-192.
  1. Choi CO. Pollution in solution, drug-resistance DNA as the latest freshwater threat. Scientific American. January 2007: 22-23.
  1. Associated Press. Wyoming officials considering Yellowstone pollution fines. Las Vegas Review-Journal. October 31, 1998:9B.
  1. Milstein M. Park sewage systems on the verge of failure, internal report states. Billings Gazette. March 8, 1999. Available at: http://www.billingsgazette.com/ wyoming/990308_wyo015.html. Accessed July 5, 2006.
  1. Aherne GW, Briggs R. The relevance of the presence of certain synthetic steroids in the aquatic environment. J Pharm Pharmacol. 1989;41(10):735-736.
  1. Shore LS, Gurevita M, Shemesh M. Estrogen as an environmental pollutant. Bull Environ Contam Toxicol. 1993;51(3):361-366.
  1. Tabak HH, Bunch RL. Steroid hormones as water pollutants. I: Metabolism of natural and synthetic ovulation-inhibiting hormones by microorganisms of activated sludge and primary settled sewage. Developments in Industrial Microbiology. 1970;11:367-376.
  1. Tabak HH, Bloomhuff RN, Bunch RL. Steroid hormones as water pollutants. II: Studies on the persistence and stability of natural urinary and synthetic ovulationinhibiting hormones and treated wastewaters. Developments in Industrial Microbiology. 1981;22:497-519.
  1. Desbrow C, Routledge EJ, Brighty GC, Sumpter JP, Waldock M. Identification of estrogenic chemicals in STW effluent. 1. Chemical fractionation and in vitro biological screening. Environ Sci Technol. 1998;32(11):1549-1558.
  1. Levy SB. The Antibiotic Paradox: How the Misuse of Antibiotics Destroys Their Curative Powers. New York: Harper Collins; 2002.