Drugs in Our Water

Aging baby boomers and expanding patient populations are depending on our health care system more than ever and the heavy reliance on pharmaceutical drugs is having an effect on our environment. With more patients seeking care, and new treatments being developed, pharmaceutical drug use in America is on the rise. Many of these drugs – hormones, blood pressure medications, antibiotics – are showing up in our rivers, streams, and oceans.

An article recently published in the New York Times, “Drugs Are in the Water. Does It Matter?” explores whether the drugs found in our water supply has an affect on human health. The medical industry and researchers point out there is a lack of evidence showing there is any human impact from Pharmaceuticals and Personal Care Products (PPCPs). The article also explores the other side of the argument and suggests that it would be irresponsible for researchers to assume there is no impact on human health considering the well-demonstrated environment effects, as well as “pseudo-persistence,” simulation of persistence due to continuous introduction of PPCPs in the environment.

Christian Daughton, EPA expert on PPCPs, emphasizes the potential for the “nocebo” effect – real, adverse physiological reactions people sometimes develop when they learn they have been exposed to something – may play a serious role in future health outcomes. The question remains, aren’t the confirmed impacts on the aquatic environment and health enough proof?

To date, risks to aquatic life include “intersexing” of fish, where males are carrying immature eggs. This is associated with hormones or chemical residues that mimic hormones, which are seeping into our water systems (See Symbiosis 4.1). Although concentrations of drugs in the environment are generally minute, scientists are finding accumulations of these chemicals in our water stream, due to continuous exposure from excretion and improper disposal.

Drugs enter the environment via human excretion or through disposal into trash and toilets, and fall under the category of PPCPs. Unreliable wastewater treatment methods and a lack disposal programs for unused and expired medications allow thousands of chemicals to enter our water system.

In February, the White House Office of National Drug Control Policy released the Federal regulations on the Proper Disposal of Prescription Drugs (see below). Federal recommendations suggest unused pharmaceuticals be mixed with coffee grinds or kitty litter, placed in an impermeable bag, and thrown out with the trash. They also recommend certain drugs be flushed down the toilet. Last on their list, they suggest taking unused medications to community pharmaceutical take-back programs.

The Teleosis Institute and other dedicated organizations are working hard to improve disposal methods by making community based take-back programs more widely available and accessible for all residents. To actualize this goal, the Teleosis Institute will launch a Green Pharmacy Pollution Prevention Campaign to develop the first ongoing community take-back program for unused medications in Berkeley, CA. As a part of this effort, we are working with a number of local pharmacies and health care establishments to serve as return sites throughout the city.

Next month, look for the Winter/Spring issue of Symbiosis: The Journal of Ecologically Sustainable Medicine, and a brochure on PPCPs and the Environment. In addition to the most up to date research, these educational resources will provide readers with practical information for reducing the impact of health care on the environment. (See our consumer and provider drug disposal recommendations below).

To find out how you can participate in preventing pharmaceutical pollution, visit our Events Calendar for safe disposal sites. On May 23rd, Jennifer Jackson from EBMUD will speak at Teleosis about Bay Area take-back initiatives including Teleosis’ Green Pharmacy Pollution Prevention Campaign. We hope join us in creating a safe and healthy environment.

Teleosis Institute’s Consumer and Provider Drug Disposal Recommendations:

Pharmacists and Providers

• Always take cost-effectiveness and environmental impact into account when comparing medications that are equally safe and suitable for the purpose.
• Prescribe starter packs and refill packs whenever available.
• Educate consumers about the importance of proper disposal of pharmaceutical waste at a take-back site or event, and never down the toilet or in the trash.
• Do not prescribe more medications than can be used; if in doubt, repeating the prescription is preferable.
• Review and regularly reassess the patient's total consumption of medication in order to reduce waste.
• Learn more about which drugs have the largest environmental impacts.

Consumers

• Dispose of pharmaceutical waste at hazardous waste take-back sites or events.
• Do NOT dispose of unused/expired medications in the trash or down the toilet.
• Ask for medications with low environmental impact.
• Ask for low prescription amounts and refill options.
• Encourage your provider to take-back unused/expired drugs.
• Commit to health prevention strategies to reduce your reliance on medications.

Federal Regulations on the Proper Disposal of Prescription Drugs:

• Take unused, unneeded, or expired prescription drugs out of their original containers and throw them in the trash.
• Mixing prescription drugs with an undesirable substance, such as used coffee grounds or kitty litter, and putting them in impermeable, non-descript containers, such as empty cans or sealable bags, will further ensure the drugs are not diverted.
• Flush prescription drugs down the toilet only if the label or accompanying patient information specifically instructs doing so.
• Take advantage of community pharmaceutical take-back programs that allow the public to bring unused drugs to a central location for proper disposal. Some communities have pharmaceutical take-back programs or community solid-waste programs that allow the public to bring unused drugs to a central location for proper disposal. Where these exist, they are a good way to dispose of unused pharmaceuticals.