Feature: High Water

Dare to keep drugs out of your drinking water
by Shaun Bailey

It's an otherwise slow shift at the hospital when, just after 2 p.m., patient John Doe is wheeled into the emergency department. After taking the man's vital signs, residents determine he has suffered a "myocardial infarction"; what doctors call a heart attack. With no time to spare, they order intravenous nitroglycerine for improved blood pressure, norepinephrine for shock and heavy, repeated doses of morphine for pain.

Across town at the wastewater treatment plant, sewage streams in from the hospital’s 600 or so patients and staff. The typical treatment plant is well equipped to clean tens, if not hundreds of millions of gallons of wastewater per day, removing grease, grit, organic material, scum, solids, trash and, well, use your imagination. However, it isn’t designed to remove pharmaceuticals like those given to John Doe.

To be fair, hospitals aren’t entirely to blame. The truth is, anyone who takes prescription or over-the-counter medication sends trace amounts of these substances into their wastewater, which, in our region, is returned to the Delaware River and Bay after a thorough cleaning by wastewater treatment plants. And it’s not just sick people. Healthy people send pharmaceuticals into the water supply as well.

Only a small portion of medication is absorbed by the human body. The rest passes through, gets flushed and is sent via sewers to treatment plants. And unused pharmaceuticals disposed of by flushing share the same fate.

At the Southeast Water Treatment Plant in Philadelphia, scientists are using sophisticated methods to monitor levels of pharmaceuticals, including antibiotics, psychiatric medicine, veterinary drugs and pain relievers.  Currently they are screening for 70 drugs.  Last year, a test yielded a total of 17 different pharmaceuticals and byproducts in the local drinking water (The number was initially reported as 56 due to a transcription error, according to the Philadelphia Water Department.)  Notably, Philadelphia is one of the few places in the country where officials are even looking for these compounds, which are only detectable due to relatively new technology.

“We tested for every compound for which a test was available. The amounts of chemicals that we found are extremely small,” says Kelly Anderson, an environmental scientist at the Philadelphia Water Department. “Imagine drinking eight glasses of water a day for over 40,200 years. That’s how much water you would have to drink to take in the amount of acetaminophen in a single dose.”

The trouble is, overall prescription-drug use is increasing in the United States. According to the Kaiser Family Foundation, the number of prescriptions purchased in the United States increased from 2.2 billion to 3.8 billion between 1997 and 2007. That’s an increase of 72 percent during a time span when the U.S. population only grew by 11 percent. It is unknown precisely how many of these medications go unused, but earth911. com puts the number at somewhere between 20 percent and 60 percent.

Humans are not the only ones who could be affected when medications make their way into waterways. Fish, frogs and other aquatic species may be especially vulnerable due to their constant exposure to water. Patient John Doe would have to eat hundreds of thousands of fish dinners to get the same dose of medicine he received at the hospital, but researchers have found that even extremely diluted pharmaceuticals can harm wildlife throughout the food chain, down to the smallest life forms.

“Our research in New York streams and rivers shows a strong relationship between high levels of caffeine, which is a proxy for other pharmaceuticals, and low abundance and diversity of the aquatic insect community,” says Dr. Anthony Aufdenkampe, a scientist at the Stroud Water Research Center. “However,” Aufdenkampe adds, “the insect community might be responding to other co-related factors, such as contaminants associated with poor land use, sewage, etc. Research is currently lacking regarding the viability of aquatic species over multiple life cycles due to conditions which are now typical in our streams, where organisms are simultaneously exposed to dozens of pharmaceuticals and other compounds.”

Reduce Your Unused Medication Pollution

Fortunately, there is something citizens can do to prevent increasing levels of pharmaceuticals from entering their water supply. You may even practice such a routine right now when you dispose of household hazardous materials, such as used motor oil, gasoline and paint thinner. Similar to these pollutants, pharmaceuticals should never be flushed down the drain. Instead you are advised to remove any labels to protect your privacy before returning them to your pharmacist, if permitted. It’s also a good idea to request partial prescriptions in the first place. That way you are less likely to have leftover doses.

If your pharmacy does not accept unused pharmaceuticals, the best solution is to store them in a cool, dry and secure place far from the reach of children until you can drop them off at a neighborhood collection event. However, not all hazardous waste programs accept prescription medications. If yours does not, experts suggest that you:

  • crush pills and add water
  • put flour in liquids
  • combine medication with an undesirable substance, such as coffee grounds, kitty litter or sawdust
  • seal in a nontransparent container and put in the garbage

Pharmaceutical collection events are few and far between, but awareness has spurred the creation of scattered pilot programs. One successful model is Medicine Cabinet Clean-Out Day, which is organized by Nurses Healing Our Planet, an ad-hoc committee formed by the Delaware Nurses Association. This group has held a total of five collection events since 2008, and it now plans to host future events twice per year in partnership with local law enforcement and Christiana Care Health System of Newark, DE. At these collection events, “controlled” or addictive substances collected by volunteers must be immediately turned over to police officers. Each event has yielded gallons of these drugs, with a street value well over $1 million.

The Philadelphia Water Department recently wrapped up a pilot take-back program involving two long-term care facilities and one senior center. In the future, its staff hopes to expand upon this research.

The concept of recycling medication is still in its infancy, but there are a few places that periodically accept expired and unused pharmaceuticals and personal care products (restrictions apply). These trailblazers include:

  • Delaware Nurses Association
  • Berks Co. Solid Waste Authority
  • Burlington Co. Hazardous Waste Facility
  • Earth911.com

“Clearly the issue of pharmaceuticals in our waterways is not something we are going to solve overnight,” says Jennifer Adkins, executive director of the Partnership for the Delaware Estuary, a nonprofit seeking to bring people together to solve water quality issues in the Delaware River and Bay. “The first step to addressing this problem is to simply limit the waste in our own medicine cabinets.”

Shaun Bailey is the Marketing and Communications Coordinator for the Partnership for the Delaware Estuary.