Pharmaceutical drugs given to people and to domestic animals – including antibiotics, hormones, strong pain killers, tranquilisers and chemotherapy chemicals – are present in surface water, in groundwater and in drinking water at the tap. As reported in 2016, nearly half of Americans used at least one prescription drug in the past 30 days. Nearly 22 percent used three or more during that timeframe and more than 10 percent used five or more. What is not metabolised is excreted in urine or faeces (in general between 30 - 90 percent of any medicine taken is excreted) where it enters the wastewater stream (and most water treatment plants are not equipped to remove drugs from the water supply). Medications applied topically in the form of a cream or lotion are also problematic when the unabsorbed portion gets washed down the drain. Unused medications may be flushed down the toilet or drain by individuals and also by health care facilities, like nursing homes. The manufacture of pharmaceuticals may lead to higher drug contamination levels downstream from the factories. Once in waterways, these unnatural chemicals pose not only a risk to human drinking water supplies but also cause harm to marine life.
In many populated areas of the world, between 30 to 60 drugs can be measured in a typical water sample. This is rarely done, however; drugs are one of the few groups of chemicals in water that are not monitored. The official position of most administrations concerned with water pollution is that excreted drugs are not a problem because the concentrations found in the environment are usually below one part per billion (ppb). Notwithstanding, many drugs have been measured at environmental concentrations that individually exceed one part per billion (ppb); and several drugs measured together can also often exceed one ppb.
Reverse osmosis and activated charcoal systems can remove many (but not all) pharmaceutical drugs.
Processing antibiotic-tainted water through wastewater treatment plants doesn’t necessarily mean they’re removed from the water supply.
Deep inside the holding tanks of untreated sewage sludge, diverse communities of bacteria have time to proliferate. This muddy mixture often contains an alarming concentration of antibiotics that were either flushed down or expelled through human waste which interacts with nearby bacteria and destroys all but the most drug-resistant varieties, therefore speeding up the evolutionary process of antibiotic resistance.
Even more sinister, the soupy sludge created in wastewater treatment plants give bacteria plenty of time to mingle together, and occasionally different varieties will swap strands of DNA with each other in a process called horizontal gene transfer.
Little research has been done on low level concentrations of pharmaceutical drugs in the environment, but it is known that some chemicals have potent effects on wildlife at concentrations far below one ppb. For example, Ibuprofen prevents the growth of some bacteria. In marine environments many pharmaceuticals can kill crustaceans and exposure to anti-anxiety medication causes behavioral changes in salmon and wild European perch. Many drugs are designed to modify hormone systems. Estradiol, the female sex hormone (and a common water pollutant) can alter the sex characteristics of certain fish at concentrations as low as 20 parts per trillion. The antibiotic streptomycin stops the growth of algae and some plants; another obvious concern is disseminating antibiotics is their potential role in spreading antibiotic resistance.
This means that nonresistant bacteria can pick up resistant genes from other microbes and quickly evolve into superbugs that can’t be treated with any known antibiotics.
Worst of all, these ever-evolving strains of bacteria and antibiotic drugs rarely stay contained in wastewater treatment plants.
Traditionally, treatment plants have focused on removing organic material and nutrients like phosphorus and nitrogen from water, and pharmaceuticals are a relatively new concern for them to deal with.
While a major portion of dangerous chemicals are removed from the water system by the treatment process, facilities aren’t required to use filters for pharmaceutical chemicals.(xi) The laws regulating clean up procedures haven’t kept up with the influx of antibiotics on the market today, and few treatment plants are equipped to properly pull them out of the water.
Even when all but trace amounts of a pharmaceutical are removed from water, it can still be biologically active.
Research has shown that 10 percent of ibuprofen and naproxen in wastewater treatment plants is discharged out again, and even when it is properly filtered out, the medications simply become heavily concentrated in sludge instead. Because some of this sludge may eventually be released back into the environment for use as fertilizer (possibly even for food crops), the problem doesn’t go away. (xi) (xiii)
In light of these concerns, wastewater treatment plants are pursuing better ways to remove all traces of pharmaceuticals from sewage. The range of potential techniques include relying on medication-munching microbes (xiv) and treating water with ozone. (xv) However, these treatment options are still more advanced than what most plants can handle, are extremely expensive, and still can’t completely remove every trace of pharmaceuticals from treated water.
The first study that detected drugs in sewage took place at the Big Blue River sewage treatment plant in Kansas City in 1976. The problem was duly recorded in scientific literature and then ignored for 15 years. Another forgotten study conducted in Britain in the 1980s found more than 170 drugs in the River Lea in northeast London. The river water contained more than a tonne a year of drugs like aspirin and morphine derivatives, implying concentrations of up to one ppb.
A landfill used by the Jackson Naval Air Station in Florida, USA contaminated groundwater with a plume of chemicals that has been moving slowly underground for more than 20 years. The drugs pentobarbital (a barbiturate), meprobamate (a tranquiliser) and phensuximide (an anticonvulsant) are still measurable in that groundwater plume.
In 1992, water pollution monitoring in Germany detected clofibric acid, a drug used by many people in large quantities (1 to 2 grams per day) to reduce cholesterol levels in the blood. Clofibric acid is 2-(4)-chlorophenoxy-2-methyl propionic acid, a close chemical cousin of the popular weed killer 2,4-D. It has since been discovered that the entire North Sea contains measurable quantities of clofibric acid, with 50 to 100 tonnes entering the sea anew each year. The Danube River in Germany and the Po River in Italy also contain measurable quantities of clofibric acid. Of more immediate concern to humans is the finding that tap water in all parts of the city of Berlin contains clofibric acid at concentrations between 10 and 165 ppt. Also found are other drugs used to treat cholesterol such as phenazone, analgestics such as ibuprofen, antibiotics such as fluoroquinolone, and hormones such as oestrogen, as well as chemotherapy drugs for cancer treatment. The water supplies of other major cities had not then been tested, but the Swiss confirmed the presence of clofibric acid in Swiss lakes in 1998.
A study by the National Oceanic and Atmospheric Administration (NOAA) Fisheries’ Northwest Fisheries Science Center, reported in 2016, detected 81 chemical compounds in the water of Puget Sound, including the antidepressant Prozac and the diabetes medication metformin. The researchers then examined fish native to the Sound (juvenile Chinook salmon and Pacific staghorn sculpin) and detected 42 of the chemical compounds in their tissue, some at levels high enough to affect growth, reproduction and/or behavior. It’s unknown whether consuming fish contaminated with these drugs poses risks to humans and there may be additional risks because fish are exposed to complex chemical cocktails; mixtures may result in responses that occur at lower concentrations than single compounds alone. Separate research has also linked exposure to the drug metformin to the occurrence of intersex fish, where male fish show evidence of feminization. Metformin is one of the most common pharmaceuticals in wastewater (not only because it’s so commonly used but also because it is not metabolized by the human body and gets extracted unchanged). While hormone-mimicking drugs such as birth control pills were previously blamed for intersex fish detected in Pennsylvania’s Susquehanna, Delaware and Ohio river basins, metformin is not a hormone-mimicking drug. Researchers believe it may, however, be a “non-traditional endocrine-disrupting chemical.
Antidepressants are a group of drugs all-too-commonly found in water supplies. Researchers from the University of New England in Maine tested one antidepressant, Prozac, on fighting fish using concentrations similar to that found in waterways and found that after being exposed to the drug the fish became less bold. Even after the fish were allowed to swim in clean water for one week, those exposed to Prozac still had lingering behavioral effects. Such changes, should they occur in the wild, could affect the fishes’ odds of survival significantly.
A 2014 report by UK-based environmental charity CHEM Trust noted that 613 pharmaceuticals have been found in the environment globally, but this is likely a vast underestimate, since analytical detection methods ar not available for most medications in use. The report noted that 23 pharmaceuticals, including antidepressants, sedatives, antibiotics, painkillers and anti-cancer drugs, were detected in perch fish in Sweden. Ethinylestradiol from birth control pills has been detected in Baltic Sea salmon.
Over 60 percent of Americans are currently taking prescription drugs, and finding ways to properly dispose of expired or unwanted medications is a common problem. Less than 2 percent of unwanted medications are returned to the pharmacies where they came from and roughly 35 percent of medications are simply flushed down the toilet. Even more worrying, some chemicals still get into the water system when medications are used exactly as intended. Human bodies only metabolize a small fraction of the drugs they take in, meaning that a good portion of the active ingredients are excreted through urine and faeces or sweated out. This means that when you relieve yourself or take a shower, traces of the chemicals from your medication may wind up in the water system.
What is the long-term effect of drinking, day after day, a dilute cocktail of pesticides, antibiotics, pain killers, tranquilizers and chemotherapy agents?
Sewage sludge provides a major pathway by which drugs enter the environment. Until the drug problem is understood and controlled, it provides a solid scientific rationale for labelling sewage sludge a dangerous soil amendment, the use of which should be forbidden.