I’ll Have a Water… With a Splash of Warfarin

Never mind the unusual wave of intersex fish or the mutant frogs appearing in a waterway near you.

Earlier this week the Associated Press published the results of an investigation of pharmaceuticals in the nation’s waters.  The reporters found that U.S. drug companies have legally released at least 271 million pounds of pharmaceuticals into waterways, including compounds such as: lithium, used to treat bipolar disorder; warfarin, a blood thinner also used as a rodenticide and pesticide; and tetracycline hydrochloride, an antibiotic.  This investigation follows an equally disquieting finding published last year that trace amounts of pharmaceuticals were found in the drinking water of 24 major metropolitan areas.

Pharmaceuticals enter the nation’s waters primarily from health care facilities or consumers, who either excrete unabsorbed drugs or who adhere to the old (and debunked) advice to flush drugs down the toilet.  However, pharmaceuticals can also enter the water by leaching from landfills or through direct discharge from the companies themselves or from wastewater treatment plants.  The Associated Press article concludes the federal government has limited tracking of what drugs are released.  The Environmental Protection Agency and the U.S. Geological Survey are conducting tests to compare sewage at treatment plants that receive wastewater from drug-making factories versus treatment plants that do not.  Preliminary results show that treated wastewater from the former show “a disproportionate concentration in wastewater of an antibiotic that a major Michigan factory had been producing.”

In 2008, the EPA issued an interim report on unused pharmaceuticals in the health care industry, explaining that “the major environmental concerns resulting from the disposal of pharmaceuticals in wastewater include the potential that wastewater treatment facilities may not effectively remove them through treatment and the possible effects on aquatic life and human health.”  Potential impacts to humans include hormone disruption, antibiotic resistance, and the synergistic and cumulative effects of combining various drugs.  Improved techniques can now detect substances in the part-per-billion or -trillion range, revealing a wider variety of pharmaceuticals in water than ever before.

The report suggested that the disposal of pharmaceuticals as wastewater should be regulated under the Resource Conservation and Recovery Act, under which EPA regulates hazardous waste and is considering expanding regulations to include hazardous pharmaceutical waste.  Drugs could be considered hazardous because either an ingredient is specifically listed or the drug itself exhibits hazardous characteristics – ignitability, corrosivity, reactivity, or toxicity.  Pharmaceuticals already considered hazardous include common drugs such as epinephrine, nicotine, nitroglycerin (alleviates angina), warfarin (blood thinner), and some chemotherapy agents.

Other existing sources of potential regulation include the Clean Water Act and the Safe Drinking Water Act, both administered by the EPA, and individual states’ regulations.  The federal government should act to protect water bodies and drinking water quality from all contaminants that affect human health.  While the government deliberates, the proper way to dispose of expired drugs is to not flush them down the toilet but instead dispose of them at a hazardous waste facility.  As for drinking water safety, the answer is not bottled water, especially since much of it comes from the very same water sources and is no better regulated than tap water.  The AP investigation raises many questions about the quality of the nation’s water that the federal government and industrial polluters must answer.