Drugs — legal and illegal, prescribed and over-the-counter — are so plentiful in modern life that we may be literally, and figuratively, swimming in them. Nearly 4 billion prescriptions are filled each year in the U.S. and another 3.5 billion over-the-counter drugs are sold, not to mention the incalculable numbers of doses churned out by basement meth labs or distributed by Mexican drug lords. With all these drugs being used, and eventually excreted, dumped and flushed into the environment, is it really any wonder that, beginning around 2000, scientists started documenting the presence of drug compounds in the nation's waterways?
In 2002, a study by the U.S. Geological Survey concluded that “a broad range of chemicals, including human and veterinary drugs, were found downstream from highly developed areas.” Perhaps more disturbingly, the study found that 80 percent of the waterways sampled contained one or more of these drugs, which included mood stabilizers, anti-convulsants, sex hormones, antibiotics and other commonly prescribed medications.
So, what gives? Should we stop paying for our prescriptions and simply drink massive quantities of tap water as a cure-all preventative? Will Niagara Falls eventually be renamed Viagra Falls?
Fortunately, at least in Connecticut, the answer is more “no” than “yes.” But any systematic attempts to document the presence of these compounds in the state's waterways is just getting underway, and any attempt to gauge the level of risk to humans or other life forms relying on a water environment is virtually unknown.
One of the scientists taking the lead on this issue is Allison MacKay, an associate professor in the Civil and Environmental Engineering Department at UConn-Storrs. To determine if Connecticut is knee-deep in Lipitor, Viagra and Zoloft, MacKay has gone knee-deep in the Pomperaug River. The Pomperaug, a 13.4-mile-long river that flows through Woodbury and Southbury and empties into the Housatonic River, is an ideal place to take water samples because it's a relatively closed system with few tributaries feeding into it. It is also conveniently located near a place that's swarming with drug-users: Heritage Village, one of the state's largest “active adult” communities, with nearly 3,500 people aged 55 and over.
MacKay regularly grabs samples from the Pomperaug that have “quantified a signal” that the compounds are there. They are, she says, “showing up within the range reported elsewhere in the country.”
Because she is not a toxicologist, MacKay's primary role is measuring the levels found.
“We know very little about how these compounds move through the natural cycle,” she says, adding, “Does it take hours, weeks, months for the sun to break them down? We just don't know.”
In Connecticut, the presence of the drugs in the water supply is less of an issue than in other regions, because all water withdrawals for human consumption are made upriver from the sewage treatment plants. In the south, especially, such stringent monitoring of the drinking water is not done and, consequently, the levels of drug compounds in the drinking water are higher.
“All surface waters in the state are assigned uses,” explains Traci Iott, a supervising environmental analyst at Connecticut's Department of Environmental Protections. “Any body of water that contains waste assimilations like treated effluent from wastewater treatment plants can't be used as a source of drinking water. Connecticut is one of the few states with such a prohibition. Also, our wastewater treatment plants have a higher level of containment as part of an effort to protect the Long Island Sound.”
Both Iott and MacKay expressed confidence that the drug levels found in state waterways are at such minute levels that they not only don't reach “therapeutic dose” levels of the drugs but would probably have little impact at all on humans. MacKay likens the amounts to “putting an eye dropper full of dye in an Olympic swimming pool.”
“These are in the tens, hundreds and thousands of nanograms per liter which is quite small,” says MacKay. “The fact that we can detect them in the water is largely due to the advanced measurement techniques developed in the last decade. Prior to about 2000, there was no way to measure levels with such precision. Chances are traces of drugs have been in our water systems for generations, but we had no way to measure for them.”
This, however, does not preclude another, probably more serious concern: how do these doses impact the animal and plant life that relies on that water throughout its life cycle. Neither Iott nor MacKay are as sanguine about these risks. Indeed, the scientific literature in recent years is filled with reports of fish and frog deformities that are still largely unexplained.
“You have to ask risk to whom or to what,” says Iott. “I'm pretty comfortable that humans are safe because we segregate our drinking water so well, but the main life forms being exposed are aquatic and ecological. It's definitely something we're concerned about. But the data is simply not there yet to make any credible choices or draw any conclusions. We of course encourage researchers and participate in studies when we can.”
Contrary to the stereotype of seniors pouring their expired medicines down drains or flushing them down toilets, most pharmaceuticals get into the watershed through normal channels. That is, people using the drugs excrete the residues through normal bodily functions.
“This is not the result of an environmental failure,” says MacKay. “Any watershed that receives wastewater effluent will have these compounds through their proper prescribed use. Just by excreting fluids into the wastewater system, you are introducing the drugs into the environment. Of course, you don't want people flushing pills down the toilet, but the water treatment plants were not originally designed to eradicate complex compounds like these when they were built.”
In recent years, largely because of the heightened attention to this issue, drug “take back” or “drop off” programs have been organized locally, regionally, statewide and nationwide. In April, for example, the Drug Enforcement Administration coordinated a nationwide National Prescription Drug Take Back Day with state and local law enforcement. Collection sites in Connecticut for this effort were at state police barracks as well as at resident trooper offices in several towns, including Durham, Old Lyme, Essex, Woodbury, North Canaan and Bethany.
Last September, a similar one-day program that included 4,000 collection sites around the country amassed 242,000 pounds of prescription drugs, all of which were incinerated. These drug take-back programs are not inspired completely by potential damage to the environment and public health. The DEA is more interested in keeping the unused drugs from being misused, abused, repackaged, resold and/or falling into the hands of minors. For those who might be put off by the police presence, officials go to some lengths to assure respondents that all drop offs will be confidential (in some places, they supply permanent markers to obliterate personal information on the vials and capsules) and that no personal information is requested.
Individual towns have, through their water departments, hosted their own medication disposal programs, including last month in Bristol, Burlington, Southington and Wolcott.
Pitching the drugs in the trash bins is also an option, because the path from the landfill to the water supply is far harder and longer than that from the treated water. Most municipal trash is incinerated in Connecticut.
The Connecticut DEP has a guidance document about how to dispose of drugs properly, found at its website.
Dennis Schain, DEP spokesman says, “The advice is counterintuitive. Initially it was thought that flushing down toilet was OK, but now it's to package them inside coffee cans or plastic tins and put them in the trash, but not in the recycling container. Of course, the ultimate solution is green chemistry. That is, to produce pharmaceuticals that don't impact the environment the same way. Many pharmaceutical companies are focused on coming up with ways to produce green drugs.”
MacKay does not want to feed into any sense of public panic such as that which greeted the efforts to fluoridate the water in the 1950s, which some Americans saw as part of a Communist plot. Nor does MacKay want to minimize the issue. She strikes a more hopeful middle ground, seeing the issue as a “great way to highlight the day-to-day impacts that our lifestyles have on the environment.”