Expert Interviews
• an audio interview with Patrick Phillips, lead researcher for USGS on the issue of drugs in wastewater treatment facilities.
• a Q&A with Dr. Irene Ruhoy, a leading expert and proponent of the concept of “Pharmecovigilance.”

Note: A list of resources related to the issue of drug compounds in water supplies follows this article.

What should consumers do with unused medications? There was a time when the answer was simple: flush ‘em. But in light of recent studies that suggest that potentially dangerous levels of drug compounds—potentially because at this point we just don’t know—are making their way into our water supplies, consumers are being urged to hold on to old meds. Take-back programs such as the “No Drugs Down the Drain” initiative in southern California have been established for people with old medications to leave them at hazardous waste drop-off sites.

In June, I visited the South Bend, Indiana facilities of Underwriters Laboratories, which works with over 7,000 municipalities in the U.S. to monitor their treated wastewater. At this point, wastewater plants are not so concerned with pharmaceuticals as with Pharmaceutically Active Compounds (PhACs)—such as caffeine and chemicals contained in deodorants and other personal care products—finding their way into water supplies as they are widely consumed and processed by all of us.

Acetominophen and other common drug compounds are also a growing concern, Leeke says, as are less common drugs that municipalities and organizations like UL are not testing for simply because they have limited resources and can’t look for everything. much less develop the testing methods to adequately and accurately look for them.

What are the long-term effects of increased levels of caffeine or acetaminophen in our drinking water? Municipalities wish they knew, Leeke says.

There is a lot we don’t know about what compounds are in our water and what their long-term impact might be. This holds true for compounds in effluent from drug manufacturing facilities. This spring, the U.S. Geological Survey released a report detailing a study of two New York wastewater treatment facilities that receive more than 20 percent of their wastewater from pharmaceutical facilities. The outflow from these treatment plants—that is, water that had already been treated—had concentrations of API’s 10 to 1000 times greater than normal.

The report opened eyes. Sure, this kind of thing might happen in India (as has been documented), but in North America?

When USGS contacted the two drug manufacturers feeding these treatment plants to find out more about what compounds were being produced at the sites, the owners—both reputable pharma companies whose names can be gleaned from the report— were less than cooperative, says Patrick J. Phillips, USGS scientist and study lead. One site stalled, finally providing information on its products earlier this summer (following the report). The other site has stayed mum. “We had to cull that information from requests to FDA as well as looking at the Internet about what was formulated at the sites,” Phillips continues. “So at this point in time for one of the sites we do not have an exhaustive list of what was formulated.”

“In the absence of that information,” Phillips adds, “it’s hard for us to come up with an analytical strategy.”

This is a manufacturing issue. How much of an issue no one knows, but we must act, believes Dr. Irene Ruhoy of Touro University Nevada, a frequent collaborator with EPA. Manufacturers need a heightened sense of PharmEcovigilance, she says. The term has myriad components, Ruhoy says, but at its essence it is balancing ecological and human health and safety. Manufacturers must be stewards in regards to the impact of their drugs upon the environment.

U.S. drug manufacturers are behind those in Europe, where a “green drug” campaign that requires manufacturers to submit information on the potential environmental impact of new drugs has already begun. Sweden has a system of classifying a drug’s environmental risk, Ruhoy points out.

The European Environmental Agency recently developed recommendations for drug manufacturers to reach an “acceptable environmental impact” for their products Among the suggestions were that thorough environmental risk assessments, as well as risk mitigation measures, should be part of the submission process for each new drug.

Until that happens, we don’t know what we don’t know. That’s a scary thought.