Rx for Action

The old adage "dilution is the solution to pollution" doesn't appear to hold up for pharmaceuticals and personal care products (PPCPs). A new study out of the Universidade da Coruna in Spain has found that PPCP levels increase in streams receiving combined sewer overflows (CSOs) during wet weather.

Combined sewers receive both water from storm drains and sewage. During heavy rains, the combined sewers can overflow and dump untreated sewage and stormwater into local waterways. Because sewage (treated and raw) is the primary source of PPCPs in the environment, a team of researchers led by Hector Del Rio developed an extensive monitoring plan for seven PPCPs in the combined sewer systems of Santiago de Compostela.

Water samples were taken every three hours over six-day periods of dry weather in the summer and fall. Wet weather samples were collected using an automatic sampling device that was activated by rising stream water. These methods of water collection allowed for PPCP concentrations of fragrances, anti-inflammatory drugs, antiepileptic drugs, an analgesic, and caffeine to be measured over a long period of time and gave researchers a good idea of how these chemicals move through sewer systems.

The quantity of water samples yielded some surprising results. Unlike most pollutants, PPCP levels increased with an increase in water in streams. And, interestingly enough, PPCPs that are most effectively removed by wastewater treatment appeared in the highest levels in combined sewer overflows. The researchers believe that these PPCPs are strongly attracted to sewer system sediments, to which they adhere during dry weather. When a big influx of stormwater flushes out the sewer systems, these PPCP-laden sediments are washed out of the sewer, downstream, and into the automatic sampler.

If, however, there is not enough stormwater to trigger combined sewer overflows and the wastewater makes it to the sewage treatment plant, the PPCPs measured in the study stream are removed by treatment. This explains why stormwater dilution doesn't decrease PPCP levels, and may also indicate that fixing sewer systems to avoid CSOs might also decrease PPCPs in the natural environment.

Written by Corrie Layfield.

Article available at:

Del Rio, H. J. Suarez, J. Puertas, and P. Ures. PPCPs wet weather mobilization in a combined sewer system in NW Spain. Science of the Total Environment 2013; 449:189-198. http://www.ncbi.nlm.nih.gov/pubmed/23425796

Be sure to check out this article written by Brian Bienkowski, Staff Writer at Environmental Health News, on research conducted by Rebecca Klaper.

"When fish swim in waters tainted with antidepressant drugs, they become anxious, anti-social and sometimes even homicidal.
New research has found that the pharmaceuticals, which are frequently showing up in U.S. streams, can alter genes responsible
for building fish brains and controlling their behavior.

Antidepressants are the most commonly prescribed medications in the United States; about 250 million prescriptions are filled every year. And they also are the highest-documented drugs contaminating waterways, which has experts worried about fish. Traces of the drugs typically get into streams when people excrete them, then sewage treatment plants discharge the effluent.

Exposure to fluoxetine, known by the trade name Prozac, had a bizarre effect on male fathead minnows, according to new, unpublished research by scientists at the University of Wisconsin-Milwaukee.

Male minnows exposed to a small dose of the drug in laboratories ignored females. They spent more time under a tile, so their reproduction decreased and they took more time capturing prey, according to Rebecca Klaper, a professor of freshwater sciences who spoke about her findings at a Society of Environmental Toxicology and Chemistry conference last fall. Klaper said the doses of Prozac added to the fishes' water were "very low concentrations," 1 part per billion, which is found in some wastewater discharged into streams."

Full article available at: http://www.environmentalhealthnews.org/ehs/news/2013/fish-on-prozac

Central Illinois' newest permanent medicine collection program is starting strong. In its first week, the Champaign-Urbana Area Medicine Take-back Program has collected approximately 150 pounds of unwanted medicine for safe disposal.

The program's success began early in the morning on May 24, when area residents brought bottles and bags of pharmaceuticals to police stations in Champaign and Urbana. After just a few hours, the program had collected so many prescription and over-the-counter medications that officers at the Champaign Police Department had to empty the collection box that now permanently resides in the lobby. And they went on to empty it five more times that day.

Several of the people who came by said they had been holding onto their medications and waiting for an opportunity to dispose of them properly. They told reporters that they wanted to keep the pills away from their children and grandchildren, but knew that throwing them in the trash or flushing them down the toilet could contaminate local waterways and negatively impact aquatic wildlife.

"There is a need out there for programs like this. We get a lot of calls from people who want to do the right thing and dispose of their pharmaceuticals safely," said Julie Pryde, administrator for the Champaign-Urbana Public Health District. "And the good thing about this program is that it is free and accessible all the time."

Permanent programs are an important way to limit the threat pharmaceutical chemicals pose to aquatic environments. These chemicals have been found in surface, ground, and drinking water throughout the U.S. and have been shown to impair the development, behavior, and reproduction of fish and other aquatic wildlife. Making it easy for people to rid their homes of unused medication can also protect children and pets from accidental poisonings and reduce prescription or over-the-counter drug abuse.

"[The program] is a big step forward," said Robert Hirschfeld, water policy specialist for Prairie Rivers Network. "There is more to do, but this is a good start."

The C-U Area Medicine Take-back Program is sponsored by Illinois-Indiana Sea Grant, the cities of Champaign and Urbana, and other community and regional partners. Visit illinoishomepage.net/p2d2 to learn more about the program and its role in protecting environmental and public health.

Communities interested in starting their own collection programs can find how-to information here. Contact Laura Kammin at lkammin@illinois.edu or 217-333-1115 with questions or for additional support.

There is a lot of introduced legislation right now at both federal and state levels that would impact the future management of pharmaceutical and personal care product waste in the United States. Check back each week as IISG outlines the highlights of some of the bills to watch. Here's a "short" list of some of the bills IISG is currently tracking:

Pharmaceuticals

California SB 727 Medical Waste:Pharmaceutical Product Stewardship Program
Connecticut HB 6439 Disposal and Collection of Unused Medication
Illinois HB 1343 Pharmaceutical Disposal, and
HB 0072 Safe Pharmaceutical Disposal
Maine SB 881 Improve the Unused Pharmaceutical Disposal Program
Massachusetts S.399 Pharmaceutical and Personal Care Product-Laden Wastewater,
HB1977 Drug Disposal by Mail, and
HB 2033 Safe Disposal of Prescription Drugs
Michigan HR 103 Drug Take Back Awareness Week
New Hampshire SB 44 Disposal of Controlled Substances by Law Enforcement Officers
New York A00228 Establishing the Disposal of Prescription Drugs Program,
A01584/S00642 Establishing the Drug Manufacturer Collection Program,
A01609 Disposal of Drugs, Drug Disposal Sites and Home Pharmaceutical Collection,
A05465/S03985 Implementing a Drug Disposal Demonstration Program, and
A05610 Drug Management and Collection Program
Oregon HB 2075 Disposal of Prescription Drugs
Pennsylvania HB 1194 Retailers of Pharmaceutical Drugs to Implement Drug Collection System, and
HB 2466 Collection and Disposal of Medicines
Utah HJR020 Provides for studying ways to prevent drug abuse by young people and ways to promote prescription drug disposal when taking medication is no longer necessary, and
HB0120 Amends the Division of Occupational and Professional Licensing Act related to commercial and academic detailing for prescription drugs
West Virginia HB 2113 Establishing a two-year pilot program on the disposal of unused pharmaceuticals

Personal Care Products

Federal SB 696 Safe Chemicals Act of 2013, and
HB 1385 Safe Cosmetics and Personal Care Products Act of 2013
Massachusetts H 1990 Safe Cosmetics, and
HB 2062 Healthy Cosmetics
Minnesota SB 466 An Act Protecting Children from Exposure to Harmful Chemicals,
HF 605 Companion bill to SB466, and
SF 1166/HF 1322 Triclosan and Antibacterial Compounds Sales Prohibition
New York AB 4765 In relation to enacting the Safe Cosmetics Act of 2013
Oregon HB 3162 High Priority Chemicals of Concern in Products

Written by Laura Kammin and Corrie Layfield

A review of 5-years of pharmaceutical pollution studies in the Great Lakes region has identified six chemicals that pose the highest risk to wildlife in area rivers and lakes. At the top of the list is esterone, a synthetic form of estrogen commonly used to treat disorders associated with menopause. The hormone is joined by an anticonvulsant, an antidepressant, and three antibiotics used to treat sinus infections, tonsillitis, and pneumonia.

The comparatively high risk of these chemicals was discovered by researchers in Ontario while reviewing pharmaceutical data collected in the Great Lakes region from 2007-2012. The review included studies on wastewater effluent, surface water, groundwater, and drinking water. Taken together, these studies found over 50 pharmaceutical compounds in wastewater effluent and nearby waterways, although not all chemicals were found in both locations. Many of those same chemicals were also found in treated drinking water.

Researchers used the maximum concentrations reported and the chemical's known toxicity to calculate the risk of each pharmaceutical compound found in surface water. Six chemicals–esterone, erythromycin, sulfamethoxazole, carbamazepine, clarithromycin, and venlafaxine–stood out with levels high enough to impact the growth and development of fish and other aquatic wildlife. The individual risk posed by these six chemicals varies greatly. Results suggest that esterone is almost 37 times as risky as the antidepressant venlafaxine, the least harmful of the six.

Similar processes were used to calculate the environmental and health risks posed by chemicals found in groundwater and drinking water. Researchers found that both ibuprofen and gemfibrozil, a chemical used to regulate lipids, pose high environmental risks in groundwater. However, none of the chemicals detected over the years were at concentrations high enough to threaten human health.

These results, though, do not consider the potential impacts of long-term exposure to chemicals at lower concentrations, or what happens when wildlife are exposed to a mixture of these pharmaceuticals.

In addition to calculating risks, researchers also complied data on the effectiveness of different wastewater treatment processes in removing specific chemicals. Their results join a growing number of studies showing that current wastewater treatment methods are ineffective at removing most pharmaceutical chemicals.

Uslu M.O., Jasim, S., Arvai, A., Bewtra, J., and Biswas, N. 2013. A survey of occurrence and risk assessment of pharmaceutical substance in the Great Lakes Basin. Ozone: Science & Engineering Journal. Retrieved from: www.tandfonline.com/doi/full/10.1080/01919512.2013.793595#tabModule.

While low levels of pharmaceuticals have been found in lots of other fish, no one, until recently, had looked for them in sharks. Now, bull sharks in Florida join the growing list of species known to be impacted by pharmaceuticals in the environment.

To learn if sharks living in Florida rivers were showing similar drug accumulation rates as other fish, researchers sampled blood plasma from animals living in a river receiving up to 44 million gallons of treated wastewater a day and those living in a river minimally impacted by wastewater. Sharks were collected during the summer with a longline fishing method, which uses many baited hooks on a fishing line laid at the bottom of the river. Blood samples were taken from the sharks, which were then released, and samples were analyzed in the lab for synthetic estrogen, antidepressants, a cholesterol reducer, and an impotence treatment.

Low levels of at least one pharmaceutical were found in the plasma of sharks in the sewage-impacted river, while plasma from only one of the sharks from the reference river contained measurable levels of medicine. The researchers point to these finding as evidence that pharmaceuticals can bioaccumulate in sharks, but, thus far, haven't been measured at levels that would hurt sharks. Since this was a small study, broad conclusions about pharmaceuticals in shark populations can't be made, but their findings do generate some interesting questions about the impact of human waste on organisms that life in both fresh and salt water during their life cycles.

Written by Corrie Layfield

Beginning May 24, residents will have 24/7 access to safely dispose of their unwanted or expired medications, including controlled substances. IISG is happy to announce that the C-U Area Medicine Take-back Program will collect and properly dispose of pharmaceuticals to help reduce accidental poisonings of children and pets, prevent drug diversion and abuse, and limit environmental impacts.

Residents can drop off their medications in the collection boxes in the lobbies at:

• Urbana Police Department, 400 South Vine St., Urbana
• Champaign Police Department, 82 E. University Ave., Champaign
• University of Illinois Police Department, 1110 W. Springfield Ave., Urbana

Both prescription and over-the-counter medicines, as well as veterinary pharmaceuticals will be accepted. Illicit drugs, syringes, needles, or thermometers will not be accepted. The program will take medications from residential sources only. No personal information remaining on the containers will be used; privacy of any personal information will be strictly maintained. The collected drugs will be incinerated, which is the environmentally-preferred disposal method.

The new take-back program is a partnership between Illinois-Indiana Sea Grant, Urbana Police Department, Champaign Police Department, University of Illinois Police, Champaign County Sheriff's Office, the International Prescription Pill and Drug Disposal Program (P2D2), City of Champaign, City of Urbana, Illinois American Water, University of Illinois Student Sustainability Committee, UI Illinois Sustainable Technology Center, Champaign County Regional Planning Commission, Champaign-Urbana Public Health District, WCIA 3 News, and Prairie Rivers Network.

Illinois American Water, the P2D2 Program, and Carle Rx (now Walgreens) started a program in C-U in 2009, but due to current federal regulations, the two locations may not accept controlled substances. The C-U Area Medicine Take-back Program is the first in Champaign County to be able to collect controlled substances, but it is not the only one in central Illinois. IISG helped the Maroa Police Department start a program in Macon County in 2011. And there are several P2D2 drop-boxes in Effingham County. As word of these programs spread, hopefully more communities will soon join in to safely dispose of their unused medicines.

New research on the impacts of pharmaceutical pollutants in water will be presented at this year's Conference on Great Lakes Research, held June 2-6, as part of a larger session dedicated to contaminants in the Great Lakes region. The two-day session will cover a range of issues, including contaminant testing, impacts to wildlife, and pollution trends overtime.

Presentations begin on June 5 with new research on pollutants that are a longstanding problem in the Great Lakes region, including PCBs, mercury, and chemicals used in driveway sealants. Research on these legacy contaminants will focus on their concentrations, dispersal, and environmental impacts in the years after federal regulations barred their use.

Day two of the session is dedicated to pharmaceuticals and other emerging contaminants more recently discovered in the Great Lakes. Among the presentations is a study indicating that pharmaceutical hormones may impact the sexual development of female fish more than their male counterparts. Other presentations will introduce techniques for identifying new contaminants, discuss impacts of flame retardants on birds, and reveal changes in bacterial communities caused by a common nanomaterial.

Prior to the session, 15 researchers and students will also present findings related to new and historical contaminants during the conference poster session on June 4.

The International Association for Great Lakes Research's (IAGLR) 56^th Annual Conference on Great Lakes Research is sponsored by Illinois-Indiana Sea Grant and Purdue University. The four-day program includes research sessions, panel discussions, keynote speakers, and workshops on a variety of topics. To view the entire program, visit the conference website.

Researchers from Ball State University and the U.S. Geological Survey studied Sugar Creek in central Indiana for a year to document the abundance and transport of human and veterinary pharmaceuticals. Given that 18 swine and cattle concentrated animal feeding operations (CAFOs) are within close proximity to the stream, they were not shocked to discover that lincomycin and sulfamethazine, two antibiotics used regularly at the CAFOs, were found in measurable quantities in the water. In fact, concentrations of these two pharmaceuticals were about 30% higher in a stretch of the creek immediately adjacent to one of the swine CAFOs, just as they had predicted.

What was unexpected was the lack of variation in concentration of the veterinary antibiotics over time. The researchers had hypothesized that there would be more antibiotics in the creek in the fall, following manure applications to surrounding fields. Instead, they found that the highest concentrations occurred in July. Though the veterinary pharmaceuticals did not display significant temporal variation, human pharmaceuticals and personal care products (PPCPs) did. Caffeine was measured in significantly higher concentrations in the winter, while DEET, the active ingredient in many insect repellents, was more abundant in the summer.

Also unexpected was that concentrations of human PPCPs were in the same range as those documented in streams in urban watersheds, despite the fact that no wastewater treatment plant effluent is discharged into Sugar Creek. The scientists pointed to septic systems as the likely source for the human PPCPs, and noted that the role of these systems as nonpoint sources of PPCP pollution needs to be better quantified.

Bernot, M.J., L. Smith, and J. Frey. 2013. Human and veterinary pharmaceutical abundance and transport in a rural central Indiana stream influenced by confined animal feeding operations (CAFOs). Science of the Total Environment 445-446:219-230.

Efforts to secure a long-term water supply in some drought-ridden areas could also make it harder for future pharmaceutical chemicals to make it into drinking water. According to a study published this year in Science of the Total Environment, chemicals new to the market or currently undergoing testing are more susceptible to a treatment process commonly used to make wastewater safe to drink, a method gaining in popularity as more areas are forced to make the most of the water they have.

The Achilles' heel of many future chemicals is their size. While examining approximately 2,000 new pharmaceutical compounds, researchers discovered a trend towards medicines derived from natural molecules like proteins. In fact, more than 60 percent of the chemicals currently in the early stages of FDA testing are biopharmaceuticals. It will be many years, even decades, before these medicines can be bought at local drugstores. But when they do, their large size will make it easier to filter them out of wastewater.

This will especially be the case if the filter is a reverse osmosis membrane, which is specifically designed to allow smaller molecules through while trapping those bigger than its pours. Models used in the study to predict chemical behavior suggest that reverse osmosis would remove over 98 percent of the 2,000 chemicals tested. And the chemicals that made it through would likely not persist in the environment.

Right now, reverse osmosis is commonly used in household drinking water purification systems and to desalinate sweater. But cities like San Diego, Phoenix, and Tampa have shown interest in using this same process to recycle and reuse wastewater after it leaves a conventional treatment plant.

Lim, S.J., Fox, P. 2013. Prediction of the potential fates of future pharmaceutical compounds in indirect potable reuse systems. Science of the Total Environment, 444:417-422.