Excreted and flushed through our sewage works and waterways, drug molecules are all around us. A recent analysis of streams in the US detected an entire pharmacy: diabetic meds, muscle relaxants, opioids, antibiotics, antidepressants and more. Drugs have even been found in crops irrigated by treated waste water.
The chemical contaminants that infest city water supplies in industrialized nations are abundant, including fluoride, chlorine, lead, mercury, arsenic and dozens of pharmaceuticals.
Mitigating the problem of pharmaceuticals in drinking water has been an ongoing health issue for decades. The amounts that end up in your glass are minuscule, however, someone prescribed multiple drugs is more likely to experience side effects, and risks rise exponentially with each drug taken by a person over 65. So could tiny doses of dozens of drugs have an impact on your health?
"We don't know what it means if you have a lifelong uptake of drugs at very low concentrations," says Klaus Kummerer at the University of Luneburg, Germany.
Anna Fels, a psychiatrist and professor at Weill Cornell Medical College in New York City, wrote in a New York Times op-ed that lithium, an antimanic drug that decreases abnormal brain activity, is present in varying levels in the water supply and "“has been largely ignored for over half a century." If you didn’t know, lithium was also included in early recipes of the soda 7Up.
"These drugs have been individually approved, but we haven't studied what it means when they're together in the same soup," says Mae Wu at the National Resources Defense Council, a US advocacy group.
Learning From History
"Besides pharmaceuticals, there are varieties of dioxins, insecticides, herbicides, pesticides, chemical additives and heavy metals, which when combined, create a toxic cocktail affecting every system in the body, even at extremely low concentrations," said Clarke Brubaker, environmental toxicologist.
While there is a paucity of data on some of the contaminants, regulated chemicals such as atrazine, metolachlor, triclosan found in drinking water samples have been demonstrably linked to serious human and environmental health problems. Atrazine, for example, is used nationwide to kill broadleaf and grassy weeds, primarily in corn crops. It has been shown to be harmful to humans, mammals, and amphibians even when the amount used is less than the government allows. Atrazine is also associated with infertility, low birth weight, and abnormal infant development in humans. The chemical’s use is widespread, but for agriculture its use in concentrated in the Midwest farmbelt.
Levels of a widely used class of industrial chemicals linked with cancer and other health problems -- polyfluoroalkyl and perfluoroalkyl substances (PFASs) -- exceed federally recommended safety levels in public drinking-water supplies
Thirty years ago, no one paid attention to endocrine disruptors, artificial chemicals found in a variety of materials. These environmental contaminants are now linked to breast cancer and abnormal development in children. The cocktail in our water involves many more compounds, so this time we can't afford to wait for negative effects to emerge.
The issue of drugs in our water came to a head earlier this year when researchers were taken aback by the discovery of some drug residues in crops irrigated with treated waste water in Israel (Environmental Science & Technology, doi.org/bqdd).
To see if these residues passed into the body, Benny Chefetz at the Hebrew University of Jerusalem and his colleagues focused on an epilepsy drug called carbamazepine, which they detected in cucumbers, lettuce and other produce. Volunteers who consumed an irrigated crop had a dramatic spike in the drug's levels in their urine, which took over a week to clear. Those who ate crops irrigated by fresh water saw no effect. "This was a big surprise," says Chefetz, who plans to study at-risk groups such as pregnant women and children.
We shouldn't worry about an instant effect in healthy adults, says Chefetz, as the levels were 10,000 times lower than from a 400 milligram pill. "But we don't know what will happen with small children exposed to low levels of pharmaceuticals for a generation," he says, and it's not practical or ethical to run a clinical trial. "There's no data about that."
As water scarcities become more widespread, many regions plan on utilizing recycled waste water for their populations. California plans to increase its use for crops in response to drought, for example. This suggests drug residues in our drinking water are set to rise. But fresh water isn't immune either.
Paul Bradley of the US Geological Survey and his team checked streams in the eastern US for 108 chemicals, a drop in the bucket of the 3000 drug compounds in use. One river alone had 45. And even though two-thirds of the streams weren't fed by treated waste water, 95 per cent of them had the anti-diabetic drug metformin, probably from street run-off or leaky sewage pipes (Environmental Science & Technology, doi.org/bqdb).
"The number of chemicals we are exposed to is very, very large, and we don't understand those impacts," says Bradley.
Recent stats show one in five Americans had used three or more prescription drugs in the past 30 days and addiction is on the rise to combat many diseases, disorders and pain.
Drinking tap water contaminated with PFOA is also serious health risk. The highest measured levels of PFOA in human blood in the US, other than factory exposures, are in people who have consumed PFOA contaminated tap water in West Virginia and Ohio. These people had PFOA levels in their blood 100 times higher than the levels found in the water, and far higher than the average person in the US.
"These compounds are potent immunotoxicants in children and recent work suggests drinking-water safety levels should be much lower than the provisional guidelines established by EPA," said Elsie Sunderland, senior author of the study and associate professor at both the Harvard Chan School and SEAS.
The pharmaceutical and personal care products, or P.P.C.P.'s, are being flushed into rivers from sewage treatment plants or leaching into groundwater from septic systems. According to the Environmental Protection Agency, researchers have found these substances, called "emerging contaminants," almost everywhere they have looked for them.
Officials who deal with these compounds have the complex task of balancing reassurance that they take the situation seriously with reassurance that there is probably nothing to worry about. As a result, scientists in several government and private agencies are devising new ways to measure and analyze the compounds, determine their prevalence in the environment, figure out where they come from, how they move, where they end up and if they have any effects.
The big unknown is how these low-dose drug cocktails affect people. Usually, researchers assess risk by varying doses of one drug. They ask what dose causes a specific result, like mortality in a lab animal or signs of cancer. But you cannot assess multiple drugs in small doses over a long time period, says Kummerer.
"Industry says we need sound science, but what does that mean?" he says. "If it's a clear dose-effect relation, then we cannot establish this."
Drugs given to animals are also entering the water supply. One study found that 10 percent of the steroids given to cattle pass directly through their bodies, while another study found that steroid concentrations in the water downstream of a Nebraska feedlot were four times as high as the water upstream. Male fish downstream of the feedlot were found to have depressed levels of testosterone and smaller than normal heads, most likely due to the pharmaceutical contamination in their water.
"It brings a question to people's minds that if the fish were affected ... might there be a potential problem for humans?" said EPA research biologist Vickie Wilson.
"We've got hundreds of chemicals circulating in our blood that our grandparents did not have," says John Sumpter at Brunel University London. "We can test each of these chemicals in turn and not see any adverse effect, but I'm not sure the whole mixture doesn't do anything."
Some say the industry could do more. "Once drugs are on the market, they claim they have no responsibility," says Chefetz. Bodies like the European Federation of Pharmaceutical Industries and Associations disagree. A spokesperson points to efforts like a collaboration within the Innovative Medicines Initiative to generate reliable ways of judging potential risk for pharmaceuticals.
Maybe we should accept we don't know what is going on and take action to minimise the risks: a precautionary approach. There are two possible solutions.
One is to upgrade water treatment facilities. It's an option Switzerland has gone for, but it isn't cheap - it will cost the country over $1 billion. In England, it is estimated that just removing the hormone estradiol from sewage plants would cost billions of pounds.
"The public needs to decide if reducing these compounds is important enough to pay for," says Bradley.
"We don't know what it means if you have a lifelong uptake of drugs at very low concentrations"
Another issue is that treatment doesn't remove all unwanted compounds and can transform some into new and unknown chemicals, says Kummerer. He argued against the approach last week at the Risk Assessment of Pharmaceuticals in the Environment conference in Paris.
Instead, he is calling for greener pharmaceuticals that degrade readily in the environment.
Reports of contamination with pharmaceutical residues can be alarming, even when there is no evidence that anyone has been harmed. In 2004, for example, the British government reported that eight commonly used drugs had been detected in rivers receiving effluent from sewage treatment plants. A spokeswoman for the Department for Environment, Food and Rural Affairs said it was "extremely unlikely" that the residues threatened people, because they were present in very low concentrations. Nevertheless, news reports portrayed a nation of inadvertent drug users - "a case of hidden mass medication of the unsuspecting public," as one member of Parliament was quoted as saying.
Christopher Daughton, a scientist at the Environmental Protection Agency and one of the first scientists to draw attention to the issue, said P.P.C.P. concentrations in municipal water supplies were even lower than they were in water generally because treatments like chlorination and filtration with activated charcoal alter or remove many chemicals. Dr. Daughton, who works at the agency's National Exposure Research Laboratory in Las Vegas, said he believed that if any living being suffered ill effects from these compounds, it would be fish and other creatures that live in rivers and streams.
Traditionally, pharma firms have focused on the stability of drugs, ensuring their products have a long shelf life. Kummerer believes it's time for a rethink. Existing drugs can be made to react and break down under conditions not found in the body, such as light or a specific pH. He has shown it's possible to redesign drugs for heart disease so that they degrade faster in the environment (RSC Advances, doi.org/bqdg), though these molecules require testing before clinical use.
The increased drugs are largely antidepressants, along with diabetes and ulcer meds. College kids, it turns out, had been diluting the far druggier waste water of the older generation (Science of the Total Environment, doi.org/bqfm).
But if the companies won't play ball, perhaps we need to hit them where it hurts - the bottom line. Drugs are assessed for their environmental impact but results cannot prevent them being sold. Doing so could shift thinking, but it is a big stick. Would blocking a cancer drug on environmental grounds really be acceptable?
Still, a ban could encourage firms to produce greener drugs. "This could create revenue for innovative companies," says Kummerer. It's thought some are already active in this area, but keeping the research under their hats, says John Warner of the Warner Babcock Institute for Green Chemistry in Wilmington, Massachusetts.
"Drugs in the environment is a serious issue, but current regulations work against solving the problem by looking for stable drugs," he says. "The fact you don't hear about all these great things pharma is doing in this space doesn't mean they are not doing it."
However we decide to deal with the drugs in our water, the lessons of the endocrine disruptors suggest we should start soon, even in the face of uncertainty about their effects.
"This hasn't been getting enough attention," says Wu. "The problem hasn't been getting better because we are just ignoring it."
The Environmental Protection Agency (EPA) requires hundreds of tests each month on municipal water supplies, but the Food and Drug Administration (FDA), which regulates bottled water, requires only one test a week on bottled water.
This is no new phenomenon but its effects are becoming more apparent as testing technology evolves. Testing technology has gone from being able to test water in terms of parts per million to parts per billion. The impact of some of these drugs is more clear than others. For example, antibiotics are showing up in our drinking water, which is scary when you consider that 65,000 Americans die per year from antibiotic resistant bacteria. Some of the drugs have even been linked with diabetes, breast cancer, and kidney problems. Even worse, healthcare facilities dump about 250 million pounds per year, which could end up in our water supply. These hazardous drugs could include oncology drugs and toxic pain killers.
Cleaner Living And Filtering
We can talk about it until the cows come home, but what can we do to fix the problem? First of all, we need to come up with a means of properly disposing of unused pharmaceuticals that linger in our medicine cabinets. Most parts of the country don't have a means of disposing of residential hazardous medical waste like they do for other hazardous waste.
Comprehensive chemical analysis of water supplies is costly, extraordinarily time-consuming, and viewed by risk managers as prompting yet additional onerous and largely unanswerable questions.
Very little research has been conducted on the specific effects of trace drugs in drinking water, but what evidence is there gives cause for alarm. Contamination of environmental water sources has caused male fish to exhibit female traits and led to damaging effects on other wildlife species. Laboratory research indicates that small levels of drugs can cause cancer cells to proliferate faster, slow kidney cell growth and cause inflammation in blood cells. At a time when the American population is suffering from skyrocketing infertility and hormone imbalances, it seems outrageous that health authorities would not be looking more closely at this issue and working on ways to protect the public from pharmaceutical pollution.
Because water is consumed regularly in large quantities over a lifetime, and because humans are exposed to many combinations of dozens of different drugs, the effects on the human body may be significantly greater than those seen in the lab. And unlike most pollutants, drugs are specifically designed to cause changes in the human body, thus they are far less likely to be "inert" than other chemicals that might be found in the water supply.
"These are chemicals that are designed to have very specific effects at very low concentrations," said zoologist John Sumpter of London's Brunel University. "That's what pharmaceuticals do. So when they get out to the environment, it should not be a shock to people that they have effects."
Bottom Line: Stay away from direct consumption of tap water and research effective filtration methods that remove fluoride, lead, arsenic, or specific contaminants including pharmaceuticals. Not only will it improve the taste, it will improve your health.
To really get the resistant biologicals, the fluoride, heavy metals, and other contaminants, the customer may consider one of the high-end drinking water filters. These cost between two and four hundred dollars and come in models for both over and under the sink.
Even in Europe, where governments have gone much further in addressing trace levels of pharmaceuticals in the environment, there’s scant political will to invest broadly in advanced wastewater treatment.
“The cost isn’t acceptable right now,” Yves Levi, a pharmacist and professor of public health at Paris-South 11 University, said in an interview in French. “No one knows if the risk is considerable or not.”
Another advanced process at drinking water treatment plants, the use of carbon filters, also lets some pharmaceuticals through.
Names like Alpine, MultiPure, and Spectrapure are among the dozens of brand names that have come along during the past 20 years. Everyone claims to be the best, of course, but we can find some important similarities in their advertising. When you begin to compare the better water filters, you notice common concerns:
- cryptosporidium and giardia lamblia cysts
- pesticides and toxic chemicals
- heavy metals
Killing microbials is not a big deal since most of that's been done by chlorine. Most contaminants are removed by the better filters. The problem when choosing a filter seems to come down to five main concerns: fluoride, minerals, THMs, nitrates and pharmaceuticals.
No filter will remove every contaminant, in part because the list of risky chemicals keeps growing. But here are the most common types of filters and the major contaminants they are designed to trap:
- Carbon filters include countertop pitchers, faucet-mounted models, undersink models (which usually require a permanent connection to an existing pipe), and whole-house or point-of-entry systems (usually installed in the basement or outside). Carbon, a porous material, absorbs impurities as the water passes through. What they remove: Lead, PCBs, chlorine byproducts (chloramines and trihalomethanes), certain parasites, radon, pesticides and herbicides, the gasoline additive MTBE, the dry-cleaning solvent trichloroethylene, some volatile organic compounds, some levels of bacteria (such as Cryptosporidium and Giardia) and a small number of pharmaceuticals.
- Reverse-osmosis systems push water through a semipermeable membrane, which acts as an extremely fine filter. They're often used in conjunction with carbon filters. However, these systems waste 4 to 9 gallons (15 to 34 liters) of water for every gallon (3.8 liters) filtered. What they remove: Chemicals carbon filters may miss, including perchlorate, sulfates, fluoride, industrial chemicals, heavy metals (including lead), chlorine byproducts, chlorides (which make water taste salty), and pharmaceuticals.
- Ultraviolet light units disinfect water, killing bacteria. Countertop units can be found for under U.S. $100, but most whole-house units cost $700 and upward. What they remove: Bacteria. Experts recommend using them with carbon filters to remove other contaminants.
- Distillers, probably the least practical home method, boil and condense water. While countertop units are available, distillers use lots of electricity, generate excess heat, and require regular cleaning. Explore filters or other alternatives to remove your contaminants, or, in a pinch, buy distilled water. What they remove: Heavy metals (including lead), particles, total dissolved solids, microbes, fluoride, lead, and mercury.
If you can get drinking water from a local natural spring that is tested regularly for contaminants, you are lucky. Collecting and drinking your own spring water is your best choice--in terms of both water quality and expense. Drinking spring water is indeed one of the healthiest choices since it has optimal pH unlike distilled and reverse osmosis which are more acidic. If you know that the spring water is, in fact, from a natural spring and has not been treated with chemicals, it is one of the best choices for your hydration.