PERSONAL CARE PRODUCTS IN WATER:
What Is the Bottom Line for Consumers?
There are many ways for
pharmaceuticals and personal care products to enter ground water and
surface water. These include water that we drink and that we use for
recreation such as swimming, fishing, and boating. Of course, water
also is home to a multitude of aquatic animals. There are no studies
to date documenting human harm from the trace amounts of
pharmaceuticals and personal care products measured in water, but
there are studies in animals which indicate possible concerns. Even
though substantive measures would require major resources and
cooperation by a number of government and private entities, there
are steps that individuals can take to limit the amount of
pharmaceuticals and personal care products that they introduce into
ground and surface water.
How and why should
consumers be concerned about drug disposal?
The federal government
offered consumers the first-ever nationwide guidelines for disposing
of household drugs in 2007.1 The goals were to prevent
unintentional poisonings from unused and/or expired drugs in the
home, prevent misuse and diversion of discarded drugs, and to keep
drugs within engineered landfills, instead of in the water supply.
The means suggested were simple:
Mix unused drugs with
old coffee grounds or kitty litter, or something else that no
one would be tempted to swallow.
Place this material in
a container or zip-top plastic bag.
Discard the container
with household trash.
The old recommendation of
flushing drugs down the toilet or drain is no longer advised.
Exceptions are for extremely toxic drugs and controlled substances
which may be exceptionally unsafe if swallowed unintentionally,
taken in overdose, or abused; the most common example is narcotic
How do drugs and
personal care products enter the water supply?
Even if all consumers
followed these recommendations, there are many ways for drugs and
personal care products to enter the water supply. Examples include:
Drugs and their
breakdown products that are eliminated in urine and feces and
flushed down the toilet, thus entering the water supply through
sewage systems or as leachate from inadequate or leaking septic
Drugs that are
eliminated through the skin and personal care products applied
to the skin, that then are washed down the drain.
Drugs and personal
care products that spread onto clothing; when the clothing is
washed, the chemicals go down the drain.
Drugs from health care
facilities that may not be legally required to discard drugs as
hazardous materials, for example, long-term care facilities,
medical and dental offices, and veterinarians.
from hospitals and other health care facilities, from which
human waste is flushed or washed down the drain, just as it is
Drugs from animal
feeding operations and ranches.
Domestic animal waste.
Waste water treatment
plants that do not filter all drugs, potentially releasing drugs
into the drinking water, water used for irrigation,3
and/or into the sludge that may be used to fertilize food crops.4
Storm water overflow,
during which water bypasses waste water treatment plants.
i.e. direct release of untreated sewage into bodies of water.
What drugs are found in
The Associated Press
compiled a list of pharmaceuticals found in tap water in several
areas around the country. These compounds were identified in tests
conducted by federal government agencies and individual water
providers. Among the drugs that were found in tap water were
acetaminophen, caffeine, antibiotics, antidepressants,
anticonvulsants, antihistamines, non-steroidal anti-inflammatory
drugs, steroids, and female sex hormones.5 The study
notes that water companies are not required by the federal
government to test their water for pharmaceuticals, many water
companies do not routinely test tap water for these compounds, and
most companies do not make test results generally available.
The U.S. Environmental
Protection Agency (EPA) reported that, in addition to steroids and
antibiotics, more than one hundred pharmaceuticals and personal care
products have been identified in drinking water and other
environmental samples.6 In a pilot study of fish from
five sites near wastewater treatment sites and a control site in a
non-polluted area, seventeen pharmaceutical compounds were found in
fish from the five streams, including antidepressants and an
antihistamine, but not in fish from the control site.7
The U.S. Geological Survey
collected drinking water samples from ground-water and surface-water
sites in half the U.S. states. Chemicals found included metabolites
of nicotine and caffeine,
bisphenol-A, fire retardants, and a number of pharmaceuticals.8
In an earlier study by the
U.S. Geological Survey of 139 streams in 30 states, researchers
assessed the water for the presence or absence of 95 chemicals. One
or more was detected in 80 percent of the streams. Eighty-two of the
95 chemicals tested for were found at least once. In addition to
pharmaceuticals, researchers found triclosan, used as an
antimicrobial/disinfectant in consumer products; DEET, used in
insect repellants; fire retardants; detergents; and plasticizers.9
Government and industry
researchers note, though, that the chemicals are found in minute
amounts. For as long as humans have ingested, injected, inhaled, or
applied drugs and chemicals, these substances and/or their
metabolites most likely have been entering the environment. Many or
most of them are being identified now because testing has become
increasingly sensitive. In other words, an unknown number of
substances may have been present in water for some time, but it’s
only recently that technology existed to measure such small
quantities.10 Some question whether drugs found in
amounts as low as parts per billion, or parts per trillion, are even
capable of causing harm, as these amounts are far lower than
Is aquatic life
A number of
pharmaceuticals and personal care products have been measured in
tissue of aquatic species in the U.S. For example, fish exposed to
wastewater from a metropolitan area sewage treatment plant exhibited
endocrine disruption, i.e. male fish produced female egg-yolk
proteins.12 In a widely reported study of smallmouth
bass from the Potomac River, male fish were found to have female
ovarian tissue within their testes.13 Studies of
pharmaceuticals and other contaminants have been conducted in many
countries and have included insect and aquatic life as targets, with
many types of alterations found in structure and function. No one
believes that the presence of human drugs and other products is
desirable in water and wildlife. Even so, it can be a challenge to
ascribe some changes in aquatic life and other wildlife to the
presence of drugs, personal care products, and other substances in
the water if the baseline incidence of a particular abnormality is
not known for comparison.
Are there implications
for human health?
To date, no studies
implicate chemicals in water with human health problems. There are
concerns for a number of reasons, however.
As testing becomes
more sensitive, we may learn that even more drugs, personal care
products, and other contaminants are in the water that we use
for drinking and recreation.
It is not known if
exposure to chemicals in drinking water poses a hazard for
pregnant women and their fetuses. It is theoretically possible
that a woman may be ingesting drugs that are contraindicated in
pregnancy. Also, it is not known if continual exposure to low or
trace levels of these substances has an effect on the woman or
It is theoretically
possible for someone to ingest a drug to which he or she is
Drug resistance is a
theoretical issue, if someone is regularly ingesting measurable,
even though tiny, amounts of a drug over a period of time.
Studies of potential
health risks are typically carried out with one drug or
substance at a time. It is not known what, if any, problems may
occur with life-long ingestion of ever-changing combinations of
drugs and chemicals.
Even with these potential
concerns, the U.S. water supply is considered safe, based on current
knowledge. EPA asserts that U.S. drinking water is among the safest
in the world.14 (EPA notes that there are more than
155,000 public suppliers of drinking water in the U.S. and provides
information for researching the quality of water in individual
What is being done to
monitor for and eliminate pharmaceuticals and personal care products
regarding environmental pollutants is voluminous. Research is
ongoing in several areas, for example:
various health care facilities manage unused pharmaceuticals.16
in water17, 18 and elsewhere in the environment.19
potential toxicity of pharmaceuticals and other substances to
aquatic life, wildlife, humans, and the environment.
environmental fate of pharmaceuticals, personal care products,
and other chemicals as they enter the waste stream.
substances from entering the environment.
Determining how best
to strengthen the infrastructure of the nation’s water system,
including upgrading water treatment plants to prevent
contaminants from entering the drinking water supply;
eliminating failing septic systems; and preventing contaminants
from reaching aquifers from landfills.
What is being done now
to eliminate drugs and personal care products from the water supply?
The EPA is considering
more than 100 chemicals, including pharmaceuticals, for inclusion in
regulations under the Safe Water Drinking Act. Also, the U.S.
Department of the Interior is funding water infrastructure
There are requirements
that pharmaceutical companies and other industries discharge only
treated water. Depending on the geographic area, there may be local
regulations for agricultural and animal management that address
environmentally sound disposal of animal waste and pesticides. Many
health care facilities contract with disposal firms to discard
unused pharmaceuticals in an environmentally sound manner. Community
pharmacies and law-enforcement organizations sometimes sponsor
community “drug take-back” programs, allowing consumers to turn in
drugs that then will be disposed of safely, according to relevant
hazardous materials guidelines. Water infrastructure improvements to
limit or eliminate the number of substances released into drinking
water are desirable but would be very expensive.
What can consumers do?
It would be ideal if drugs
and personal care products, along with pesticides and other
chemicals, never reached the water supply. Realistically, achieving
this goal would require massive resources and cooperation among
academic, private, and government entities. No one is advising
consumers to stop taking needed medicines, using sunscreen and
insect repellants, or medicating their pets as needed. Every
consumer, though, can take individual steps to limit introduction of
drugs and personal care products into the water supply.
Buy only drugs and
products that are needed.
Buy the minimum
quantity needed. Purchasing a “giant size” bottle of medication
that cannot be used up before expiring is wasteful; unused drug
can enter the water supply when discarded.
Take only the
prescribed or recommended amount of needed drugs.
Apply skin care
products according to label instructions.
Ask your physician for
drug samples, if they are available and appropriate for your
condition, before filling a prescription that might not work for
you. (Be sure all drug samples are stored safely, out of sight
and reach of children.)
If you have unused
prescription medicines, ask your pharmacy if they will take them
back for disposal. If not, find out if they know of drug
take-back programs in your community.
If you are a veteran
living in Baltimore, Washington, DC, or West Virginia, you may
be able to participate in a mail-in drug disposal service.
Veterans receive specially-marked envelopes and instructions
with their prescription refills.21
If drug take-back
programs are not available to you, carefully follow federal
guidelines for disposal of unneeded and expired drugs.
If you have a septic
tank/field, be sure that it is maintained properly to eliminate
leakage of pharmaceutical and personal care product waste into
Clean up pet waste
The basic science research
in this field is voluminous. Some targeted studies may be identified
from the bibliographies within the following web sites and
Blazer VS, Iwanowicz LR, Iwanowicz DD, et
al. Intersex (testicular oocytes) in smallmouth bass from the
Potomac River and selected nearby drainages. Journal of
Aquatic Animal Health 2007; 19: 242-253