Pharmaceuticals lurking in U.S. drinking water

AP probe found traces of meds in water supplies of 41 million Americans

By Jeff Donn, Martha Mendoza and Justin Pritchard

A vast array of pharmaceuticals — including antibiotics, anti-convulsants, mood stabilizers and sex hormones — have been found in the drinking water supplies of at least 41 million Americans, an Associated Press investigation shows.


To be sure, the concentrations of these pharmaceuticals are tiny, measured in quantities of parts per billion or trillion, far below the levels of a medical dose. Also, utilities insist their water is safe.

But the presence of so many prescription drugs — and over-the-counter medicines like acetaminophen and ibuprofen — in so much of our drinking water is heightening worries among scientists of long-term consequences to human health.

From California to New Jersey
In the course of a five-month inquiry, the AP discovered that drugs have been detected in the drinking water supplies of 24 major metropolitan areas — from Southern California to Northern New Jersey, from Detroit to Louisville, Ky.

Water providers rarely disclose results of pharmaceutical screenings, unless pressed, the AP found. For example, the head of a group representing major California suppliers said the public “doesn’t know how to interpret the information” and might be unduly alarmed.

How do the drugs get into the water?

People take pills. Their bodies absorb some of the medication, but the rest of it passes through and is flushed down the toilet. The wastewater is treated before it is discharged into reservoirs, rivers or lakes. Then, some of the water is cleansed again at drinking water treatment plants and piped to consumers. But most treatments do not remove all drug residue.

And while researchers do not yet understand the exact risks from decades of persistent exposure to random combinations of low levels of pharmaceuticals, recent studies — which have gone virtually unnoticed by the general public — have found alarming effects on human cells and wildlife.

“We recognize it is a growing concern and we’re taking it very seriously,” said Benjamin H. Grumbles, assistant administrator for water at the U.S. Environmental Protection Agency.

Members of the AP National Investigative Team reviewed hundreds of scientific reports, analyzed federal drinking water databases, visited environmental study sites and treatment plants and interviewed more than 230 officials, academics and scientists. They also surveyed the nation’s 50 largest cities and a dozen other major water providers, as well as smaller community water providers in all 50 states.

Key findings
Here are some of the key test results obtained by the AP:

Officials in Philadelphia said testing there discovered 56 pharmaceuticals or byproducts in treated drinking water, including medicines for pain, infection, high cholesterol, asthma, epilepsy, mental illness and heart problems. Sixty-three pharmaceuticals or byproducts were found in the city’s watersheds.


Anti-epileptic and anti-anxiety medications were detected in a portion of the treated drinking water for 18.5 million people in Southern California.

Researchers at the U.S. Geological Survey analyzed a Passaic Valley Water Commission drinking water treatment plant, which serves 850,000 people in Northern New Jersey, and found a metabolized angina medicine and the mood-stabilizing carbamazepine in drinking water.
A sex hormone was detected in San Francisco’s drinking water.

The drinking water for Washington, D.C., and surrounding areas tested positive for six pharmaceuticals.
Three medications, including an antibiotic, were found in drinking water supplied to Tucson, Ariz.
The situation is undoubtedly worse than suggested by the positive test results in the major population centers documented by the AP.

The federal government doesn’t require any testing and hasn’t set safety limits for drugs in water. Of the 62 major water providers contacted, the drinking water for only 28 was tested. Among the 34 that haven’t: Houston, Chicago, Miami, Baltimore, Phoenix, Boston and New York City’s Department of Environmental Protection, which delivers water to 9 million people.

Some providers screen only for one or two pharmaceuticals, leaving open the possibility that others are present.

The AP’s investigation also indicates that watersheds, the natural sources of most of the nation’s water supply, also are contaminated. Tests were conducted in the watersheds of 35 of the 62 major providers surveyed by the AP, and pharmaceuticals were detected in 28.

Yet officials in six of those 28 metropolitan areas said they did not go on to test their drinking water — Fairfax, Va.; Montgomery County in Maryland; Omaha, Neb.; Oklahoma City; Santa Clara, Calif., and New York City.

The New York state health department and the USGS tested the source of the city’s water, upstate. They found trace concentrations of heart medicine, infection fighters, estrogen, anti-convulsants, a mood stabilizer and a tranquilizer.

City water officials declined repeated requests for an interview. In a statement, they insisted that “New York City’s drinking water continues to meet all federal and state regulations regarding drinking water quality in the watershed and the distribution system” — regulations that do not address trace pharmaceuticals.


In several cases, officials at municipal or regional water providers told the AP that pharmaceuticals had not been detected, but the AP obtained the results of tests conducted by independent researchers that showed otherwise. For example, water department officials in New Orleans said their water had not been tested for pharmaceuticals, but a Tulane University researcher and his students have published a study that found the pain reliever naproxen, the sex hormone estrone and the anti-cholesterol drug byproduct clofibric acid in treated drinking water.

Of the 28 major metropolitan areas where tests were performed on drinking water supplies, only Albuquerque; Austin, Texas; and Virginia Beach, Va.; said tests were negative. The drinking water in Dallas has been tested, but officials are awaiting results. Arlington, Texas, acknowledged that traces of a pharmaceutical were detected in its drinking water but cited post-9/11 security concerns in refusing to identify the drug.

The AP also contacted 52 small water providers — one in each state, and two each in Missouri and Texas — that serve communities with populations around 25,000. All but one said their drinking water had not been screened for pharmaceuticals; officials in Emporia, Kan., refused to answer AP’s questions, also citing post-9/11 issues.

Not just an urban problem
Rural consumers who draw water from their own wells aren’t in the clear either, experts say.

The Stroud Water Research Center, in Avondale, Pa., has measured water samples from New York City’s upstate watershed for caffeine, a common contaminant that scientists often look for as a possible signal for the presence of other pharmaceuticals. Though more caffeine was detected at suburban sites, researcher Anthony Aufdenkampe was struck by the relatively high levels even in less populated areas.


He suspects it escapes from failed septic tanks, maybe with other drugs. “Septic systems are essentially small treatment plants that are essentially unmanaged and therefore tend to fail,” Aufdenkampe said.

Even users of bottled water and home filtration systems don’t necessarily avoid exposure. Bottlers, some of which simply repackage tap water, do not typically treat or test for pharmaceuticals, according to the industry’s main trade group. The same goes for the makers of home filtration systems.

Contamination is not confined to the United States. More than 100 different pharmaceuticals have been detected in lakes, rivers, reservoirs and streams throughout the world. Studies have detected pharmaceuticals in waters throughout Asia, Australia, Canada and Europe — even in Swiss lakes and the North Sea.

For example, in Canada, a study of 20 Ontario drinking water treatment plants by a national research institute found nine different drugs in water samples. Japanese health officials in December called for human health impact studies after detecting prescription drugs in drinking water at seven different sites.

In the United States, the problem isn’t confined to surface waters. Pharmaceuticals also permeate aquifers deep underground, source of 40 percent of the nation’s water supply. Federal scientists who drew water in 24 states from aquifers near contaminant sources such as landfills and animal feed lots found minuscule levels of hormones, antibiotics and other drugs.

Increasing popularity of prescription meds
Perhaps it’s because Americans have been taking drugs — and flushing them unmetabolized or unused — in growing amounts. Over the past five years, the number of U.S. prescriptions rose 12 percent to a record 3.7 billion, while nonprescription drug purchases held steady around 3.3 billion, according to IMS Health and The Nielsen Co.

“People think that if they take a medication, their body absorbs it and it disappears, but of course that’s not the case,” said EPA scientist Christian Daughton, one of the first to draw attention to the issue of pharmaceuticals in water in the United States.

Some drugs, including widely used cholesterol fighters, tranquilizers and anti-epileptic medications, resist modern drinking water and wastewater treatment processes. Plus, the EPA says there are no sewage treatment systems specifically engineered to remove pharmaceuticals.

One technology, reverse osmosis, removes virtually all pharmaceutical contaminants but is very expensive for large-scale use and leaves several gallons of polluted water for every one that is made drinkable.

Another issue: There’s evidence that adding chlorine, a common process in conventional drinking water treatment plants, makes some pharmaceuticals more toxic.

Human waste isn’t the only source of contamination. Cattle, for example, are given ear implants that provide a slow release of trenbolone, an anabolic steroid used by some bodybuilders, which causes cattle to bulk up. But not all the trenbolone circulating in a steer is metabolized. A German study showed 10 percent of the steroid passed right through the animals.

Water sampled downstream of a Nebraska feedlot had steroid levels four times as high as the water taken upstream. Male fathead minnows living in that downstream area had low testosterone levels and small heads.

Other veterinary drugs also play a role. Pets are now treated for arthritis, cancer, heart disease, diabetes, allergies, dementia, and even obesity — sometimes with the same drugs as humans. The inflation-adjusted value of veterinary drugs rose by 8 percent, to $5.2 billion, over the past five years, according to an analysis of data from the Animal Health Institute.


Ask the pharmaceutical industry whether the contamination of water supplies is a problem, and officials will tell you no. “Based on what we now know, I would say we find there’s little or no risk from pharmaceuticals in the environment to human health,” said microbiologist Thomas White, a consultant for the Pharmaceutical Research and Manufacturers of America.

But at a conference last summer, Mary Buzby — director of environmental technology for drug maker Merck & Co. Inc. — said: “There’s no doubt about it, pharmaceuticals are being detected in the environment and there is genuine concern that these compounds, in the small concentrations that they’re at, could be causing impacts to human health or to aquatic organisms.”

Recent laboratory research has found that small amounts of medication have affected human embryonic kidney cells, human blood cells and human breast cancer cells. The cancer cells proliferated too quickly; the kidney cells grew too slowly; and the blood cells showed biological activity associated with inflammation.

Freaky fish mutations
Also, pharmaceuticals in waterways are damaging wildlife across the nation and around the globe, research shows. Notably, male fish are being feminized, creating egg yolk proteins, a process usually restricted to females. Pharmaceuticals also are affecting sentinel species at the foundation of the pyramid of life — such as earth worms in the wild and zooplankton in the laboratory, studies show.

Some scientists stress that the research is extremely limited, and there are too many unknowns. They say, though, that the documented health problems in wildlife are disconcerting.


“It brings a question to people’s minds that if the fish were affected ... might there be a potential problem for humans?” EPA research biologist Vickie Wilson told the AP. “It could be that the fish are just exquisitely sensitive because of their physiology or something. We haven’t gotten far enough along.”

With limited research funds, said Shane Snyder, research and development project manager at the Southern Nevada Water Authority, a greater emphasis should be put on studying the effects of drugs in water.

“I think it’s a shame that so much money is going into monitoring to figure out if these things are out there, and so little is being spent on human health,” said Snyder. “They need to just accept that these things are everywhere — every chemical and pharmaceutical could be there. It’s time for the EPA to step up to the plate and make a statement about the need to study effects, both human and environmental.”

To the degree that the EPA is focused on the issue, it appears to be looking at detection. Grumbles acknowledged that just late last year the agency developed three new methods to “detect and quantify pharmaceuticals” in wastewater. “We realize that we have a limited amount of data on the concentrations,” he said. “We’re going to be able to learn a lot more.”

While Grumbles said the EPA had analyzed 287 pharmaceuticals for possible inclusion on a draft list of candidates for regulation under the Safe Drinking Water Act, he said only one, nitroglycerin, was on the list. Nitroglycerin can be used as a drug for heart problems, but the key reason it’s being considered is its widespread use in making explosives.

Long-term affects?
So much is unknown. Many independent scientists are skeptical that trace concentrations will ultimately prove to be harmful to humans. Confidence about human safety is based largely on studies that poison lab animals with much higher amounts.

There’s growing concern in the scientific community, meanwhile, that certain drugs — or combinations of drugs — may harm humans over decades because water, unlike most specific foods, is consumed in sizable amounts every day.

Our bodies may shrug off a relatively big one-time dose, yet suffer from a smaller amount delivered continuously over a half century, perhaps subtly stirring allergies or nerve damage. Pregnant women, the elderly and the very ill might be more sensitive.

Many concerns about chronic low-level exposure focus on certain drug classes: chemotherapy that can act as a powerful poison; hormones that can hamper reproduction or development; medicines for depression and epilepsy that can damage the brain or change behavior; antibiotics that can allow human germs to mutate into more dangerous forms; pain relievers and blood-pressure diuretics.

For several decades, federal environmental officials and nonprofit watchdog environmental groups have focused on regulated contaminants — pesticides, lead, PCBs — which are present in higher concentrations and clearly pose a health risk.

However, some experts say medications may pose a unique danger because, unlike most pollutants, they were crafted to act on the human body.

“These are chemicals that are designed to have very specific effects at very low concentrations. 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,” says zoologist John Sumpter at Brunel University in London, who has studied trace hormones, heart medicine and other drugs.

And while drugs are tested to be safe for humans, the timeframe is usually over a matter of months, not a lifetime. Pharmaceuticals also can produce side effects and interact with other drugs at normal medical doses. That’s why — aside from therapeutic doses of fluoride injected into potable water supplies — pharmaceuticals are prescribed to people who need them, not delivered to everyone in their drinking water.

“We know we are being exposed to other people’s drugs through our drinking water, and that can’t be good,” says Dr. David Carpenter, who directs the Institute for Health and the Environment of the State University of New York at Albany.

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How meds in water could impact human cells
Ingesting scant amounts could have powerful effect, experiment shows

Troubled by drugs discovered in European waters, poisons expert and biologist Francesco Pomati set up an experiment: He exposed developing human kidney cells to a mixture of 13 drugs at levels mimicking those found in Italian rivers.

There were drugs to fight high cholesterol and blood pressure, seizures and depression, pain and infection, and cancer, all in tiny amounts.

The result: The pharmaceutical blend slowed cell growth by up to a third — suggesting that scant amounts may exert powerful effects, said Pomati, who works at the University of New South Wales in Sydney, Australia.

Taken alone, this was a modest study. But in fact Pomati’s work is part of a body of emerging scientific studies that indicate that over time, humans could be harmed by ingesting drinking water contaminated with tiny amounts of pharmaceuticals.

In another recently published study, Pomati discovered that some of those pharmaceuticals could amplify — or reverse — the effects of some others.

For example, the cholesterol drug bezafibrate and asthma drug salbutamol each seem to stimulate cell growth. Combined in the laboratory, they slowed it way down. The same cholesterol drug appeared to make cells more sensitive to harm from the antibiotic fluoroquinolone.

And Pomati’s work indicates some drugs cause cellular effects at scant concentrations that — strangely — cannot be seen at higher levels.

Such findings are preliminary; they alone cannot demonstrate the same effects within the human body. But they provide scientific hints, just like cellular experiments that routinely guide discovery of new drugs.

Estrogen risks
They also heighten worry about the possible effects on especially vulnerable groups, like the very young, old or sick. “My wife is pregnant, and I don’t let my wife drink the water ... where I know that there are pollutants like pharmaceuticals in concentrations that are detectable and in mixtures that are complex,” said Pomati.

Elsewhere in the world, other researchers are finding results similar to Pomati’s.

In research awaiting publication, human breast cancer cells grew twice as fast when exposed to estrogens taken from catfish caught near untreated sewage overflows in Pennsylvania, compared with other fish.

The University of Pittsburgh researchers didn’t calculate how much effect came from pharmaceuticals instead of natural hormones, but their earlier work points to birth-control pills and hormone treatments as important contributors, said lead researcher Conrad Volz.

“There is the potential for an increased risk for those people who are prone to estrogenic cancer,” said Volz, who studies environmental hazards at the university’s Cancer Institute.


He said people who regularly drink water containing low levels of hormones may be at higher risk, since they would presumably consume more of these drugs than those who only occasionally eat such fish.

\'Kaleidoscope of chemicals\'
Scientists at the Helmholtz research center in Leipzig, Germany, linked low levels of the pain reliever diclofenac to an inflammatory-like response in human blood cells, according to biologist Kristin Schirmer. Inflammation at the wrong time and place plays a role in conditions ranging from infections and arthritis to heart disease.

Sandra Steingraber, a biologist at New York’s Ithaca College, adds that many efforts to determine how trace drugs affect humans don’t fully consider the whole range of pharmaceuticals in the environment and whether someone has been exposed at more susceptible times, like during childhood or old age.

“The timing makes the poison as much as the dose,” she said. “And the dose itself is not the dose from just any one thing — it’s from this whole kaleidoscope of chemicals.”

Taking notice of accumulating evidence, the drug industry has backed studies of its own in recent years that have found very slight, if any, risk to humans.



But these studies haven’t used water samples analyzed for drugs. Instead, the studies estimate danger from what’s known about how much of a drug is sold and how toxic it is to animals. Then, safety margins are added for unknowns, such as possible effects of decades of exposure.

Those margins are just educated guesses. Also, the studies usually ignore what might happen to people exposed to the complex combinations of medicines that are often found in drinking water.

Then, there are the byproducts of the drugs. When medications are digested and processed through water treatment plants, they may take a new metabolic form.

“They miss some of the big issues. Our research shows mixtures are so prevalent,” said Dana Kolpin, a U.S. Geological Survey water expert who launched a plethora of research in 2002 after finding pharmaceuticals in most samples taken from 139 streams in 30 states. “If there are any cumulative or additive issues, you can’t just dismiss things so quickly.”


Even if Kolpin is right, the industry may be focusing on the wrong pharmaceuticals, said chemist James Shine at the Harvard School of Public Health, who oversaw what’s probably the broadest risk review yet, a yet-to-be-published study covering scores of the most common drugs sold in the United States.

As suspected, some chemotherapy drugs turn up high on that list. But blood-pressure diuretics, though rarely considered, appear to pose more risk than many drugs more often evaluated.

Even when researchers downplay risk, that may not be the final word.

People “are going to be concerned about being medicated by mandate when you turn on the tap,” said Dr. Stevan Gressitt, a psychiatrist who’s led a push for a program in Maine that allows consumers to turn in unused pharmaceuticals for secure disposal or destruction. “And that’s going to be seen if the level is (only) one molecule in 100 taps.”

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U.S. expands efforts to regulate meds in water
EPA lists 13 pharmaceuticals as candidates for regulation

Federal regulators under President Barack Obama have sharply shifted course on long-standing policy toward pharmaceutical residues in the nation\'s drinking water, taking a critical first step toward regulating some of the contaminants while acknowledging they could threaten human health.

A burst of significant announcements in recent weeks reflects an expanded government effort to deal with pharmaceuticals as environmental pollutants:

For the first time, the Environmental Protection Agency has listed some pharmaceuticals as candidates for regulation in drinking water. The agency also has launched a survey to check for scores of drugs at water treatment plants across the nation.

The Food and Drug Administration has updated its list of waste drugs that should be flushed down the toilet, but the agency has also declared a goal of working toward the return of all unused medicines.
The National Toxicology Program is conducting research to clarify how human health may be harmed by drugs at low environmental levels.

The Associated Press reported last year that the drinking water of at least 51 million Americans contains minute concentrations of a multitude of drugs. Water utilities, replying to an AP questionnaire, acknowledged the presence of antibiotics, sedatives, sex hormones and dozens of other drugs in their supplies.

The news reports stirred congressional hearings and legislation, more water testing and more disclosure of test results. For example, an Illinois law goes into effect Jan. 1 banning health care institutions from flushing unused medicine into wastewater systems.

The EPA\'s new study will look for 200 chemical and microbial contaminants at 50 plants that treat drinking water. The list includes 125 pharmaceuticals or related chemicals. This research will help federal water officials decide if regulations are needed.

In the first move toward possible drinking-water standards, the EPA has put 13 pharmaceuticals on what it calls the Contaminant Candidate List. They are mostly sex hormones, but include the antibiotic erythromycin and three chemicals used as drugs but better known for other uses.

They join a list of 104 chemical and 12 microbial contaminants that the EPA is considering as candidates for regulation under the Safe Drinking Water Act. No pharmaceutical has ever reached the list in its 12-year history, but medicines now make up 13 percent of the target chemicals on the latest list \"based on their potential adverse health effects and potential for occurrence in public water systems,\" the EPA said.

They take a place beside such better-known contaminants as the metal cobalt, formaldehyde, the rocket fuel ingredient perchlorate, and the disease germ E. coli.

‘A major public concern’
\"I think this does signal a change in the regulatory and research approaches,\" said Conrad Volz, a University of Pittsburgh scientist whose research raises questions about the risk of eating fish from waters contaminated with sex hormones. \"What\'s happening is pretty amazing.\"

Several scientists within and outside government tied the stronger focus on human health to the Obama administration and the president\'s appointment of Lisa Jackson, a highly regarded former head of the New Jersey Department of Environmental Protection, to run the EPA.

\"I think we are trying to be as aggressive as we can. We understand it\'s a major national issue. We understand it\'s a major public concern,\" said Peter Silva, the new water administrator at the EPA.


However, making the candidate list provides no assurance that a chemical will reach full-blown regulation. In fact, no chemical on the list has ever been made subject to a national water quality standard, EPA officials acknowledge. They intend to make preliminary decisions on some of the latest contaminants by mid-2012.

\"They\'ve made a lot of good first steps, so now were waiting to see those carried through,\" said Nneka Leiba, a researcher at the Environmental Working Group in Washington.


A health threat?
Water utilities and drug makers are wary of the federal moves. Difficult scientific questions remain over the possible threat posed to humans by minuscule concentrations in drinking water, where drugs are typically found in parts per billion or trillion. That\'s way below medical doses.

However, some researchers fear that very small daily amounts of unwanted drugs in water could do cumulative harm to people over decades, possibly in combination with other drugs or in sensitive populations like children or pregnant women.

Alan Goldhammer, a vice president of the Pharmaceutical Research and Manufacturers of America, said such trace amounts \"really do not pose a human health issue.\"

\"We do get concerned if we think that somebody is going to require that the consumers spend money and not get any health benefit,\" added Tom Curtis, a lobbyist for the Denver-based American Water Works Association.

The U.S. Geological Survey first began taking notice of pharmaceutical contamination several years ago. But until now the federal government has focused on the presence of pharmaceuticals in rivers and streams.

A recently released EPA study found more than 40 pharmaceuticals — everything from antibiotics to heart medicine to antidepressants — at nine publicly owned wastewater treatment plants. The drugs appeared in concentrations measured in parts per billion and trillion. Many passed right through the plants.

Linda Birnbaum, who is director of the National Institute of Environmental Health Sciences and also oversees the National Toxicology Program, said some program research is focusing on how much environmental pharmaceuticals can reach animal blood and tissues and how that might compare with humans.

Program to return unused drugs
Waste pharmaceuticals reach the environment when people take medicine and excrete the unmetabolized portion. Millions of pounds of waste drugs also escape into waterways from hospitals, drug plants and other factories, farms and the drains of American homes, the AP has reported.

On its new list, the FDA, which regulates medicines, says only 10 active ingredients in controlled-substance drugs need to be flushed to keep them away from children, abusers and pets.

At the same time, the agency announced it is working with partners to develop programs to return unused drugs instead of flushing them down the drain. The agency wants \"to encourage their development and future use for all drugs,\" declared Dr. Douglas Throckmorton, deputy director of the FDA\'s Center for Drug Evaluation and Research. Returned drugs are usually incinerated, which destroys most active ingredients. Community drug takeback programs have increased considerably since the AP\'s PharmaWater reports.

The recent announcements have been striking in their speed and breadth. Just last year, Ben Grumbles, Silva\'s predecessor at the EPA Office of Water under President George W. Bush, said only one pharmaceutical was under consideration for the list of candidates for water standards. And it was the heart medicine nitroglycerin, better known as an explosive.

Yet some environmentalists say the government should take even bolder action. \"Identifying the nature and scope of the problem is not the same thing as addressing the causes of the problem,\" said George Mannina, an environmental lawyer in Washington.


He said the EPA should do more to keep drugs out of the nation\'s water supplies and not rely on expensive filtering systems at water treatment plants.

Jon Holder, a vice president at Vestara, a seller of equipment to manage waste drugs, said the EPA should be more aggressive about enforcing hazardous waste laws that already apply to some drugs used by hospitals.

\"We applaud the light that\'s being shined on it, but we also recognize that the simple enforcement of existing law would go a long way,\" he said.


Copyright 2009 The Associated Press. All rights reserved.
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