Cocktails of Dozens of Drugs In Our Water Supply Remain Unfiltered

By Marco Torres

So-called safe drinking water supplies coming out of our taps are now proven to contain industrial chemicals and pharmaceuticals linked to toxicity, developmental problems, tumour growth and hormonal disruptions. One glass of tap water now contains hundreds of contaminants that are not filtered through federally approved guidelines which monitor safety standards servicing millions of people.

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?

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“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.

“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

Learning From History

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.

Unknown Cocktail

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.

Sources:
ap.org
harvard.edu
newscientist.com
ibtimes.com
nationalgeographic.com
treehugger.com
nytimes.com

Marco Torres writes for PreventDisease.com, where this article first appeared.