And what can we do about it? What’s In Our WATER? And what can we do about it? Pharmaceuticals and Personal Care Products (PPCPs)

What’s in our WATER Our water comes from many sources. And the way we use it is just one part of a continuous cycle. Presenter Notes People don’t always associate the water in a river, lake, or underground well with the stuff we drink from the faucet. But we take water from these sources, use it for drinking, cooking, bathing, etc., and when we’re finished with it, it is returned to the local waterways. In most communities, the water that is flushed down toilets or drains travels first to a wastewater treatment plant where it undergoes several physical and biological processes before it is released back to the local waterway. The water is then picked up by the next community and used all over again. NOTE: The presenter may want to explain the steps in the water cycle that are illustrated in the slide, point out where water is typically drawn by the drinking water treatment plant, where it’s released back into the environment after wastewater treatment, and the difference between upstream and downstream. Point out that in some communities or homes the water is drawn from an underground well and treated in a septic or onsite system before being released back into the environment. Water Cycle Diagram courtesy of ESA / AOES Medialab, www.esa.int

What’s in our WATER Drugs and chemical residues from personal care products are showing up in waterways. Presenter Notes For years, it has been a common practice to discard unused or outdated medications by flushing them down the toilet. Consequently, a growing number of prescription medications plus chemical compounds found in personal care products, which include sunscreen, antibacterial soap, lotions and perfumes (that flow down the drain when we wash or shower) are being found in waterways across the country. These compounds are referred to as PPCPs (pharmaceuticals and personal care products), and they include a diverse collection of thousands of chemical substances. These substances can also enter the environment through leaching from landfills, runoff from confined animal feedlots, storm drain overflow containing raw sewage, and via straight pipes from rural homes. Some Statistics: Personal Care Products’ Use and Ingredients 1 Personal care products (cosmetics) are essentially unregulated under the Federal Food, Drug, and Cosmetics Act. The U.S. Food and Drug Administration (FDA), the federal agency responsible for ensuring that cosmetics are safe, has no statutory authority to protect the public from these substances. The average adult uses 9 personal care products every day, resulting in the application of 126 unique chemical ingredients to the skin. Due to gaping holes in federal law, companies can put virtually any ingredient into personal care products and pre-market safety tests are not required. Children are at particular risk: they have thinner skin and their bodies’ ability to detoxify and excrete chemicals can be limited. The FDA estimates there are about 12,500 ingredients in personal care products; only 11 percent have been assessed for safety by the cosmetics industry. FDA has prohibited or restricted only nine ingredients. 1 Statement of Jane Houlihan on Cosmetics Safety, Environmental Working Group (May 2008). Discussion draft of the Food and Drug Administration “Globalization Act” Legislation: Device and Cosmetic Safety, before the Subcommittee on Health of the Committee on Energy and Commerce United States House of Representatives

What’s in our WATER Little is known about the effect these compounds may have on people who drink the water or the aquatic wildlife in the waterways. Presenter Notes Researchers are trying to determine what effect these substances may have on underwater wildlife and their habitats and also whether there is any potential threat to human health. The U.S. Geological Survey conducted a nation-wide study of 139 streams and found low concentrations of numerous chemical compounds related to health management (both human and animal) and to personal care. The U.S. Environmental Protection Agency is currently exploring ways to curb the amount of pharmaceutical waste disposed from hospitals, long-term care facilities and veterinary hospitals. The EPA is also commissioning the National Academy of Sciences to determine the potential risk to human health from low levels of pharmaceutical residues in drinking water. Some Findings about Endocrine Disruptors in Environmental Settings2 (Endocrine disrupting chemicals are contaminants that are able to interfere with the actions of normal hormones. Hormones effect bodily functions such as growth or metabolism.) Researchers have observed “feminization” in fish, including: Elevation in the percentage of female fish populations; Changes in behavioral characteristics, such as nesting; Male fish with female characteristics, such as female egg cells in testes or female egg protein in blood. 2 Statement of Dr. Robert M. Hirsch, Associate Director for Water, U.S. Geological Survey, U.S. Department of the Interior, before the Committee on Environment and Public Works Subcommittee on Transportation Safety, Infrastructure Security and Water Quality, 4/15/08.

What’s in our WATER When people take medicine, some of it is absorbed, but most of the compounds pass through the body and are flushed down the toilet. Presenter Notes Medications for anxiety, pain, cholesterol management, asthma, epilepsy, and heart disease, to name a few, were found in drinking water sources across the country in a study conducted by the Associated Press (published March 10.2008). Every year the number of prescriptions written by doctors is increasing; $200.7 billion was spent for prescriptions in 2005, almost five times the amount spent in1990. Some Statistics on Prescription Drug Use3 U.S. is the top consumer of prescription drugs in the world. Almost 65% of the U.S. population takes physician-prescribed medication. This high use of prescription drugs is due to the pharmaceutical industry’s aggressive direct marketing to consumers (the public) primarily through television advertisements. While medicines can and do save lives, the U.S. is a “grossly overprescribed nation.” More than 100,000 thousand Americans (273 per day) die each year not from their illness but from their prescription drug, making prescriptions medicines a leading cause of death. 3 Melody Petersen (2008),Our Daily Meds: How the Pharmaceutical Companies Transformed Themselves Into Slick Marketing Machines and Hooked the Nation on Prescription Drugs. Sarah Chrichton Books, Farrar, Straus and Giroux, New York, NY.

What’s in our WATER Wastewater treatment plants don’t remove pharmaceuticals from the water that they treat and discharge into waterways. Presenter Notes Wastewater treatment plants are not designed to remove drugs from the water. The physical and biological processes that clean the water are very efficient, but PPCPs fall outside of that realm. Homeowners who have septic tanks need to be especially careful about discarding unused medication in the toilet or down the drain because some compounds, like antibiotics, can disrupt the treatment processes and create a risk of groundwater contamination from the PPCPs and also from fecal matter. In addition, drinking water treatment plants are neither designed nor required by regulations to monitor for or remove PPCPs from the water they treat.

What’s in our WATER The potential for harm to human health is not known at this time. But, there is growing concern about how these drugs and other compounds may affect people over time and with repeated exposure through everyday water use. Presenter Notes The compounds being found are trace amounts measured in parts per billion or trillion. These are small amounts, but no one knows how they may alter the natural biological processes in underwater plant and animal habitats. There is also concern that they may accumulate in tissues as they move up the food chain. With the number of prescription and over the counter drugs increasing, and with an estimated $35 billion of personal care products purchased every year by U.S. consumers, it makes sense that we should try to prevent as much of these PPCP compounds from entering our wastewater as possible.

What’s in our WATER And what can we do about it Don’t flush unused portions of prescriptions down the toilet. Presenter Notes One of the simplest ways individuals can help to prevent drug compounds from entering our waterways and drinking water sources is to dispose of them otherwise than via the toilet, unless the label or accompanying patient information specifically says to do so. Even though this method of disposal was recommended for years, the number and amount of prescription medications entering our nation’s waters is too great to be ignored. Federal guidelines from the Office of National Drug Control Policy suggest to do the following with unused or outdated medications (see the next two slides).

What’s in our WATER And what can we do about it Some communities have pharmaceutical take-back programs. Others have collection sites where the drugs can be destroyed. Presenter Notes While these “community pharmaceutical take-back programs” and drug collection sites are rare, as awareness grows about the potential problems associated with medications in our waterways, more will be created. The case study reported in the Safe Drinking Water Trust newsletter in your handouts demonstrates one community’s way to prevent pharmaceuticals from getting into drinking water. The city of Bella Vista, Arkansas, bought a drug incinerator called the “Drug Terminator.” The Terminator, which is kept at the local police department, uses forced air to accelerate a wood-burning fire. A special injector chute pushes the drugs into the fire where they are destroyed.

What’s in our WATER And what can we do about it Make the drugs unpalatable by dumping them in with wet coffee grounds, glue or used kitty litter. Make them safe for disposal in the landfill by putting them into a leak-proof container, then throw them in the trash. Presenter Notes Disguising or destroying the integrity of prescription medications will make them unattractive to anyone who might find them in the garbage. Putting the medications into a plastic container conceals the contents. Although you would ordinarily want to recycle plastics, and although eventually the drugs may leach into the groundwater, this disposal method is recommended by the U.S. Environmental Protection Agency where no other safe means of destroying prescription medicines exists.

What’s in our WATER And what can we do about it When using or buying personal care products, we can make conscientious choices. Presenter Notes Personal care products create an entirely different problem, since they enter the water in a less intentional manner. Lotions, soaps, perfumes, etc., have become an integral part of day-to-day life. Although no one can expect for the population to give up their cleaning and grooming rituals, reducing the number of PPCPs brought into the home is a first step in decreasing the amount of contaminants that enter waterways. The next best thing is to make good choices when it comes to using, buying, and throwing away excess of these kinds of products. Ideas for reducing use include cutting out products you don’t need, eliminating multiple soaps, cleansers, and gels; and limiting nail polish, perfume, and eye make-up to special occasions.4 Many personal care items can be bought in bulk, allowing consumers to refill their own containers. Many products are available that consist of all natural ingredients and are biodegradable. You can also choose unscented products and avoid any that are labeled as antibiotic, such as hand and bath soaps. Unused portions of personal care products should never be emptied into the sink or toilet. They can be disposed of in the garbage, although there still is the potential that they may eventually leach into the groundwater along with the problem of throwing away recyclable containers. Four key ingredients to avoid, which are found in at least 50 percent of standard cosmetics and personal care products, are (1) fragrance, (2) phthalates (improves product performance i.e. fixes fragrance, prevents chipping of nail polish, improves hair spray), (3) parabens (cosmetic preservative), (4) triclosan (antibacterial).4 4 Diane MacEachern, (2008), Big Green Purse: Use your spending power to create a cleaner, greener world. Published by the Penguin Group, New York, NY.

What’s in our WATER And what can we do about it Often we feel helpless to make a difference, but in this case, there are things each of us can do to help keep our water safe and clean for today and in the future. Presenter Notes

Some images in this presentation © 2003-08 www.photos.com. Presented by: Rural Community Assistance Partnership Website: www.rcap.org Phone: 888-321-7227 National Environmental Services Center Website: www.nesc.wvu.edu Phone: 800-624-8301 Presenter Notes This presentation was made possible by Grant Number 90EF0066 from the Office of Community Services, Department of Health and Human Services. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Office of Community Services, Department of Health and Human Services. Some images in this presentation © 2003-08 www.photos.com.