   |  | | Protecting your family and the environment | By Mike Magee, MD
It's hard to know these days just what to do with the old medicines in your medicine cabinet. It seems one way or another, they're a threat to other human beings.
This month we learned that if you throw them out, and especially if you flush them down the toilet, they end up in our drinking water. That's right! A study by the Associated Press, conducted over a 5 month period, surveyed the water detection results of water authorities for our 50 largest metropolitan areas as well as dozens of regional water providers.
Finding number one: Many sites don't routinely test the water for pharmaceuticals. It is not required by the FDA. Of the 62 major water providers contacted, only 28 had records of such tests.1,2
Finding number two: The vast majority of those who tested their source watersheds, the surface and ground water reservoirs they drew from, found trace levels of multiple medicines in the water. Since most of the currently used water treatment technology doesn't filter out many of these drugs, not surprisingly, tests were positive in the post-treatment water headed for your home and business. "That's it,” you say. "It's bottled water for me." Well, remember, bottled water is tested less than your tap water and frequently comes right out of the tap.
Finding number three: The pharmaceuticals found represent a wide array of compounds -- from painkillers and anti-depressants to hormones, chemotherapeutic agents and stimulants, just to name a few. Though only in trace amounts, the government hasn’t set "safe limits" for the products.1,2,3
So what is the potential for harm to humans and the environment? The simple answer is: No one knows.4 Microbiologist Tom White, on behalf of PhRMA, the pharmaceutical industry trade association says, "Based on what we know, I would say we find there is little or no risk from pharmaceuticals in the environment to human health."2 But the director of Environmental Technology for Merck – a PhRMA member -- says, "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."2
So let's step back and examine how the stuff is getting into our water and why? First of all we're buying a lot of drugs by prescription and over the counter in this country. 3.7 billion prescriptions were filled last year, along with an additional 3.3 billion over-the-counter purchases. That's a rise of 12% over the past five years.5 Part of this is tied to the aging population, and part to a culture that turns first to medicines to fix their problems. What's clear as well is that most Americans, some 3 out of 4, go off their medication treatment plans, leaving residual pills to grow old and stale in their medicine cabinets, and find their way at some point in the toilet or garbage pail, or worse yet in the hands of youthful family members anxious to experiment with your drugs.6
Finally, even if taken appropriately, up to 90% of oral drugs are never actually metabolized in your bodies, but rather are discarded in your urine or stool.3 We tend to think our bodies "use up" the medicines we take, but in reality, that's not the case most of the time. And that means the compounds are deposited into the wild or directly into water treatment plants. Either way, too often, portions of the original dose find their way back into our water supply.3,7
So what do we do? Well, as therapists will tell you, the first step is to admit we have a problem. Thanks to the AP investigation, we've shinned a light on it. Second, we need to study and understand it, and everyone from the FDA to major metropolitan centers to water-basin scientists are fast at work testing, testing, testing, with the intent of providing new directions regarding safe limits of the compounds. Third, major health organizations from the AMA to hospital organizations to nursing homes are examining the problem in order to adjust policies that are more in tune with our new knowledge of this potential threat. And finally, what about you and I? What can we do? Well, first, don't flush your old drugs. Secure them and consider them hazardous waste for now. Second, don't over-treat. It's much better to live healthy than to have to treat disease. Third, if you need a prescription, take all your pills as directed. Unless you have a complication, there shouldn't be left-overs. Finally, get more involved in your area. Check with your water authority, your doctor and your hospital on the issue. And expect further guidance over the next 12 months.
For Health Commentary, I'm Mike Magee.
References:
1. Donn J, Mendoza M, Pritchard J. AP Probe Finds Medicines In Drinking Water. Boston Globe. 9 Mar 2008.
2. Prescription Drugs Found In Drinking Water Across the US. CNN. 10 Mar 2008.
3. Reynolds KA. Pharmaceuticals in Drinking Water Supply. WC&P. June 2003: Vol 45, No. 6.
4. Eilperin J. Pharmaceuticals in Waterways Raise Concern:Effect on Wildlife, Humans Questioned. Washington Post. 23 June 2005; Page A03
5. Gatyas G, Longwell L. IMS Health Reports U.S. Prescription Sales Grew 3.8 Percent in 2007, to $286.5 Billion. IMS Health. 12 Mar 2008.
6. Magee M. Improving Patient Adherence. Health Politics. May, 2004.
7. EPA. Pharmaceuticals and Personal Care Products.
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