By Conference Staff
March 24, 2008

There has been considerable media attention recently on water quality research reporting the presence of minute quantities of prescription and over-the-counter medicines found in water samples. Newspapers and televised media have reported results of an Associated Press (AP) investigation that collected information on the presence of caffeine, acetaminophen, ibuprofen, anti-inflamatories, antibiotics, anti-convulsants, mood stabilizers, etc. in watersheds across the nation. While present in drinking water sources, these contaminants are found in minute quantities, such as parts-per-billion or parts-per-trillion levels that are far smaller than doses prescribed by doctors or recommended/approved for human ingestion.

While American water utilities respond that the drinking water supplies are still among the safest in the world, the presence of these contaminants has prompted federal, state and local government action. The U.S. Environmental Protection Agency (EPA) and some states and cities have initiated efforts to learn where they come from, how widespread they are in water resources, what levels are typically found, whether they have potential harmful impacts at long-term/low-dose levels in humans, what can be done to prevent them from entering water resources, and reducing or eliminating them if they get into the water supplies. To date, however, the trace amounts found in drinking water (both municipal tap water and bottled water) have not been linked to disease or symptoms of disease.

Like many other environmental issues, once a pollutant is found in the air, land or water, the United States benefits from well-established environmental laws that trigger an assessment of whether or not the levels present are harmful, and what standards and practices should be adopted to regulate them to protect public health and the environment. This has been the environmental regulation paradigm in America for the last several decades, and while it may not be perfect, it has adequately addressed many of the major threats to public health. What drives this paradigm is the remarkable advances in detection technology. Yet once a substance is detected, the regulatory machinery must be applied in accordance with scientific method and in compliance with established legal procedure to determine the best course of action. Otherwise, scarce public resources may be unwisely invested, and perhaps not really address the problem in the best way.

There is no currently definitive inventory of how the medicines enter water resources. There is only speculation. It is assumed that the primary contributors to medicines in the water supply include: individual consumers passing medicines through their systems into the sanitation systems; consumers continuing to flush unused medicines down their toilets (no longer a recommended practice); some hospitals and health clinics also sending unused medicines down the drain; pharmaceutical production facilities usually have permits to discharge treated wastewaters; as much as forty percent of all antibiotics are fed to livestock that may end up in poorly controlled feedlots and grazing areas into rivers, streams, and underground water supplies. Other sources may be responsible for some portion of the medicines entering drinking water supplies.

It may be impossible to eliminate all of these sources from contaminating water resources, but there are some practices that can reduce the amount of discharged materials. Medical centers and consumers can participate in unused medicine return programs. Individual consumers should stop flushing unused medicines down the toilet. If unused medicines are discarded they should end up in modern landfills that meet the EPA’s Subtitle D regulated standards that are designed to prevent leaching into groundwater resources. Also, the EPA could take a fresh look at pharmaceutical company permits under the National Discharge Elimination Program if they determine that the levels of these contaminants present an unacceptable risk to human health or the environment.

The AP investigation provides an insight into a potential risk situation. It raises a question of public interest. It does not constitute a scientific study, nor does it meet the scientific rigors of a health assessment study. What it does do is point out that these trace contaminants are not isolated to any particular geographic area, but are more widespread. This is not “new” news. Researchers have known of these trace amounts for some time. As the body of scientific knowledge concerning the presence of these contaminants increases, the EPA must determine if a national detection and monitoring study should be funded. Water utilities that may be required to perform on-going monitoring for medicines in water supplies will find it expensive and should be reflected in user rate increases. This should not merely result in an unfunded federal mandate that adds more mandated costs to the current $82 billion annual local government expenditure for water and sewer services.

ent $82 billion annual local government expenditure for water and sewer services.

Safe Water Supplies

It is widely recognized that American cities rank very high in providing among the cleanest and safest water in the world. By contrast, the World Health Organization has estimated that 80 percent of infectious diseases worlwide are waterborne, and children and infants are among the highest at-risk populations. This is not the case in the U.S., where the rate of waterborne infectious disease is rare.

The combination of local government commitment to water and sewer investment and the requirements of the Clean Water Act and Safe Drinking Water Act have created a continually improving system geared toward protection of public health and the environment. Once new pollutants are discovered EPA determines what the safe standards and practices should be. Once EPA determines these standards, the local water agency must then invest additional money to meet the new standards in order to protect the health of the public. Since the original passage of the Clean Water Act, EPA has added new pollutants to the list that require treatment and this process helps cities make wise investments to protect public health with limited local government resources.

The medicines that have been identified in our water resources will likely fall into this pattern of detection, assessment and regulation/prevention. Since the contaminants cited are at minute amounts (parts per billion-parts per trillion) there is no cause for alarm. This is not to suggest the contaminants will or should be ignored.

According to research by the Conference of Mayors, cities spent $82 billion in Fiscal Year 2005 to provide water and sewer services and infrastructure throughout the United States. In total from 1992-2005, cities spent $841 billion. Combined water and sewer spending is second only to education expenditures by local government.

The nation’s cities cannot do this alone. The federal government, through the states, provided approximately $1.8 billion in loans to cities on an annual basis. Some 98 (plus) percent of all spending on water and sewer in America is provided by local government. Addressing the medicines in our water resources should be approached with a true federal-local government partnership to effectively deal with this issue.