Drugs in our Water

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During the past year, headlines about “drugs in the water” have alerted the public to an unsettling fact: our lakes, rivers, streams and groundwater contain trace amounts of pharmaceutical drugs that can enter our drinking water. The growing list includes plenty one would rather not down in a glass of water on a hot day: antibiotics and painkillers, hormones and tranquilizers, drugs to treat blood cholesterol, epilepsy and cancer, musk fragrances, and phthalates, a family of chemicals found in cosmetics, perfumes and hair products.

We don’t yet know how these chemicals may affect human health but the animal previews include reproductive and brain function disorders. To its credit, the federal government has been working for the past two years on a plan to protect the health of Canadians from this emerging potential threat. A project with the acronym EARP (for Environmental Assessment Regulations Project) has been wending its way through the bureaucracy and will surface this fall. Unfortunately, EARP has veered off the mark. If the project continues on its present path, the environment that sustains our health will garner less protection than the drug and toiletry industry’s bottom line.

Because much of this form of pollution comes from personal (not industrial) use of chemicals, public awareness is key. Everyone needs to grasp the problem, see the range of potential solutions, and engage in a process of change. And because women have a particular relationship to the products in question, an awareness of gender differences must be central to any analysis. Prevention should be paramount, a principle that gets only lip service in EARP documents. The easiest way to reduce the environmental burden of drugs and toiletries is for everyone to use them less often.

Oddly, EARP materials never mention reduced use. As someone who took part in several EARP consultations, I believe the reason for this is simple: the process was geared to assuage industry fears of added costs and lost revenues. Health and environmental groups, when consulted at all, faced a pre-set, legalistic agenda, drafted by government lawyers for their industry counterparts.

Personal use chemicals get into the environment in the most prosaic of ways. Fifty to 90% of the active ingredients of a medication are excreted and enter the sewage system; from there they may pass to a water treatment plant that is not designed to remove them. Unused drugs get flushed down the toilet or sink (mothers have been told to do this, for the safety of children). Hospitals and nursing homes dispose of vast quantities of pharmaceuticals, untouched when residents change or discontinue medications, or die. Drugs taken in life’s home stretch likely contaminate posthumously, leaching from cemeteries into groundwater. Farmers give veterinary drugs to their animals, including large amounts of antibiotics. Drug-contaminated sewage sludge is sold as farm fertilizer.

Drugs aren’t the whole problem: soaps, shampoos, cosmetics and perfumes contain chemicals that disappear down the drain, but persist in the ecosystem.

Calling the result a “chemical soup” sounds over the top when concentrations may be as little as one part per trillion. But science suggests that chronic exposure to multiple bioactive substances may well harm human health, even at low levels. Drugs are designed to have effects in small quantities; they are not meant to be mixed, willy-nilly. Researchers are discovering “windows of vulnerability” when developing embryos are exquisitely sensitive to chemicals, even minute amounts. Since environmental tests for these chemicals are still in their infancy, the discoveries so far are baseline levels.

Women Should Lead the Debate
Because of cultural norms, women are the family members most often responsible for the purchase of drugs and food, food preparation, caring for sick family members and disposal of home-use products. Many drugs are gender-specific (e.g., birth control products, menopausal hormone therapy), or are prescribed more often to women than to men (e.g., anti-depressants). Many of these prescribing patterns reflect the unnecessary medicalization of women’s lives, that is, the prescribing of drugs to "treat" such healthy life stages as menstruation, pregnancy and menopause.

Women are also the main users of cosmetics, perfumes and hair products, many of which contain phthalates, a family of industrial chemicals linked in animal studies to permanent birth defects in the male reproductive system.

A study Health Canada commissioned as part of EARP found that women were more interested than men in learning about safe disposal of drugs and were more likely to state that they would act on such information, even if it were inconvenient. Women were also more likely than men to state that they flushed unwanted drugs down the toilet or sink, a difference that probably reflects women’s role as protectors of the health of children. The survey didn’t ask how consumers felt about reducing drug use.

As its name suggests, EARP is mostly about new regulations. Beginning sometime in the coming year, Health Canada will require drug companies and other manufacturers to expand their product safety tests. New products will have to pass tests of toxicity after release into the environment, not just during use. Tests will be phased in for products already on the market.

Manufacturers are nervous. What if the new tests are expensive, slow down marketing, reduce international competitiveness, or keep some products off the shelves altogether? These are natural questions for manufacturers to ask, but they are the wrong questions to guide a program to protect health and the environment.

Women’s health and environment groups should be leading this debate, but few have taken on the issue. Most community-based groups opted out of the government consultations after one introductory meeting. And no wonder: the scientific and regulatory documents were not prepared for activists. They were written for industry scientists, lawyers and marketers, who take EARP very seriously indeed.

If my prescription drug can end up in your morning coffee, every home medicine cabinet is a public concern. Fortunately, plenty can be done. In a series of wide-ranging papers published in the journal, Environmental Health Perspectives, scientist Christian Daughton of the US Environmental Protection Agency lays out a grand plan for the short, medium and long-term. His short-term suggestions range from curtailing ads that promote drug use to consumers, to restricting physician drug samples, reducing drug doses, developing smaller package sizes, exploring non-toxic alternative treatments, and recycling, rather than disposing of, some unused drugs. He cites an Ontario survey estimating that the province wastes over $40 million in medications each year.

Eliminating inappropriate drug use, overuse and abuse will, Daughton argues, improve health, save money and help protect the environment. We can all tape that message to the medicine cabinet mirror.

Health researcher, Sharon Batt lives in Halifax. She is active in Women and Health Protection, and Prevention First, two coalitions that advocate regulations to protect health and the environment.

The analysis in this article draws from a discussion paper on drugs in the environment prepared for Women and Health Protection, and available online at, www.whp-apsf.ca.

A version of this article first appeared in the Globe and Mail (07/31/03).