If you take medication with a glass of tap water, you may be getting more medicine than your doctor prescribed. A study by the Associated Press on the presence of pharmaceuticals in the nation's water supply has identified an alarming array of prescription substances that are reaching more than 40 million Americans in cities across the country.
It's happening as much from the drugs we take and then excrete through normal bodily waste into our sewer and septic systems, as from human, agricultural and even veterinary practices. But people also flush unused pharmaceuticals down the toilet and pour them down drains, and they get leached from landfills. While so far the concentrations have been acknowledged to be small -- holding steady at a parts-per-billion or trillion metric -- the spectrum of medications is significant, including antibiotics (both human and veterinary), analgesics, antidepressants, cholesterol-lowering and anti-hypertension drugs, anti-convulsants, acetaminophen, ibuprofen, reproductive hormones, and chemicals common in plastics, as well as insecticides, fire retardants and solvents. (An article last week in Environmental Health Perspectives highlighted the issues concerning environmental pollutants.)
In another study by the United States Geological Survey that tested for 95 contaminants in water supplies nationwide, 80 percent of the samples from 139 streams in 30 states had at least one of the substances being tested for, with an average of seven contaminants in each sample. These findings included traces of anti-anxiety medications in the drinking water delivered to approximately 18.5 million Southern Californians. In western Montana, the study found aquifers had been penetrated by waste water from a high school, and contained trace elements of acetaminophen, caffeine, codeine, antibiotics and warfarin, in addition to a mood-stabilizing drug for bipolar disorder and nicotine.
The problem continues to grow from the sheer volume of prescription and over-the-counter medications being consumed nationally, as well as from the interconnectedness of surface water and ground water sources that feed most of the water supplies nationwide, the federal government has yet to establish safety limits for pharmaceuticals in water, or to set federal standards for testing. The Safe Drinking Water Act of 1974, which was amended only once in 1994, hasn't been updated since the year 2000.
Clearly, as with air pollution or any other environmental issues we face in a region as populated as Southern California, we can't wait for federal rules and regulations to catch up. Although we do not know if these small quantities of unwanted drugs cause any problems, it would be prudent on our part to keep the exposure as low as possible. We can each contribute toward mitigating the problem through a few basic changes in behavior. Since most of us have or will take some kind of medication, whether on a short or long-term basis, learning how to use and dispose of pharmaceuticals safely can become as second nature as recycling or conserving energy. Here are some guidelines:
o Rather than throw loose pills or liquids down a drain, keep the medication well sealed in its original container. Remember to cross out the patient's name or remove the label. If you have chemotherapy drugs, ask your physician the best way to dispose of them.
o Return unwanted or unused drugs to a pharmacy or an approved collection program.
o Don't dispose of medicines with food waste to prevent animals from eating them.
o Don't throw empty medicine containers into a recycling bin.
Is Bottled Water the Solution?
Not necessarily. Tap water suppliers are required to perform regular water quality tests and publish the findings; makers of bottled water aren't. In fact, in a survey by the Environmental Working Group (EWG), 38 contaminants were found in 10 big-selling brands.
Note to self: Don't refill those plastic bottles. Over time they break down and release plastics chemicals into the water. Use stainless steel water bottles instead.
What About Filtered Tap Water?
Yes, especially for a baby's formula. But just any water filtration choice won't necessarily do the trick. To get the right filter for the water you're drinking, you have to know what contaminants are in it. Water is a local business. The EWG has a National Tap Water Atlas. Read it before you go shopping for a water filter.
The main filtration systems are carbon filters, which are fairly cost effective, and reverse osmosis systems that remove the most number of contaminants, but are expensive. You can also choose from systems as simple as a filtration pitcher to faucet mounted, faucet integrated, on counter, under-sink, and whole house filters.
Whichever kind you choose, get a water filter that's certified, meaning one that's been vetted by a reputable independent agency like the California Department of Public Health or the National Sanitation Foundation, so that when you turn on the tap, all you'll be getting is water.
Follow Glenn D. Braunstein, M.D. on Twitter: www.twitter.com/CedarsSinai