Pharmaceuticals and Endocrine Disruptors in Drinking Water Supplies

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Pharmaceuticals and Endocrine Disruptors in
Drinking Water Supplies

• Gary Ginsberg
• Toxicologist
• Connecticut Dept Public Health

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AP Drugs found in drinking water March 2008
Drinking Water of 41 Million Americans
Contaminated with Pharmaceuticals
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AP Report

• 56 Pharmas or byproducts in Philly water
• Many US cities likely affected
• Most water companies do not test or report
  results
• List includes antibiotics, mood elevators,
  tranquilizers, heart meds, pain relievers,
  hormones

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The Arguments For/Against Worrying

• YES, Worry
• STPs cant remove
• Chem interactions?
• Fish affected
• Supplies not sampling
• No one knows what it means!!

• NO, Dont Worry
• Only trace levels chemists fault
• Pharms taken levels
• Many systems not affected
• Water tainted a long time
• No documented effects

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Where do PPCPs Come From?

• Rx and OTC meds excreted from body
• PCPs washed down drain during shower
• Unused meds flushed down the toilet
• Veterinary drug use
• Farm use of antibiotics, hormones, pesticides

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Where Does Your Water Come From?
?
PPCPs
?
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What PPCPs are being found

• Ibuprofen British rivers 3 ppm
• Tylenol
• Various EDCs, mostly estrogenic (BPA)
• Caffeine
• Carbamazepine
• DEET
• Erythromycin

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USGS Pharma Survey, 2002 from 139 US Streams
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Estrogens in Surface Waters

• Alkylphenols dish soap
• Bis-Phenol A canned food, consumer prods
• Triclosan disinfectant
• 17-ethinyl estradiol 19-norethisterone the
  pill

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Groundwater Surveys

• Most frequently detected PPCPs
• USGS (2008) sampled 25 public supply wells-
  untreated (raw) water
• Tetrachloroethylene 24 (dry cleaning solvent)
• Carbamazepine 20 (anti-epileptic)
• Bis-phenol A 20 (plastics, tin cans)
• Dimethylxanthine 16 (caffeine metabolite)
• Detections less frequent and lower than in stream
  study

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Evaluation of Exposures/Risks

• One by one set MCLs?
• Tox data gaps
• Extrapolation of drug effects at therapeutic dose
  to trace levels in drinking water
• Sensitive receptors not intended to get the drug
• Mixtures issue
• Generic de minimus level e.g., 1 ppb?
• Bioassays to screen for toxicity and EDC?
• Given uncertainties why not prudent avoidance?

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Possible Estrogenic Dose Health Implications

• 17a-ethinyl estradiol (ovulation inhibitor)
• USGS streams survey
• 16 detection frequency
• Mean 0.07 ug/L, Max 0.83 ug/L
• Child ingesting 1 L/day for 10 kg body wt
• 0.007 to 0.083 ug/kg/d
• Birth Control Pill Estrogen Dose 20-50 ug
• 0.33 to 0.83 ug/kg/d
• Variety of other estrogens also in streams

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Does Chlorination Help?

• USGS/USEPA survey of 10 public supplies
• Raw vs finish water
• Reduction compound-specific
• No data for hormones yet
• Uncertain breakdown or reaction products
• PPCP Cl- ???
• Need bioassay to evaluate
• No database of PPCPs in finished DW
• AP report data not available

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Lab study of chlorine vs ozone removal of PPCPs
(Westerhoff, et al. 2005)
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Does Chlorine Residual Remove PPCPs?? (Gibs, et
al. 2007)
1.2 ppm residual x 10 days

• No Removal
• 52 PPCPs
• Caffeine
• Carbamazepine
• Erythromycin
• Ibuprofen
• Phthalates

• Effective Removal
• 46 PPCPs
• Tylenol
• Codeine
• Tetracycline
• Trimethoprim
• Trichlosan
• BPA

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USGS Study of 1 Public SupplyStackelberg, et al.
2007

• Large urbanized watershed
• 9 of water entering DWTP is recycled
• 45 PPCPs detected in source water
• 21 detected in finish water reduced concs
• Removal mostly from GAC filtration and
  disinfection
• 200-300 min with NaHypochlorite

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Stackelberg, et al. 2007 Sci Tot Env 377 255-272
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• Cape Cod Breast Cancer Study
• Silent Spring Institute
• Rates of breast cancer 15 higher on Cape
• Longer residence, higher risk
• Septic ? potable wells ? estrogenic DW
• theoretical link to breast cancer

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Prudent Avoidance

• Avoid Tainted Water
• if minimize fecal steroids and drugs in drinking
  water, then improve water quality
• Minimize use of recycled water
• Test for indicator compounds
• DEET, Ethinyl estradiol, BPA, Caffeine,
  Erythromycin, Carbamazepine, Fecal steroids
• Develop criteria for indicator compounds based
  upon industry BMPs
• Develop new sewage and finished water treatment

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Connecticut No Recycling of Water for Potable
Use

• According to State Statute (22a-417)
• No industrial or public wastewater discharges
  into public drinking water supply drainage
  areas
• No degradation of land owned within public water
  supply watershed areas.
• Oversight of ?100,000 acres of watershed land
  owned by public water systems
• New groundwater wells for public water must be
  separated away from potential sources of
  pollution
• Could still have private wells affected by septic

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• Myth
• Rx Drugs Should Be Flushed Down Toilet
• Reality Needs proper disposal
• Federal Guide to prevent abuse/protect waters
• Not down toilet
• Remove from original container
• Mix with cat litter in sealed bag
• Bring to local pharmacy
• CTDEP Discard in trash

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Keeping Pharmas From Getting Flushed

• Hospitals/nursing homes ed campaign
• Controlled Substance Act drain is acceptable
  disposal
• Return to manufacturer/reverse distributors
• New protocols being developed to manage and
  dispose
• Collection days at some pharmacies, water cos
• Original containers
• Drugs get burned in approved incinerator

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Antibiotic Resistance

• Due to common and inappropriate exposure to
  antibiotics
• High dose kill off beneficial flora, resistant
  strains remain
• Drinking water antibiotic levels too low to kill
  off microbes
• Farm animals antibiotics breeds resistant
  strains
• Can be transferred to people
• No evidence so far that trace antibiotics in DW
  are a risk for resistant bacteria

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Summary

• PPCPs indicator of sewage/septic contam of
  drinking water
• Strongly implicated in ecological effects
• Individually, most at low levels, risk unlikely
• Estrogenic agents common and potentially a health
  concern
• Cumulative effect multiple PPCPs unknown
• MCLs not available, so BMPs essential

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Summary

• BMPs to limit exposure
• Management of Pharma wastes
• Management of water reuse
• New options for grey water use
• E.g., irrigation, sanitation, not drinking?
• Management/treatment of sewage
• Management of septic systems
• Testing and treatment of drinking water