Tracking the Issue of Pharmaceuticals and Personal Care Products (PPCPs) in the

Environment

Brandon KernenNew Hampshire Department of Environmental Services

Brandon.Kernen@des.nh.gov271-0660

Emerging Substances of Concern

• Global Organic Contaminants

• Pharmaceuticals and Personal Care Products

• Endocrine Modulating Chemicals

• Nanoparticles

• Industrial Chemicals (new and recently recognized)

Includes prescription and over-the-counter (OTC) medications, cleaning agents, cosmetics, nutritional supplements, & skin care products

Produced and used in larger volumes yearly

Released via small quantity generators

Biologically active

Commercial labs cannot analyze

Pharmaceuticals and Personal Care Pharmaceuticals and Personal Care Products (PPCPs)Products (PPCPs)

PPCPs in the Environment

• DES has been tracking and assessing this issue for several years

• Recent headlines regarding pharmaceuticals in drinking water confirm the importance of our efforts and focus on this emerging issue

PPCPs – DES Program Interest

• Drinking Water• Wastewater - Surface Water Discharges• Wastewater - Groundwater Discharges• Watershed Management – Ecological Impacts• Residuals Management• Solid Waste Management• Air – Incineration of Solid Waste• Household Hazardous Waste Management• Hazardous Waste Management• Environmental Health Program

NHDES Interests in PPCPs

• Assessing Occurrence (overcoming analytical lab issues)• Fate & Transport• Human Health/Ecological Health• Source Characterization (individual use & disposal,

vet/livestock, manufacturing) • Treatment (wastewater/drinking water)• Pollution Prevention (green chemistry, life cycle analysis, take

back programs, public education, behavior modification)• Risk Communication/Perspective• Public Education• Policy/Regulation (fed/state reg, policy, liability, nonreg)

Source: U.S. Center for Disease Control and Prevention. National Center for Health Statistics. National Health and Nutrition Examination Survey.

Percent of persons reporting prescription drug use in the past month by age

0 10 20 30 40 50 60 70 80 90 100

1988-1994

1999-2002

1988-1994

1999-2002

1988-1994

1999-2002

1988-1994

1999-2002

1988-1994

1999-2002

unde

r 18

year

s18

-44

year

s45

-64

year

s65

yea

rs a

ndov

eral

l age

s

one or two prescribed drugs three or more prescribed drugs

Medicine Use in NH

• In 2006, fifteen millions prescriptions were filled in New Hampshire

• 2 out of 3 people that visit a doctor leave with a prescription

Source: New Hampshire Board of Pharmacy

NH Drug Deaths

Source: Dr. Andrews, Chief Medical Examiner for NH, 2007 PowerPoint Presentation

Drug Deaths 2000-2007 By Manner

Source: Dr. Andrews, Chief Medical Examiner for NH, 2007 PowerPoint Presentation

Reducing pharmaceuticals in the environment would require changes in:

1) When and how medicine is prescribed and used;

2) How pharmaceuticals are designed and engineered so they do not persist once released in the environment;

3) Wastewater and drinking water treatment technologies; and

4) How unused medicines are disposed of.

2008 AP Study2008 AP Study• 28 of 35 drinking water systems in the US had

detectable levels of pharmaceuticals

U.S. Geological Survey Monitoring StudyU.S. Geological Survey Monitoring Study

• 139 streams analyzed in 30 states

• Contaminants identified in 80% of these streams

• 82 contaminants identified (many were pharmaceuticals)

• Co-occurrence common; average 7 distinct contaminants identified per stream

Medicines in the EnvironmentMedicines in the Environment

Kolpin, D.W. et al. 2002. “Pharmaceuticals, hormones, & other organic wastewater contaminants in U.S. streams, 1999-2000: A national reconnaissance.” Environmental Science & Technology. 36(6):1202-1211.

Aquatic exposure – chemicals in the aquatic environment can result in continuous, multigeneration exposure.

Feminization of fish - link to estrogen exposure?

Ex: Boulder Creek, CO: female white suckers outnumber males by > 5 to 1; 50% of males have female sex tissue (David Norris, Univ. of Colorado at Boulder)

Effects of antidepressants on fish and frog development?

Ex: Lab studies show low levels of common anti-depressants, including Prozac, Zoloft, Paxil and Celexa, cause development problems in fish, and metamorphosis delays in frogs (Marsha Black, Univ. of Georgia)

Effects on Aquatic Organisms: Effects on Aquatic Organisms: Cause for ConcernCause for Concern

Top 11 Compounds in Drinking Water

• Atenolol• Atrazine• Carbamazepine• Estrone• Gemfibrozil• Meprobamate

• Naproxen• Phenytoin• Sulfamethoxazole• TCEP• Trimethoprim

Ongoing Studies in NH• Fish Tissue and Water in the Merrimack

River (EPA)

• PPCP loading in the Merrimack River Watershed (UNH)

• Squam Lake Association/Squam Lake

• Wastewater at a County Nursing Home/Prison

• Water pre and post treatment from a reservoir

• Seeking funding to assess leachfield sites at nursing homes

Squam Lake Association/NHDES Lab Target Analytes

• Acetaminophen

• Caffeine

• Trimethoprim

• Carbamazapine

EPA Analytical Methods

• 1694 Pharmaceuticals and Personal Care Products in Water, Soil, Sediment, and Biosolids by HPLC/MS/MS

• 1698 Steroids and Hormones in Water, Soil, Sediment, and Biosolids by HRGC/HRMS

Other Analytical Methods

Thoroughly summarized in:

“State of Knowledge of Endocrine Disruptors and Pharmaceuticals in Drinking Water”

AWWA Research Foundation, 2008

Assessment of Medicine Disposal Options White Paper Developed by DES

Summarizes• Medicine use trends in the United States;• Legal issues affecting how unused medicines may be

collected and disposed;• Potential health and environmental issues associated

with releasing medicines to solid waste facilities and wastewater disposal systems;

• Typical unused residential medicine disposal and reuse practices in New Hampshire; and

• Options for managing unused medicines in New Hampshire.

Expired Medication Disposal HabitsExpired Medication Disposal Habits

Boehringer, S. “What’s the Best Way to Dispose of Medications?” (2004)

Returned to Pharmacy

Did Not Dispose

Flushed Trashed

Used All Prior to Expiration

500 patients surveyed:

54% disposed of medications in the trash

35.4% flushed drugs down the toilet or sink

7.2% did not dispose of medications

2% used all medication prior to expiration

1.4% returned medications to the pharmacy

Unused Medicine Collection Events

• Require extensive planning to address controlled substance, hazardous waste and disposal requirements

• Need financial resources for pharmacists, hazardous waste specialists and disposal

• NHDES recommended SOP available

• A guidance document is available from Northeast Recycling Center.

DES Medicine Disposal Policies Developed to Date

• Residential disposal policy developed working with a workgroup of 80+ stakeholders

• Medicine collection and disposal SOP

• Draft medicine disposal policies for school nurses

• Draft medicine disposal policies for hospice

DES Medicine Disposal Policies that Need to Be Developed

• Non hazardous and non controlled substances in hospitals & institutions

• Physician offices

• Veterinarian

• Nursing homes

NH’s Household Medicine Disposal Message

Help Prevent Pollution, Poisonings and Drug Abuse!Dispose of your Unneeded Medication

6 Steps to Safety

1) Pour medicine into a sealable plastic bag.2) If the medicine is a solid, add a small amount of water to dissolve it.3) Add any undesirable substance (such as dirt, coffee grounds or

kitty litter) to the liquid medicine in the plastic bag. 4) Seal the bag and immediately dispose of it in the trash for regular

pick-up.5) Use marker to black out any personal contact information on the

empty medicine container prior to disposing of it in the trash.6) For more information, consult www.nh.gov/medsafety.

Do NOT flush medicine down the toilet unless accompanying product information instructs that it is safe to do so. Don't keep unneeded

medications in the home.

For more information or in case of an accidental poisoning, call the poison center at 1-800-222-1222.

Medicine Disposal as Solid Waste• Addresses environmental, drug abuse and drug

poisoning concerns• Solid Waste in NH

– 15% Incinerated– 85% in Landfills (almost all landfills are lined and capped)

• Most medicine disposed of in a landfill will be retained by solids or break down through chemical processes

• Leachate at lined landfills is collected and can be treated.

• Solid waste disposal is readily available to households.

Marketing of the Residential Disposal Message

• New state website (www.nh.gov/medsafety)

• News articles will be published by various organizations

• Letters will be sent to licensed health care workers, municipal officials and solid waste officials

• Posters will be made available to interested organizations

2009 International Symposium on Pharmaceuticals in the Home and

Environment

October 18-20, 2009

Northport, Maine

http://www.mainebenzo.org/