Pharmaceuticals in Water This page is a mirror of the current wiki of the same name. This version contains comments from Dr. Pence to guide everyone in their next efforts.

Overall Comments:
I was very impressed looking through the history of this wiki to observe that the three participants really captures the team-spirit of the wiki. It was indeed a group project to which everyone contributed. The structure emerged as everyone worked, and pieces got moved around to enhance the overall organization. You definitely have the knack of the project, and I'll include some notes for next time below:
  • This page is reasonably well integrated among all the pieces, and putting it all into a single page makes the organization very obvious of what is supposed to come first.
  • The citations need some work. Firstly, the links should be worked into the text, even if it is just "Further information may be found at..." Also, the references at the bottom need to be cited within the text using superscripts in order of use.
  • Some minor issues with spelling, grammar, etc should be caught by the editors.
  • Remember that one of the strengths of websites is the incorporation of pictures. If you think about how you read a textbook, the pictures break up the flow and allow enough visual variety to let the reader process the information more effectively.


INTRODUCTION
Contaminants of emerging concern such as pharmaceuticals and personal care products (PPCPs), have received and continued to attract significant worldwide media attention (newspapers, magazines, radio, and T.V) over the last two decades. Studies have shown that pharmaceuticals are present in the nation's waterbodies, ground water, coastal marine environments, and many finished drinking water. This issue has generated concern among governments/regulators, member states, industry, municipalities, and the public. PPCPs are found where people or animals are treated with drugs and people use personal care products. PPCPs are found in any water body influenced by raw or treated sewage, including rivers, streams, and drinking water supplies. PPCPs have been identified in most places sampled (USGS). {Is that supposed to be a citation? Not clear} Further research suggests that there may be some ecological harm when certain drugs are present. There is an expected increase in the use of pharmaceuticals by world population, veterinary, and agricultural drugs worldwide. {Sentence not clear.} There are a number of critical issues regarding the occurrence, human health effects, and treatment and disposal options for PPCPs in the environment, drinking water, and wastewater treatment systems. The focus of this study is intended to provide some fundamental background of the PPCPs in the environment; environmental occurrence and sources of PPCPs in finished drinking water and source water; approaches to assess health risks to vulnerable populations; existing pharmaceutical take-back and safe disposal programs to reduce water pollution.
Pharmaceuticals and personal care products (PPCPs) {Defined in the previous paragraph} are an extraordinarily diverse group of chemicals comprising all human and veterinary medicine {Should be "medicines" to agree with the plurals.} such as antibiotics (available by prescription or OTC; including biologics, and illicit drugs); agricultural practice (e.g., pesticides); diagnostic agents (e.g., X-ray contrast media); human health “nutraceuticals” (bioactive food supplements such as huperzine A); functional foods (“phoods” and “bepherages”); cosmetic care, such fragrances (e.g., musks) and sunscreen agents (e.g., 4-methylbenzylidene camphor, octocrylene); also included are therapeutic drugs in current use comprise more than 3,000 distinct bioactive chemical entities {I think you've got several sentences merged here- it doesn't make a complete sentence.} formulated (using a wide selection of so-called inert "excipients" ingredients used in PPCPs manufacturing and formulation; e.g., parabens) into tens of thousands of registered end-use products; personal care products contribute untold numbers of additional ingredients and formulations. Two classes of therapeutics that have received the most attention are the antibiotics due to their potential for resistance selection among pathogens and steroidal hormones due to the overlap with endocrine disruptors {Good wikipedia citation}(“Pharmaceuticals”). {The Pharmaceuticals reference seems to be hanging- it's not well integrated with the rest of the text. What does it support?}
{Introduction is well done. Good framework for the rest of the contributions and sets up the whole topic well.}
SOURCES OF PPCPs
PPCPs can enter the environment from a number of different pathways that include: human activity (large quantities of PPCPs can enter the environment after use by individuals or domestic animals from a variety of urban activities), hospital waste, release of untreated sewage treated wastewater from excessive precipitation, municipal effluent, municipal biosolids, municipal holding ponds, purposeful disposal to domestic sewage, purposeful disposal to landfills, aquaculture, confined animal feeding operations (veterinary drug use especially antibiotics and steroids), agriculture (poultry, swine, dairy, irrigation with reclaimed water, and cattle operations), pest control, and, uncontrolled and purposeful dumping of materials from illicit drug manufacturing and trafficking. Origin {Awkward link. Try to integrate it into the text better}
Most of the ingested drugs are release {"released" proof-reading} to the environment primarily through excretion (urine and feces) {missing a comma} bathing, and disposal of unwanted medications to sewers and trash. Some PPCPs are easily broken down and processed by the human body or degrade quickly in the environment, but others are not easily broken down and processed, so they enter domestic sewers. Excretion of unused and untreated PPCPs depends on individual drug composition and the ability of individual bodies to break down drugs depends on age, sex, health, and individual idiosyncrasies. {Punctuation} Free excreted drugs and derivatives can escape degradation in sewage treatment facilities because they dissolve easily and don't evaporate at normal temperatures or pressure. {Try to avoid contractions in formal writing} PPCPs make their way into the soil and into aquatic environments via sewage, treated effluent from domestic sewage discharged to surface waters, re-injected into aquifers via recharge, overflow of storm events, system failures, and release of treated/untreated hospital wastes, and recycled/ reused (irrigation or domestic uses). The existing conventional municipal sewage plants are not designed to remove PPCPs. They designed {missing word} to treat the conventional priority pollutants. Removal of PPCPs requires more varied and complex treatment practices than conventional wastewater treatment. Currently, there are no municipal sewage treatment plants that are engineered specifically for PPCP removal or for other unregulated contaminants. Effective removal of PPCPs from treatment plants varies based on the type of chemical and on the individual sewage treatment facilities. (“Pharmaceuticals”) {Again- weave the link into the text}
Other potential route to the environment include leaching from municipal landfills, release to private septic/leach field into groundwater, “straight-piping” from homes (untreated sewage discharged directly to surface waters), direct release to open waters via washing/ bathing/swimming, discharge of regulated industrial manufacturing waste streams , runoff from confined animal feeding operations (CAFOs) and medicated pet excreta, release to open water from aquaculture (medicated feed and resulting excreta), spray-drift from agriculture from tree crops (e.g., antibiotics), sewage discharge from cruise ships (millions of passengers per year), oral contraceptives used as soil amendment and plant growth tonic{Really? oral contraceptives are used for soil amendment and plant growth tonic?} , transfer of sewage sludge (“biosolids”) to land (e.g., soil amendmentd {Spelling} as fertilizer) and transgenic production of proteinaceous therapeutics by genetically altered plants (“molecular farming” and “bio-farming”). Other environmental source {plural} of PPCPs is the release of drugs that included: uncontrolled and purposeful dumping of materials from illicit drug manufacturing and trafficking and drugs that serve double duty as pest control agents such as: 4-aminopyridine, which is used as avicide and it has also been used to manage some of the symptoms of multiple sclerosis; warfarin (anticoagulant) that is used as rat poison; azacholesterol an antilipidemics that is used as rodent reproductive inhibitors; certain antibiotics used in the control of orchard pathogens; caffeine and stimulant used as frog control. {That sentence is mighty tangled} ("Are Pharmaceuticals") {Is that supposed to be a link?}

More studies have identified drinking water as a source of PPCPs. Traces of PPCPs have been found to be present in {delete} nationwide and throughout the world’s water supplies including Asia, Australia, Canada and Europe, Swiss lakes and the North Sea. These studies mostly identified antibiotics, anti-convulsants, mood-stabilizing carbamazepine, prescription drugs, over-the-counter medicines (e.g., acetaminophen and ibuprofen) and sex hormones in drinking water. A well-known potential source of contamination is the groundwater infiltration into the water supplies that has {have} been contaminated by sewage. Moreover, water treatment plants are not really designed to remove PPCPs residues. (“AP: Pharmaceuticals”) {Link?}

EXTENT OF POLLUTION
Studies have shown that pharmaceuticals are present in the nation's water-bodies. A study conducted by the Toxic Substances Hydrology Program of the U.S. Geological Survey (USGS) a national scale in 20002 {2002, I think} concluded that a wide range of PPCPs were found in wastewaters samples taken downstream from residential, industrial, and agricultural areas of high urbanization and animal production. During 1999 and 2000, water samples from 139 streams in 30 states were collected and analyzed for the most common list of 95 pharmaceuticals that include human and veterinary antibiotics, “natural and synthetic hormones, detergent metabolites, plasticizers, insecticides, and fire retardants” (“Pharmaceuticals”){Link?}. At least one of these chemicals was found in 80 % of the stream water samples. 50 % {Don't start sentences with numbers} of the streams contained at least 7 of these chemicals, and 33% of the streams {Singular} water samples contained at least 10 of these chemicals. The most frequently detected chemicals found in more than 50% of the streams water sampled nationwide were "coprostanol (fecal steroid), cholesterol (plant and animal steroid), N-N-diethyltoluamide (insect repellent), caffeine (stimulant), triclosan {Why did some merit links and some didn't?} (antimicrobial disinfectant), tri (2-chloroethyl) phosphate (fire retardant), and 4-nonylphenol (nonionic detergent metabolite)" ("Pharmaceuticals"){ Link?}. The most frequent compounds detected were steroids, nonprescription drugs, and insect repellent. The highest concentrations were detected for detergent metabolites, steroids, and plasticizers. Out of the 95 chemicals only 14 have a drinking water criteria. The sampling data results were compared to the drinking-water criteria; howerver, the detected concentrations did not exceeded any of the standards or criteria. This study also concluded that there is no {not} enough evidence to support that the exposure to low levels of the chemicals found in this study pose a threat to human or environmental health. (“Pharmaceuticals”) {See above}
Another study conducted in 2002 by USGS has concluded that the discharges from wastewater treatment plants serving urban areas are sources of glyphosate to streams. Glyphosate is a non-selective systemic most widely used herbicide in the world, absorbed through the leaves, injected into the bole, or applied to the stump of a tree, used to control weeds in both agricultural fields and in urban settings. During this study, the discharges into surface water from 10 nationwide wastewater treatment plants were sampled. Despite of the fact glyphosate was detected at low concentration, sampling data results indicated that the direct discharge from these plants has {Tense shift} the potential to contribute with significant amounts of glyphosate into the streams. Samples were collected from the receiving water at three locations: upstream and downstream of the wastewater discharge and from the treated wastewater discharge.
In 27 percent of the samples, glyphosate was detected in the wastewater. Also, this chemical was present in 20% of the
http://toxics.usgs.gov/photo_gallery/photos/emer_cont/IndicatorStudySlide.jpg
http://toxics.usgs.gov/photo_gallery/photos/emer_cont/IndicatorStudySlide.jpg
downstream samples; it was present in 12% of the upstream samples. Also, this study concluded that additional investigations are necessary to establish the relative mass loading of glyphosate from different potential sources (e.g., agricultural and sewage treated wastewaters). ("Glyphosate")
A recent study of the water-quality of streams in the Boulder Creek Watershed, Colorado conducted by U.S. Geological Survey (USGS) in 2000 found pharmaceuticals and organic wastewater chemicals in streams and rivers water samples from this watershed. It was found that pharmaceuticals were present in 55 percent of the samples and organic wastewater chemicals were present in 77 percent of the samples. This study revealed that the water samples contained "a complex mixture of pharmaceuticals, wastewater chemicals, pesticides, and trace metals" ("Are Pharmaceuticals){Link?} . The findings and results of this study indicate the presence of PPCPs such as sulfamethoxazole (antibiotic), triclosan, and caffeine. Most of the detected compounds do not have water-quality standards, but few of the detected compounds exceeded water-quality standards. As {An?} adverse ecological effects of such complex chemical mixtures in the watershed is that "native fish populations were found to exhibit endocrine disruption, including low male-to-female sex ratio and fish having both female and male reproductive organs (gonadal intersex)". {No particular reason why this sentence deserves to be quoted. It should be paraphrased.} (“Are Pharmaceuticals”).{See Above}
THE EFFECTS OF PPCPs
The direct human health risks of PPCPs are yet to be established. The EPA is performing studies that assess and evaluate the removal of contaminants during wastewater and drinking water treatment. The concentration of PPCPs in water bodies is so dilute that a person would need to drink million of gallons of water to get the equivalent exposure to a single prescribed dose. The risk to human health is small based on this reasoning. {Think about chronic vs. acute exposure. We can't reason away the risk necessarily.} Other considerations include side effects of combining prescriptions and exposure to drugs one needs to avoid.[1] The European community took an earlier and more aggressive approach to PPCPs than the U.S.A. with respect to research and regulation. For example alkylphenols (used in detergent manufacturing) and their metabolites are recognized by the European Union as toxic with the potential to bioaccumulate; however the US has yet to adopt regulation for use of these xenobiotic known endocrine disruptors. (“Alkylphenolic”){ Link should be integrated}
POSEIDONwas a large research project of the European Union, the descriptive title of the project is “Assessment of Technologies for the Removal of Pharmaceuticals and Personal Care Products in Sewage and Drinking Water Facilities to Improve the Indirect Potable Water Reuse”. {Comma Splice} The project covered a range of PPCPs: 1 tranquilizer, 1 antiepileptic, 1 contraceptive (17α-ethinylestradiol), 1 contrast medium, 2 polycyclic musks, 2 antiphlogistics, 2 lipid regulators, 2 antibiotics. The findings, reported in June of 2005, concluded that the most effective means of PPCP removal from water include biological degradation, sorption, and ozonation. Coagulation, flocculation, and disinfection with chlorine were generally unsuccessful at PPCP removal.(""PPCPs' Double Life"")
Studies on the effects of PPCPs on the environment had been absent until the late 1990’s and at that time great gaps in the data existed. Many studies currently are underway to assess the potential ecological effects of PPCPs. The EPA has several such studies that range from hydrolytic transformation of emerging contaminants to the many studies of endocrine disrupters on fish species. Antibiotics are among the most concerning of pharmaceuticals {awkward} found in water bodies. Much of the data on the effects of PPCPs in the environment has been focused on antibiotics due to the direct effects they can have on a microbe community. Another potential effect of antibiotics is the accelerated creation of antibiotic resistant bacteria. Detection of antibiotic-resistant bacteria and antibiotics have become a regular occurrence for water samples collected from streams by the USGS.("PPCPs' Double Life") {These links are better integrated} Antidepressants such as Paxil, Zoloft, and Prozac are associated with considerably {typo} delay in the metamorphosis of amphibians, a critical factor in their chances of survival. Amphibians and fish are used as biological indicators because they are sensitive to subtle changes. The danger of subtle changes is that they may go unidentified of mistakenly attributed to another source. (" Pharmaceuticals") {See above}

DETECTION AND SOLUTIONS

Scientists suspect that one of the main problems with pharmaceuticals in water is that water and sewer {Sewage} treatment plants are not set up to filter out the chemicals and compounds found in drugs and personal care items (PPCPs). {General concept was mentioned above under "Sources of PPCP's" and they should be linked.} Europeans were the first to detect pharmaceuticals and remnants of personal care items in their lakes, steams and waterways. For nearly a century, scientists in Europe have been monitoring the amount of unwanted drugs in their water. This prompted the United States to take a closer look at what was flowing in our water. Recently, the National Ground Water Association and the American Chemical Society have begun to address the problem at their annual meetings.
It was nearly 20 years ago when scientists from the Environmental Protection Agency (EPA) found excreted aspirin, caffeine and nicotine in sludge taken from a US sewage treatment plant. Around the same time, Herman Bouwer of the United States Agricultural Research Service in Phoenix, Arizona found clofibric acid in the groundwater under a treatment facility which artificially recharged groundwater. He warned officials and said that the findings were significant because if clofibric acid, cholesterol-lowering drug, could make it through a treatment plant, so could much worse substances. Both of these findings were essentially ignored; Officials {no capital letter after a semicolon} didn't follow up on the found contamination, and the findings became insignificant.
During the mid-1990s, Europe took the lead in pharmaceutical contamination research. A German chemist, Thomas Ternes, studied what happened to prescription medications after they were excreted. He focused his study on drugs found in sewage, treated water and rivers. Ternes was aware that he would find some pharmaceutical residue in water, but when he discovered 30 of the 60 drugs he tested for, his findings were quite surprising. Up until that point, no one was aware of the effects the drugs were having on the environment. He identified antibiotics, antiseptics, epilepsy drugs, lipid-lowering drugs, analgesics, beta-blocking heart drugs, and agents used for diagnostic x-rays. Due to these findings, he went on to coordinate the project POSEIDON to help remove personal care products from wastewater and drinking water, soil aquifer treatment and to aid in the environmental risk assessment of PPCPs in water. The overall goal of the project was to make water safer for humans and to study new technologies for removing and preventing PPCPs from entering the environment.
More recently, Glen Boyd of Tulane University reported other concerns about pharmacueticals in the water supply. He announced that low levels of clofibric acid, naproxen – a pain killer, and the hormone estrogen had been detected in the Mississippi River, Lake Ponchetrain, and in the tap water in Tulane. Estogen levels in the tap water of Tulane averaged 45 parts per trillion with a high of 80 parts per trillion. Anticancer agents, psychiatric drugs and anti-inflammatory compounds were all found by Chris Metcalfe of Trent University in Ontario leaving sewage treatment plants.
Currently, the United States Geological Survey is beginning the first nationwide study of "emerging contaminants" found in streams. The term "emerging contaminants" refers to newly recognized contaminants which are potentially harmful to humans or the environment, have a lack of information pertaining to the risks and/or enter the environment in an unintended manner. The project will not only provide more information about these compounds, but will also focus on their potential threat to the environment and human health. They will be looking for the presence of human and veterinary pharmaceuticals, sex and steroidal hormones, antidepressants and antacids. The samples will come from 100 streams across the USA, representing a vast number of geographical and hydrogeological settings. Some streams are located after sewage treatment plants, others above dams, but each stream is highly susceptible to contamination by certain compounds. These testing sites will give scientists an indication of the potential for drugs to enter the environment. Suitable lab methods will also be testing {tested} during this study to help determine the best way to measure contaminants at very low levels. The entire study will take five years to complete, however, some results have already been reported.
Thus far the study has found caffeine, codeine, cholesterol-lowering agents, chemotherapy agents, anti-depressants and Premarin – an estrogen replacement drug. There are many examples of studies done that confirmed the presence of pharmaceuticals in drinking and treated water. While some scientists do not think that the very low levels of drugs will ever pose a problem to human health, others disagree and believe strongly that eventually the human population will be affected. It is suspected that some ecosystems in the United States have already felt the effects of pharmaceuticals entering the environment.
Deformed frogs are often considered as early warning signs that damage is being done to aquatic environments. There is no easy solution to fixing the problem, since scientists are not sure how to begin. The US Fish and Wildlife Service teamed up with the American Pharmacists Association to launch “SMARxT DisPOSAL” which is an educational program aimed at the public to spread awareness about the effects of pharmaceuticals on fish and wildlife. The program also provides instructions for the proper way to dispose of unused medications. They recommend that instead of flushing unused drugs down the drain, that they be poured into a sealable plastic bag, then crushed and diluted with water to help dissolve it. Kitty litter, sawdust or coffee grounds are supposed to be added to the plastic bag to help deter animals or children from ingesting the medication. The last step is to seal the bag and put it in the trash. There are some drugs that they recommend be flushed down the drain – including oxycontin – to help keep narcotics off the street. To help combat the problem, some communities have started pharmaceutical collection programs. People who live in communities who have these programs can drop their unused and unwanted drugs off at a local hazardous waste drop off or at participating pharmacies who will properly dispose of the drugs. Some people suggest that the levels of pharmaceuticals in our waterways is to {are too} low to have any impact on human health. While this may be true now, the health care system in the United States is ever growing and more drugs will eventually make their way into our environment. By making small changes now, we may be able to avoid a more long term problem.
The immediate step towards solving this problem is source control. Previously it was recommended to dispose of prescriptions by flushing them down the toilet. This is now only recommended for prescriptions that are labeled with this instruction. Now the appropriate way to dispose of prescriptions is to through {throw} them in the trash in a secure container. Other disposal methods include returning them to the pharmacy for incineration as is promoted by the governments of Australia and Canada or bringing the pharmaceuticals to a local household hazardous waste collection event. There are easy ways for us to reduce the sources of PPCPs. We need to start immediately with simple programs such as public education. There is no need to wait for state agencies’ regulations and studies to undertaking basic programs. While the studies of the long term effects from PPCP contamination must also be continued. {Sentence Fragment}

REFERENCES

Mahoney, Sherleen H. (2006-9-1). "PPCPs' Double Life". Water and Wastewater News. Retrieved on 2009-2-10
"Pharmaceuticals in Our Water Supply." http://ag.arizona.edu/AZWATER/awr/july00/feature1.htm (10 Feb 2009)
"EU Project - Poseidon." http://poseidon.bafg.de/servlet/is/2884/?lang=de (17 Feb 2009)
"Emerging Contaminants in the Environment." USGS. http://toxics.usgs.gov/regional/emc/ (10 Feb 2009)
"A Prescription for a Healthy Planet." SMARxT Disposal. http://www.smarxtdisposal.net/ (10 Feb 2009)
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