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There is something in the water.  And it is affecting the people.  It’s attacking their brains, and it’s changing them.  This mysterious pollutant is not the infamous biological warfare chemical “Trixie” from the 1973 film “The Crazies”, nor was it leaked by the government.  Rather it is a host of chemical components that individuals have allowed to slip into the water supply.

An alarming amount of pharmaceutical contaminants are currently being found in our drinking water.  Medical residue from everything from antibiotics, anti-convulsants, mood stabilizers, tranquilizers, heart medications, infection fighters, and hormones has been discovered from tests of drinking water around the country.  This poses serious concerns both from an environmental and a public health perspective.  The classic studies of the feminized frogs and amphibians, thought to be more sensitive to aquatic pollutants, have revealed that the cause of the problem has been pharmaceutical residue, largely from contraceptives containing high amounts of hormones. 

These studies have pointed to even bigger concerns with the amount of antibiotics and hormones found in drinking water.  Though much research has yet to be completed on constant exposure to low-dose pharmaceutical combinations, worries about their link to antibiotic resistance, neurological defects and improper hormonal development in children have already been surfacing.

But how did these contaminants get introduced into our water resources?  True, some people flush unused pills or throw them in the trash where they eventually leach into the groundwater from landfills.  However, the vast majority of over-the-counter medications, prescription drugs, and veterinary pharmaceuticals are introduced into wastewater after passing through our bodies after they are incompletely absorbed.

Escaping the problem is not truly plausible at present.  Traditional water treatment, water filters, and bottled water all fail to purify contaminated water.  Wastewater treatment facilities are designed to remove conventional pollutants and biodegradable organic material, but not synthetic pollutants.  Oftentimes, the safe dissolution of medications is chemical-specific, meaning that it would be virtually impossible for any single treatment to break down the multitude of pharmaceutical concoctions that enter the waterways. 

Many compounds used in drugs are even designed to resist biological degradation in order to maintain a longer shelf life.  Because there have never been regulations regarding water treatment before for pharmaceutical contaminants, most wastewater treatment facilities don’t even test for them, let alone treat them.

While we cannot simply forego medication, we can take into consideration how we handle unused and unwanted pharmaceuticals.  Flushing them down the toilet or rinsing them down the sink is the quickest way for them to access the water supply.  Currently, the federal government under the Office of National Drug Control recommends putting unused pills in a sealed container with kitty litter or another “undesirable substance” and simply throwing them away.  However, once they enter the landfills, these containers will eventually break down and the medications will leach into the groundwater supply. 

Another proposal for medications and other hazardous waste has been incineration.  California and Washington currently require certain drugs to be incinerated in a regulated medical waste incinerator or municipal incinerator, and Minnesota “strongly encourages incineration”.  However, this merely moves the problem around.  Incineration in an uncontrolled incinerator releases the particulate form of the substances.  Medical incinerators collect the ash and try to prevent leaching, though this ultimately does not remove the problem, just isolate it.  Unregulated incinerators may just spread the problem out into the atmosphere, where particulate matter will eventually settle and reenter the water supply, albeit in a less concentrated way.  Hence, incineration may be seen as a better practice than flushing or disposal of unused medication, but not a true solution.

Ultimately, we are going to need better water treatment if we are to deal with this problem.  Because so much residual pharmaceutical material passes from our bodies into wastewater systems, it has become necessary to improve treatment of such synthetic pollutants.  The limited studies that have been conducted on wastewater have suggested that some methods that are currently available are able to remove a majority of these pollutants.  It will likely require regulation of wastewater facilities from a government level to begin testing for and treating pharmaceutical waste.

Other standards need to be updated as well.  The EPA’s regulations for which medications must be incinerated as hazardous waste have not been significantly updated for over 20 years.  Since then, many new drugs as hazardous or even more hazardous have been created without being added to the list.

Yet government is not the only factor in the solution, and requiring the proper disposal of pharmaceutical waste could create jobs and innovation in the private sector.  In fact, there have already been technological advancements that could expand into this new industry.  For example, plasma arc waste disposal is a newer technology that shows some potential.  Plasma gasification uses extremely high temperatures to break down waste into primarily elemental gas and solid waste.  From this, it is also able to produce and sell electricity and reduce the amount of waste that must otherwise be accommodated by landfills.

Another part of the solution to unused pharmaceuticals is a method for reuse.  Pill take-back programs can be found in some communities across the United States.  These programs allow people to take their unused medication to their hospitals, pharmacies, or local collection groups to be reused for people who cannot afford the drugs, or sent to impoverished nations where they are needed. 

The National Association of Pharmacy Regulatory Authorities has expressed its support for such programs and recommends that they enlarge their scale throughout the country.  Additionally, such centers could be lucrative collection points for expired or non-reusable medications that must be properly handled and disposed of by hazardous waste operators.  Other waste-to-energy businesses are already trying to utilize this strategy in California to gain the bulk of material needed to make their operations profitable.

It will take strong public demand to truly eliminate the problem by requiring better water treatment and biodegradability standards for pharmaceuticals.  While demand can be slow to accumulate and face collective action problems, the threat it poses as more people learn of the harms existent within an industry can and has been enough to make some pharmaceutical companies begin to consider biodegradability as a factor in their products. 

It is possible that government regulation can act as a market instrument to expedite solving the collective action problem.  Once lawmakers institute a program, they still need help convincing society that individuals cannot pass off the costs of their actions as externalities.  Regulation can penalize any “free riders” who would otherwise refuse to cooperate.

Yet this does not and should not be the only approach to the problem, since the market can be the best innovator and incentive creator.  Instead of relying on a government agency to control pharmaceutical waste disposal, government can leave it to the market to produce a supply of waste handlers who are continually looking toward efficiency and technological advancement.  Just as there are incentives to recycle, a once new and unpleasant activity, there can be incentives for sorting out medications as well.

What is in the drinking water is not suspected to create homicidal maniacs.  This is fortunate, since when “Trixie” was leaked, the government operated alone and failed to save the townspeople.  In their effort to single-handedly control the situation, they also killed the one doctor, no doubt private practice, who had found a vaccine.  Both in that movie and in the case of pharmaceutical waste, government has more to gain from stepping aside and allowing the private sector to have a role in producing a solution, if only because the private sector approach will leave some people alive to be governed.

-July 23, 2010