Great Lakes Article:

Side effects may waylay nature
Experts now warn that flushing unused medicines down toilets and drains could pollute our waters and harm wildlife.
By John Myers
Duluth News-Tribune
11/30/03

It's house-cleaning day at Grandpa's home and you come across a medicine cabinet full of expired prescription drugs, stuff Grandma never got around to throwing out.

Conventional wisdom has been that expired medicines -- prescription or over-the-counter -- could be dangerous and should be flushed down the toilet to prevent accidental overdoses.

But a growing number of scientists and sewage treatment officials now are warning that those drugs often can't be removed from wastewater. Many are passing into the environment, where their effects largely remain unknown.

Based on some early effects, however, experts believe there's cause for concern. Locally and nationally, people are being asked to bring their unused medicines to a hazardous waste disposal site rather than flushing them.

Antibiotics, painkillers, hormones and other medicines are turning up in waterways, raising worrisome questions about potential human health and environmental effects. Some are so-called endocrine disrupters that can change the way animals, fish and even people's biological systems work.

In some cases, officials say drugs may harm natural bacteria -- "bugs" that break down and clean sewage, allowing other pollutants to make it through into the environment.

The issue, long in the news in Europe, made domestic headlines recently when the U.S. Geological Survey found traces of dozens of chemicals -- painkillers, estrogen, antidepressants, hypertension medicines and more -- in water samples from 30 states, including Minnesota.

Fish in water from Duluth and Twin Cities sewage treatment plants, for example, are turning from male to female. So far, researchers have not been able to trace the origin of estrogens that cause the changes. But they say it's best to keep as many chemicals out of the water as possible.

"Our treatment plant simply was never intended to remove these kinds of chemicals," said Kurt Soderberg, executive director of the Western Lake Superior Sanitary District. "There's growing evidence that some of these chemicals are getting into (the environment). Common sense dictates that we try to keep them out of the system."

The WLSSD is in the infant stages of a new program to collect unused medicines at its Household Hazardous Waste facility in Lincoln Park/West End. The district is slowly trying to get the word out to homeowners and hopes to begin an outreach to local medical facilities and pharmacies as well.

"We're in the infant stages on this," said Heidi Ringhofer, the WLSSD's supervisor of operations and maintenance. "We're just scratching the surface on this locally."

Deb Swackhamer, University of Minnesota scientist who has studied why fish change sex downstream of wastewater plants, said medicines and other compounds can get into our waters many ways.

Estrogens that are making male fish turn female were originally suspected to come from birth control hormones. Now, Swackhamer and others say that probably isn't true. They suspect the culprit lies in a combination of hormones that are joining forces in the complex sewage effluents our society now sends to treatment plants.

ANTIBIOTIC RESISTANCE

Other chemicals are equally worrisome. Antibiotics, for example, have been found in Minnesota rivers downstream from large livestock farms, apparently residual from drugs given livestock to keep them healthy and gaining weight. More antibiotics get into waterways every time we use antibacterial soaps and cleaners. And they pass through people who take more than their body can process.

Surely, Swackhamer said, the environment doesn't need people flushing more down the toilet.

"If we're teaching bugs (diseases) out there to be resistant to our suite of antibiotics, we're in for some big trouble," she said.

It's clear we use a lot of drugs. The Environmental Protection Agency estimates that we buy more than $100 billion in medicines each year, about 1.5 percent of our gross domestic product. That's tons and tons of pharmaceuticals.

It's not clear how much of that Americans flush each year, or how many are stored in medicine chests because patients don't realize the drugs have expired or don't know they may be dangerous. One study estimated the nation's nursing homes discard anywhere from $73 million to $378 million worth of drugs a year. Some are incinerated, but many are flushed.

St. Mary's/Duluth Clinic Health System, for example, gives its unused drugs to a contractor to be incinerated with other hazardous medical waste.

Other countries are leading the U.S. in getting medicines out of the water. Australia has collected more than 760 tons of medicines since starting a program in 1998 that encourages consumers to return unwanted drugs to pharmacies so they can be incinerated. Canada has a similar program.

EPA INVESTIGATING

Most U.S. pharmacies, however, won't accept unused or unwanted medicines. Walgreens, one of the nation's largest pharmacy chains, will not accept any returned drugs, company officials said last week.

The EPA is just now studying whether to develop formal drug-disposal recommendations.

"The age-old wisdom of flushing medication down the toilet... is probably the least desirable of all the alternatives," Christian Daughton of the EPA's Las Vegas laboratory wrote in an overview of the issue, published in a scientific journal last spring.

The agency is promoting a program called the Green Pharmacy to get medicines out of waterways. So far, however, there's no money, regulations or even a public awareness campaign planned to put the program into action.

Minnesota and Wisconsin have no official effort. But Michigan's Department of Environmental Quality has compiled a brochure with a stern warning "... any and all disposal of drugs down a drain or toilet is strongly discouraged."

Some of the concerns already are being taken to heart. A new contraceptive, a vaginal ring, comes with do-not-flush instructions because it still contains estrogen after it's been used. Women are instructed to wrap the NuvaRing in an accompanying foil patch and put it in a trash can out of reach of children and pets.

"We aren't going to be able to solve every problem people want to flush and send our way," Ringhofer said. "The key is to keep it out of the water to start."