Pharmaceuticals in the Environment http://www.campusecology.wsu.edu/m_roth_review_of_ppcps.pdf
by M. Roth
Stephen Harrod Buhner presents a terrifying summary of how pharmaceuticals and other
chemical agents are affecting the environment in the chapter, “The Environmental
Impacts of Technological Medicine,” from his the book, The Lost Language of Plants -
The Ecological Importance of Plant Medicines to Life on Earth (2002). His information
is so dramatic that at times it appears to be false or exaggerated. Pharmaceutical drugs
(e.g., pain killers, contraceptives, anti-depressants, cancer drugs, hormone therapies,
blood pressure medicines) are ingested and personal care products (PCPs) (e.g., skin
creams, antibacterial soaps, shampoos, sun screens, perfumes, musks) are used by many
people throughout the day, everyday, and these products are eventually rinsed off or
excreted and wash down the drain. The individual rarely gives a second thought about
where those products are going. Who would have imagined that estrogen from birth
control pills could eventually wind up in drinking water and potentially contribute to
young girls to entering puberty early? At first reading, Buhner’s arguments appear to be
slightly farfetched. How could health care drugs and personal care products harm the
environment? Therefore, it was necessary to conduct my own thorough research in
scholarly and scientific journals to evaluate the accuracy of the information provided in
his text which is clearly designed for a popular audience.
Articles I explored in peer-reviewed scientific journals on the topic of pharmaceuticals
and personal care products in the environment supported almost all of the information
presented by Buhner. This result quickly surprised me because it seems as though little
publicity has been given to this extremely significant environmental issue.
Human use of pharmaceutical drugs and personal care products has increased to
extremely high levels. Several kilotons of nonsteroidal anti- inflammatory drugs, such as
ibuprofen, alone are produced annually worldwide (Cleuvers 2003). Pharmaceuticals and
PCPs eventually get washed from the body and enter water systems, ultimately winding
up in the effluent of wastewater treatment plants and aquatic environments. Since
medical substances are developed with the intention of performing some sort of
biological function, they have a tendency to bioaccumulate and induce effects in aquatic
and terrestrial ecosystems (Halling-Sorensen et al. 1998).
Every journal article I reviewed acknowledged that pharmaceuticals and PCPs are being
released into the environment. Not only are these products being released after usage, but
also during manufacturing and disposal of unused or expired drugs (Breton and Boxall
2003). Millions of prescription and nonprescription drugs are purchased and ingested by
or applied on individuals. Ingested drugs are eventually excreted from individua ls
through urine or feces. Buhner (2002) states that high percentages of many
pharmaceuticals can be excreted from the body unmetabolized and enter wastewater as
biologically active substances. A specific example that supports this claim is provided in
a study published in the scientific journal,
2
which states that 90% of the drug, propofol found in anesthesia, is excreted
unmetabolized. This is a very high percentage and it illustrates that large amounts of
various unmetabolized pharmaceuticals are being released into wastewater where their
environmental impacts are not well known.
Unmetabolized pharmaceuticals are often the most non-biodegradable substances in the
environment (Stuer-Lauridsen et al. 2000). Their intrinsic medicinal properties give them
the tendency to bioaccumulate in other organisms besides humans and thereby potentially
provoke effects on the biota of aquatic and terrestrial ecosystems (Halling-Sorensen
1998). Many pharmaceuticals are often persistent and lipophilic – able to pass through
cell membranes, which allows them to carry out specific biological functions. Many
pharmaceuticals are relatively stable to avoid being biologically inactivated before
carrying out the ir intended pharmaceutical effects in the body.
Because many scientific journal articles clearly documented that pharmaceuticals and
PCPs are being released into the environment, I then evaluated Buhner’s (2002)
statements regarding the toxicity of various pharmaceuticals and PCPs. One of the drugs
mentioned by Buhner is clofibric acid, which is a highly persistent drug that has been
discovered in wastewater treatment plant effluents and in aquatic ecosystems, as well as
in tap water of some areas (Halling-Sorensen et al. 1998). Clofibric acid is a metabolite
of a blood lipid regulator used to lower blood cholesterol levels. Numerous studies
support Buhner’s statements regarding the relatively nonbiodegradable nature of this
pharmaceutical (Halling-Sorensen et al. 1998, Webb et al. 2003). However, a study by
Ferrari et al. (2003) that appeared in
clofibric acid does not pose a potential hazard to aquatic environments or humans.
Ferrari et al. (2003) investigated the pharmaceutical residues in sewage treatment plants
throughout France, Greece, Italy, and Sweden, and determined that the concentrations of
clofibric acid present in effluents are so low that they cause no effects on nontarget
organisms.
Chemosphere, by Klaus Kummerer (2001),Ecotoxicology and Environmental Safety claims that
Estrogen
One aspect of Buhner’s paper for which it was difficult to find legitimate scientific
support was the section on estrogen. Buhner presented a great deal of information
regarding the effects of estrogen compounds on the environment and on humans. Many
literature sources were encountered that supported his statements about the negative
effects of increasing aquatic estrogen levels on fish (Christensen 1998, Webb et al. 2003).
However, it was more difficult to find support for Buhner’s statements regarding the
effects of estrogen on humans. Buhner (2003) insinuates that the increasing levels of
estrogen in the environment, via pharmaceuticals for purposes such as menopause
symptom relief and birth control pills, could be causing adverse effects on humans, such
as reduced male sperm counts and sperm motility and younger ages of puberty in girls.
This is one aspect of Buhner’s paper that does not appear to have sufficient support,
because my review found no experimental studies that have actually linked these
symptoms with increasing levels of estrogen in the drinking water or environment.
3
F.M. Christensen (1998), a scientist at the Danish Toxicology Center in Harsholm,
Denmark, published a study that tested the human exposure and risks of higher estrogen
levels in the environment. He claims that ma ny forms of estrogen are produced and
excreted naturally by humans and other organisms and therefore occur naturally in the
environment. He acknowledges that there are synthetic forms of estrogen currently being
produced, which is increasing the level of this hormone in the environment. He also
acknowledges that these circumstances are resulting in adverse effects on fish. The
increasing occurrences of hermaphrodite fish in natural waterways are attributed to the
higher estrogen levels from wastewater treatment plant effluent. After examining the
degree of human exposure to this hormone and the way in which estrogen reacts in the
body, Christensen concludes that the human exposure to estrogen via drinking water and
foodstuffs does not pose a significant risk.
A study conducted by Webb et al. (2003) supports Christensen’s claim. They conducted
an experiment that examined the degree of human exposure to various pharmaceutical
compounds in drinking water. Based on their results it was determined that the average
daily intake of estrogen from drinking water is negligible. They assert that humans
naturally produce and intake various forms of estrogen. The level of this natural
exposure to estrogen is approximately two orders of magnitude greater than the potential
levels of exposure to synthetic estrogen from pharmaceuticals. Therefore, they suggested
that current increased levels of estrogen in the environment will not cause harmful effects
on humans.
Antibacterial Resistance
One negative environmental effect of pharmaceuticals and PCPs in the environment that
is not readily discussed by Buhner (2003) is the issue of antibacterial resistance. Halling-
Sorensen et al. (1998) discuss various instances in which antibacterial agents present in
waterways and sediments have allowed bacterial flora to develop antibacterial resistance
to those particular agents. In locations surrounding fish farms, many sediment bacteria
were found with antibiotic resistance. This resistance is attributed to the high number of
antibiotics utilized as feed additives in fish farms. Bacterial resistances to erythromycin,
tobramycin, chloramphenicol, and tetracycline were discovered in effluent from
slaughterhouses. The development of resistance to antimicrobial agents makes treatment
of infections very difficult to cure, therefore this issue is an important consideration for
the treatment of wastewater, especially that which is discharged from hospitals,
veterinary clinics, or other locations where large amounts of antibiotics are used.
Another synthetic chemical found in the environment are quaternary ammonium
compounds (QACs). Klaus Kummerer (2001), a scientist in the Institute of
Environmental Medicine and Hospital Epidemiology in Freiburg, Germany, describes the
negative effects that QACs are having on the environment. QACs are cationic
microbidical compounds that are important ingredients in disinfectants, which are used in
hospitals as well as households. They are known to inhibit the proper functioning of
aquatic microorganisms, and they have a low biodegradability. Inhibitory effects have
also been found against denitrifying bacteria in very low concentrations of QACs.
4
Because denitrifying bacteria are important constituents of wastewater treatment plants,
QACs are a synthetic chemical that disturbs the wastewater purification process in these
facilities.
The environmental effects of nonsteroidal anti-inflammatory drugs (NSAIDs) such as
ibuprofen, diclofenac, naproxen, and acetylsalicylic acid have also been tested. Michael
Cleuvers (2003) from the department of General Biology at Aachen University of
Technology in Aachen, Germany, conducted a study to determine the ecotoxicity of
NSAIDs in dilutions of single substances and in mixtures. NSAIDs are one of the most
widely used pharmaceuticals worldwide and have reached detectable concentrations in
the environment, including, in some instances, drinking water. Cleuvers acknowledged
the importance of testing the effects of mixtures of pharmaceuticals because drug
residues often occur as mixtures and not as single contaminants after entering
wastewaters and the environment. This mixing of substances results in overall higher
concentrations of drug residues.
Cleuvers (2003) determined that NSAIDs have inhibitory effects on certain functions in
non- mammalian vertebrates and invertebrates (2003). The function of NSAIDs in
humans is basically to inhibit the enzymes that catalyze the biosynthesis of prostaglandin,
which is partially responsible for causing pain and inflammation. Prostaglandins are also
present in organisms such as fish, amphibians, birds, corals, sponges, and marine algae,
where they carryout various functions, including defense mechanisms. Another effect
specific for ibuprofen was growth inhibition of certain gram-positive bacteria when
exposed to low concentrations of the drug in the environment (Halling-Sorensen et al.
1998). Buhner (2003) did not discuss the effects of NSAIDs in the environment in the
assigned chapter, but many studies concerned with this particular group of drugs have
been published in scientific journals. The negative affects associated with these drugs
supports Buhner’s general argument that pharmaceuticals are having impacts on the
environment.
Human Health
Webb et al. (2003), claim that the concentrations of many drug and synthetic chemical
residues in potable drinking water are so low that they do not pose high risks to humans.
These researchers created a framework in which to measure the indirect exposure of
various drugs from drinking water. They then examined the possible daily intake and
exposure to 60 different compounds from drinking water in Germany and compared those
values to the actual therapeutic dosages of each medication. In most cases the difference
between daily possible intake via drinking water and the therapeutic dosage differed by a
factor of at least 150,000. They claim that this indicates that the estimated indirect
exposures are extremely low and below doses that would actually cause pharmacological
effect. This study demonstrates that there is a low potential for negative impacts on
humans from pharmaceutical residues in drinking water.
Webb et al. (2003) claim that the pharmaceuticals known as genotoxins are excluded
from the category of nontoxic pharmaceuticals in drinking water. Genotoxins are
5
antineoplastics, which are extremely toxic because they are carcinogenic, mutagenic,
embryotoxic, or teratogenic. There is no threshold dose of this drug in which no
significant effects may be induced through indirect exposure. This information also
supports the statements made by Buhner when he explains that antineoplastics are
extremely toxic substances.
Treatment Facilities
In his text, Buhner (2003) discusses the various methods in which pollutants are removed
from wastewater. A study from,
treatment plants do not remove many of the pharmaceuticals and synthetic hormones,
such as those present in modern birth control pills and other prescription drugs, that enter
through water effluent (Harder 2003). Modern wastewater treatment plants now have
multiple tank systems that contain different types of bacterial and chemical conditions
that work to break down contaminants present in the wastewater, whereas older facilities
consist of single tanks that remove primarily phosphates and nitrates from the sewage
sludge. Many facilities continue to utilize this older, less efficient technique. This is a
significant issue because pharmaceuticals and other synthetic chemicals continue to be
released from wastewater treatment facilities that have not yet been upgraded to a
multiple tank purifying system (Breton and Boxall 2003).
Science News, describes how older wastewater
Conclusion
Pharmaceuticals and PCPs are being released into water systems, yet inadequate federal
and state regulations are implemented to monitor or control them, even though water
quality standards are enforced in countries throughout the world. The water quality
standards in the United States are enforced by the Environmental Protection Agency
(EPA), which executes over 170 drinking water standards, but none of these standards
currently apply to pharmaceuticals (Webb et al. 2003). Pharmaceuticals are excluded
from water quality standards in other countries as well. Nevertheless, numerous analyses
have determined that pharmaceuticals and PCPs have potential adverse human and
environmental effects from indirect exposure (Cleuvers 2003, Halling-Sorensen et al.
1998, Harder 2003, Webb et al. 2003). Just as pesticides are highly regulated by means
of rigorous pretesting to demonstrate no adverse environmental effects of the chemicals,
new pharmaceutical and PCPs manufacturing requirements might be required of industry
as a possible solution to preventing further environmental pollutionby such products.
Pharmaceuticals and synthetic chemicals from personal care products are being released
into the environment in extremely large quantities on a regular basis – of that there is no
doubt. The exact effects that each drug is having on ecosystems, biota, and humans,
however, are still are not completely understood. Therefore more research is critically
needed. The information in Buhner’s book chapter may not all be completely supported
by work published in peer-reviewed, scientific journals. His text does present an
alarming issue that deserves considerable attention and exploration. Buhner’s (2003)
paper is clearly meant as a means of gaining greater public awareness of this increasingly
important subject, and it does a fine job of doing so.
6
Literature Cited:
Buhner, Stephen Harrod. 2002. The Lost Language of Plants- The Ecological
Importance of Plant Medicines to Life on Earth. Chelsea Green Publishing:
White River Junction, Vermont.
Boxall, Alistair, and Roger Breton. 2003. Pharmaceuticals and Personal Care Products
in the Environment: Regulatory Drivers and Research Needs. QSAR and
Combinational Science 22(3): 399-409.
Christensen, F.M. 1998. Pharmaceuticals in the Environment- a Human Risk?
Regulatory Toxicology and Pharmacology 28(3): 212-221.
Cleuvers, Michael. 2003. Mixture Toxicity of the Anti-Inflammatory Drugs Diclofenac,
Ibuprofen, Naproxen, and Acetylsalicylic Acid. Ecotoxicology and
Environmental Saftey. Online:
http://dx.doi.org/10.1016/S0147-6513(03)00141-6
Kummerer, Klaus. 2001. Drugs in the Environment: Emission of Drugs, Diagnostic
Aids and Disinfectants into Wastewater by Hospitals in Relation to Other
Sources- a Review. Chemosphere 45(6-7): 957-969.
Stuer-Lauridsen, F., M. Birkved, L.P. Hansen, H.C. Holten Lutzhoft, and B. Halling-
Sorensen. 2000. Environmental Risk Assessment of Human Pharmaceuticals in
Denmark After Normal Therapeutic Use. Chemosphere 40(7): 783-793.
Kummerer, K., T. Erbe, S. Gartiser, and L. Brinker. 1998. AOX-Emissions from
Hospitals in Municipal Waste Water. Chemosphere 36(11): 2437-2445.
Halling-Sorensen, B., S. Nors Nielsen, P.F. Lansky, F. Ingerslev, H.C. Holten Lutzhoft,
and S.E. Jorgensen. 1998. Occurrence, Fate, and Effects of Pharmaceutical
Substances in the Environment- a Review. Chemosphere 36(2): 357-393.
Harder, Ben. 2003. Extracting Estrogens. Science News 164(5): 67-68.
Webb, Simon, Thomas Ternes, Michel Gilbert, and Klaus Olejniczak. 2003. Indirect
Human Exposure to Pharmaceuticals via Drinking Water. Toxicology Letters
142(3): 157-167.
Ferrari, Benoit, Nicklas Paxeus, Roberto Lo Giudice, Antonino Pollio, and Jeanne Garric.
2003. Ecotoxicological Impact of Pharmaceuticals Found in Treated
Wastewaters: Study of Carbamazepine, Clofibric Acid, and Diclofenac.
Ecotoxicology and Environmental Safety 55(3): 359-370.
by M. Roth
Stephen Harrod Buhner presents a terrifying summary of how pharmaceuticals and other
chemical agents are affecting the environment in the chapter, “The Environmental
Impacts of Technological Medicine,” from his the book, The Lost Language of Plants -
The Ecological Importance of Plant Medicines to Life on Earth (2002). His information
is so dramatic that at times it appears to be false or exaggerated. Pharmaceutical drugs
(e.g., pain killers, contraceptives, anti-depressants, cancer drugs, hormone therapies,
blood pressure medicines) are ingested and personal care products (PCPs) (e.g., skin
creams, antibacterial soaps, shampoos, sun screens, perfumes, musks) are used by many
people throughout the day, everyday, and these products are eventually rinsed off or
excreted and wash down the drain. The individual rarely gives a second thought about
where those products are going. Who would have imagined that estrogen from birth
control pills could eventually wind up in drinking water and potentially contribute to
young girls to entering puberty early? At first reading, Buhner’s arguments appear to be
slightly farfetched. How could health care drugs and personal care products harm the
environment? Therefore, it was necessary to conduct my own thorough research in
scholarly and scientific journals to evaluate the accuracy of the information provided in
his text which is clearly designed for a popular audience.
Articles I explored in peer-reviewed scientific journals on the topic of pharmaceuticals
and personal care products in the environment supported almost all of the information
presented by Buhner. This result quickly surprised me because it seems as though little
publicity has been given to this extremely significant environmental issue.
Human use of pharmaceutical drugs and personal care products has increased to
extremely high levels. Several kilotons of nonsteroidal anti- inflammatory drugs, such as
ibuprofen, alone are produced annually worldwide (Cleuvers 2003). Pharmaceuticals and
PCPs eventually get washed from the body and enter water systems, ultimately winding
up in the effluent of wastewater treatment plants and aquatic environments. Since
medical substances are developed with the intention of performing some sort of
biological function, they have a tendency to bioaccumulate and induce effects in aquatic
and terrestrial ecosystems (Halling-Sorensen et al. 1998).
Every journal article I reviewed acknowledged that pharmaceuticals and PCPs are being
released into the environment. Not only are these products being released after usage, but
also during manufacturing and disposal of unused or expired drugs (Breton and Boxall
2003). Millions of prescription and nonprescription drugs are purchased and ingested by
or applied on individuals. Ingested drugs are eventually excreted from individua ls
through urine or feces. Buhner (2002) states that high percentages of many
pharmaceuticals can be excreted from the body unmetabolized and enter wastewater as
biologically active substances. A specific example that supports this claim is provided in
a study published in the scientific journal,
2
which states that 90% of the drug, propofol found in anesthesia, is excreted
unmetabolized. This is a very high percentage and it illustrates that large amounts of
various unmetabolized pharmaceuticals are being released into wastewater where their
environmental impacts are not well known.
Unmetabolized pharmaceuticals are often the most non-biodegradable substances in the
environment (Stuer-Lauridsen et al. 2000). Their intrinsic medicinal properties give them
the tendency to bioaccumulate in other organisms besides humans and thereby potentially
provoke effects on the biota of aquatic and terrestrial ecosystems (Halling-Sorensen
1998). Many pharmaceuticals are often persistent and lipophilic – able to pass through
cell membranes, which allows them to carry out specific biological functions. Many
pharmaceuticals are relatively stable to avoid being biologically inactivated before
carrying out the ir intended pharmaceutical effects in the body.
Because many scientific journal articles clearly documented that pharmaceuticals and
PCPs are being released into the environment, I then evaluated Buhner’s (2002)
statements regarding the toxicity of various pharmaceuticals and PCPs. One of the drugs
mentioned by Buhner is clofibric acid, which is a highly persistent drug that has been
discovered in wastewater treatment plant effluents and in aquatic ecosystems, as well as
in tap water of some areas (Halling-Sorensen et al. 1998). Clofibric acid is a metabolite
of a blood lipid regulator used to lower blood cholesterol levels. Numerous studies
support Buhner’s statements regarding the relatively nonbiodegradable nature of this
pharmaceutical (Halling-Sorensen et al. 1998, Webb et al. 2003). However, a study by
Ferrari et al. (2003) that appeared in
clofibric acid does not pose a potential hazard to aquatic environments or humans.
Ferrari et al. (2003) investigated the pharmaceutical residues in sewage treatment plants
throughout France, Greece, Italy, and Sweden, and determined that the concentrations of
clofibric acid present in effluents are so low that they cause no effects on nontarget
organisms.
Chemosphere, by Klaus Kummerer (2001),Ecotoxicology and Environmental Safety claims that
Estrogen
One aspect of Buhner’s paper for which it was difficult to find legitimate scientific
support was the section on estrogen. Buhner presented a great deal of information
regarding the effects of estrogen compounds on the environment and on humans. Many
literature sources were encountered that supported his statements about the negative
effects of increasing aquatic estrogen levels on fish (Christensen 1998, Webb et al. 2003).
However, it was more difficult to find support for Buhner’s statements regarding the
effects of estrogen on humans. Buhner (2003) insinuates that the increasing levels of
estrogen in the environment, via pharmaceuticals for purposes such as menopause
symptom relief and birth control pills, could be causing adverse effects on humans, such
as reduced male sperm counts and sperm motility and younger ages of puberty in girls.
This is one aspect of Buhner’s paper that does not appear to have sufficient support,
because my review found no experimental studies that have actually linked these
symptoms with increasing levels of estrogen in the drinking water or environment.
3
F.M. Christensen (1998), a scientist at the Danish Toxicology Center in Harsholm,
Denmark, published a study that tested the human exposure and risks of higher estrogen
levels in the environment. He claims that ma ny forms of estrogen are produced and
excreted naturally by humans and other organisms and therefore occur naturally in the
environment. He acknowledges that there are synthetic forms of estrogen currently being
produced, which is increasing the level of this hormone in the environment. He also
acknowledges that these circumstances are resulting in adverse effects on fish. The
increasing occurrences of hermaphrodite fish in natural waterways are attributed to the
higher estrogen levels from wastewater treatment plant effluent. After examining the
degree of human exposure to this hormone and the way in which estrogen reacts in the
body, Christensen concludes that the human exposure to estrogen via drinking water and
foodstuffs does not pose a significant risk.
A study conducted by Webb et al. (2003) supports Christensen’s claim. They conducted
an experiment that examined the degree of human exposure to various pharmaceutical
compounds in drinking water. Based on their results it was determined that the average
daily intake of estrogen from drinking water is negligible. They assert that humans
naturally produce and intake various forms of estrogen. The level of this natural
exposure to estrogen is approximately two orders of magnitude greater than the potential
levels of exposure to synthetic estrogen from pharmaceuticals. Therefore, they suggested
that current increased levels of estrogen in the environment will not cause harmful effects
on humans.
Antibacterial Resistance
One negative environmental effect of pharmaceuticals and PCPs in the environment that
is not readily discussed by Buhner (2003) is the issue of antibacterial resistance. Halling-
Sorensen et al. (1998) discuss various instances in which antibacterial agents present in
waterways and sediments have allowed bacterial flora to develop antibacterial resistance
to those particular agents. In locations surrounding fish farms, many sediment bacteria
were found with antibiotic resistance. This resistance is attributed to the high number of
antibiotics utilized as feed additives in fish farms. Bacterial resistances to erythromycin,
tobramycin, chloramphenicol, and tetracycline were discovered in effluent from
slaughterhouses. The development of resistance to antimicrobial agents makes treatment
of infections very difficult to cure, therefore this issue is an important consideration for
the treatment of wastewater, especially that which is discharged from hospitals,
veterinary clinics, or other locations where large amounts of antibiotics are used.
Another synthetic chemical found in the environment are quaternary ammonium
compounds (QACs). Klaus Kummerer (2001), a scientist in the Institute of
Environmental Medicine and Hospital Epidemiology in Freiburg, Germany, describes the
negative effects that QACs are having on the environment. QACs are cationic
microbidical compounds that are important ingredients in disinfectants, which are used in
hospitals as well as households. They are known to inhibit the proper functioning of
aquatic microorganisms, and they have a low biodegradability. Inhibitory effects have
also been found against denitrifying bacteria in very low concentrations of QACs.
4
Because denitrifying bacteria are important constituents of wastewater treatment plants,
QACs are a synthetic chemical that disturbs the wastewater purification process in these
facilities.
The environmental effects of nonsteroidal anti-inflammatory drugs (NSAIDs) such as
ibuprofen, diclofenac, naproxen, and acetylsalicylic acid have also been tested. Michael
Cleuvers (2003) from the department of General Biology at Aachen University of
Technology in Aachen, Germany, conducted a study to determine the ecotoxicity of
NSAIDs in dilutions of single substances and in mixtures. NSAIDs are one of the most
widely used pharmaceuticals worldwide and have reached detectable concentrations in
the environment, including, in some instances, drinking water. Cleuvers acknowledged
the importance of testing the effects of mixtures of pharmaceuticals because drug
residues often occur as mixtures and not as single contaminants after entering
wastewaters and the environment. This mixing of substances results in overall higher
concentrations of drug residues.
Cleuvers (2003) determined that NSAIDs have inhibitory effects on certain functions in
non- mammalian vertebrates and invertebrates (2003). The function of NSAIDs in
humans is basically to inhibit the enzymes that catalyze the biosynthesis of prostaglandin,
which is partially responsible for causing pain and inflammation. Prostaglandins are also
present in organisms such as fish, amphibians, birds, corals, sponges, and marine algae,
where they carryout various functions, including defense mechanisms. Another effect
specific for ibuprofen was growth inhibition of certain gram-positive bacteria when
exposed to low concentrations of the drug in the environment (Halling-Sorensen et al.
1998). Buhner (2003) did not discuss the effects of NSAIDs in the environment in the
assigned chapter, but many studies concerned with this particular group of drugs have
been published in scientific journals. The negative affects associated with these drugs
supports Buhner’s general argument that pharmaceuticals are having impacts on the
environment.
Human Health
Webb et al. (2003), claim that the concentrations of many drug and synthetic chemical
residues in potable drinking water are so low that they do not pose high risks to humans.
These researchers created a framework in which to measure the indirect exposure of
various drugs from drinking water. They then examined the possible daily intake and
exposure to 60 different compounds from drinking water in Germany and compared those
values to the actual therapeutic dosages of each medication. In most cases the difference
between daily possible intake via drinking water and the therapeutic dosage differed by a
factor of at least 150,000. They claim that this indicates that the estimated indirect
exposures are extremely low and below doses that would actually cause pharmacological
effect. This study demonstrates that there is a low potential for negative impacts on
humans from pharmaceutical residues in drinking water.
Webb et al. (2003) claim that the pharmaceuticals known as genotoxins are excluded
from the category of nontoxic pharmaceuticals in drinking water. Genotoxins are
5
antineoplastics, which are extremely toxic because they are carcinogenic, mutagenic,
embryotoxic, or teratogenic. There is no threshold dose of this drug in which no
significant effects may be induced through indirect exposure. This information also
supports the statements made by Buhner when he explains that antineoplastics are
extremely toxic substances.
Treatment Facilities
In his text, Buhner (2003) discusses the various methods in which pollutants are removed
from wastewater. A study from,
treatment plants do not remove many of the pharmaceuticals and synthetic hormones,
such as those present in modern birth control pills and other prescription drugs, that enter
through water effluent (Harder 2003). Modern wastewater treatment plants now have
multiple tank systems that contain different types of bacterial and chemical conditions
that work to break down contaminants present in the wastewater, whereas older facilities
consist of single tanks that remove primarily phosphates and nitrates from the sewage
sludge. Many facilities continue to utilize this older, less efficient technique. This is a
significant issue because pharmaceuticals and other synthetic chemicals continue to be
released from wastewater treatment facilities that have not yet been upgraded to a
multiple tank purifying system (Breton and Boxall 2003).
Science News, describes how older wastewater
Conclusion
Pharmaceuticals and PCPs are being released into water systems, yet inadequate federal
and state regulations are implemented to monitor or control them, even though water
quality standards are enforced in countries throughout the world. The water quality
standards in the United States are enforced by the Environmental Protection Agency
(EPA), which executes over 170 drinking water standards, but none of these standards
currently apply to pharmaceuticals (Webb et al. 2003). Pharmaceuticals are excluded
from water quality standards in other countries as well. Nevertheless, numerous analyses
have determined that pharmaceuticals and PCPs have potential adverse human and
environmental effects from indirect exposure (Cleuvers 2003, Halling-Sorensen et al.
1998, Harder 2003, Webb et al. 2003). Just as pesticides are highly regulated by means
of rigorous pretesting to demonstrate no adverse environmental effects of the chemicals,
new pharmaceutical and PCPs manufacturing requirements might be required of industry
as a possible solution to preventing further environmental pollutionby such products.
Pharmaceuticals and synthetic chemicals from personal care products are being released
into the environment in extremely large quantities on a regular basis – of that there is no
doubt. The exact effects that each drug is having on ecosystems, biota, and humans,
however, are still are not completely understood. Therefore more research is critically
needed. The information in Buhner’s book chapter may not all be completely supported
by work published in peer-reviewed, scientific journals. His text does present an
alarming issue that deserves considerable attention and exploration. Buhner’s (2003)
paper is clearly meant as a means of gaining greater public awareness of this increasingly
important subject, and it does a fine job of doing so.
6
Literature Cited:
Buhner, Stephen Harrod. 2002. The Lost Language of Plants- The Ecological
Importance of Plant Medicines to Life on Earth. Chelsea Green Publishing:
White River Junction, Vermont.
Boxall, Alistair, and Roger Breton. 2003. Pharmaceuticals and Personal Care Products
in the Environment: Regulatory Drivers and Research Needs. QSAR and
Combinational Science 22(3): 399-409.
Christensen, F.M. 1998. Pharmaceuticals in the Environment- a Human Risk?
Regulatory Toxicology and Pharmacology 28(3): 212-221.
Cleuvers, Michael. 2003. Mixture Toxicity of the Anti-Inflammatory Drugs Diclofenac,
Ibuprofen, Naproxen, and Acetylsalicylic Acid. Ecotoxicology and
Environmental Saftey. Online:
http://dx.doi.org/10.1016/S0147-6513(03)00141-6
Kummerer, Klaus. 2001. Drugs in the Environment: Emission of Drugs, Diagnostic
Aids and Disinfectants into Wastewater by Hospitals in Relation to Other
Sources- a Review. Chemosphere 45(6-7): 957-969.
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