Pills of antibiotic cefalexin. Photographer: Sage Ross, 2014. Image: wikimedia commons.

Feeling sick? It may the drugs you just took when you drank a sip of coffee or a glass of water. Affecting not just humans but aquatic life, medications are entering the water as fast as plastic – they’re just harder to see.

Antibiotics have been found in 65% of over 70 world waterways tested. For example, a site in Bangladesh showed Metronidazole present at levels 300 times the safe limits (20,000 to 32,000 nanogram per liter (ng/l) guidelines set by AMR Industry Alliance). The most frequent contaminant? trimethoprim found at 301 of 711 river testing sites. Most prevalent antibiotic found at dangerous levels: Ciprofloxacin, in 51 of the 72 countries tested.

Chao Phraya River Drainage Basin. Image: wikimedia.

Rivers all over the world show similar results: Chao Phraya, Danube, Seine, Thames.  Some areas of the world suffer infected water more: Bangladesh, Ghana, Kenya, Nigeria, and Pakistan ranked highest of sites monitored. In general, Asia and Africa frequently exceeded safety limits for antibiotics but problems were also found in Europe, North and South America. In other words, it’s global.

Of course, antibiotics save lives. But that’s just the problem: growing global resistance to antibiotics, anti fungals, antivirals caused 700,000 deaths yearly due to drug-resistant diseases, among them tuberculosis. The United Nations’ Interagency Coordination Group on Antimicrobial Resistance predicts that by 2030, over one million people will die every year due drug-resistant diseases.

PROBLEMS: Individuals are in no small part responsible: a study in California revealed half of all medications are discarded, often into the water supply. Another problem: even if we don’t intend to, individuals deposit drugs into the water supply.  People take a lot of drugs, both prescription and over-the-counter; our bodies metabolize only a percentage of the intake, excreting the rest into wastewater systems. And then there are the larger systemic depositors: hospitals try to return unused drugs to manufacturers obtaining a credit or at least assured safe disposal, but care and nursing facilities may not have such arrangements. Certainly drug manufacturers generate highly concentrated waste; downstream of a New York State pharmaceutical manufacturing plant, antibiotic concentrations showed levels 1,000 times higher than normal. And then there’s agriculture: poultry and livestock farming are responsible for two trillion pounds of animal waste filled with the hormones and antibiotics fed to the animals to optimize growth and marketability.

Antibiotics harm fish and aquatic life. Image: Giant Group, Georgia Aquarium, Wikimedia.

Other ways animals are affected? Aquatic life itself is changing: so much estrogen has entered rivers and ponds that male fish are showing genetic changes including the development of intersex fish, especially downstream of wastewater treatment plants: notable is Washington’s Potomac River.

Filters are one approach: water treatment plants have been successful at filtering out ibuprofen but couldn’t catch diclofenax, another pain reliever. Chlorine used in drinking water treatment does reduce bacteria and also degrades acetaminophen and the antibiotic sulfathiazole, and also carbamazepine (by 75%). Still, chemicals are getting into our bodies simply by turning on the tap: Southern Nevada Water Authority found antibiotics, antipsychotics, beta blockers, and tranquilizers in the drinking water as far back as 2010. It is only getting worse.

SOLUTIONS

Pharmaceutical systems include manufacturing, distribution, consumption, disposal, and waste treatment: each step of the process offers opportunities for intervention and innovation. Regulations, at a national, local, or global level, can be effective: compliance is now an industry with consultants like Stericycle with programs “designed to meet regulatory requirements.” Of course, pharmaceutical businesses have in-house programs and systems, including segregating hazardous waste pharmaceuticals that are then sent to a Treatment, Storage, and Disposal Facility (TSDF). It’s a big business: UBS and Vanguard are investors, along with 500 other financial funds. Stericycle has 22,000 employees: competitors include Republic Services with 36,000 and Waste Management with 42,000 employees. It’s a business of the future: pharmaceutical use shows no sign of decreasing, although there is a movement to encourage safer drugs.

Jardine Water Purification Plant, Chicago, Illinois, USA. Image: wikimedia.

Nations and cities can take action. Water facilities such as the Jardine Water Purification Plant in Chicago, Illinois, world’s largest by volume, draws water from the American Great Lakes for distribution to 390 million urban residents. Research and innovation here could lead the way. In Europe, Germany invested one billion euro in the last two decades to water infrastructure including wastewater collection and treatment, in some ways advancing beyond the EU’s Council Directive 98/83/EC.1

Waterways themselves can innovate. When the Roman Aqueducts were built, it was due to an increasingly polluted Tiber River. When London’s water supply from the Thames became problematic, a public-private system was developed: the New River. Will the Grand Canal of China, part of the Belt and Road Initiative, lead research and action to improve the aquatic environment ? Might Inland Waterways International champion ways to improve the health of rivers and other created waterways?

SOLUTION: YOU – What can you do?

Don’t purchase bulk or volume packaging, avoiding accumulation of unused or expired chemical formulations.

Never flush unused medications, vitamins, or supplements down the drain.

When you must dispose, trash/landfill is preferable to flush/water. First, remove pills from container (recycle container),  then crush the pills, add a bit of water, and seal the result in a strong plastic bag before placing in trash.

MORE

Boxall, Alistair. York Environmental Sustainability Institute, and SETAC Helsinki 2019: https://helsinki.setac.org/wp-content/uploads/2019/05/SETAC-Helsinki-programme-book.pdf; and .https://www.york.ac.uk/yesi/news/pharmaceuticals/

Craft. “Stericycle Competitors and Alternatives.” https://craft.co/stericycle/competitors/

Fox, Kara. “The world’s rivers are contaminated with antibiotics, new study shows.” 27 May 2019, CNN. https://www.cnn.com/2019/05/27/health/antibiotics-contaminate-worlds-rivers-intl-scli/index.html.

Harvard University. “Drugs in the water.” June 2011, Harvard Health Letter. https://www.health.harvard.edu/newsletter_article/drugs-in-the-water.

Society of Environmental Toxicology and Chemistry (SETAC). https://www.setac.org

Stericycle.com NASDAQ: SRCK

University of York. “Antibiotics found in some of the world’s rivers exceed ‘safe’ levels, global study finds.” 27 May 2019. https://www.york.ac/uk/news-and-events/news/2019/research/antibiotics-found-in-some-of-worlds-rivers/

Building the World Blog by Kathleen Lusk Brooke and Zoe G Quinn is licensed under a Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Unported Licen