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Pharmaceuticals are being detected regularly in our nation’s waterways and with this comes rising concern about potential long-term adverse effects to both humans and aquatic organisms from continuous environmental exposure. The main source of pharmaceutical loading into our waterways is via municipal sewage systems, with current wastewater treatment plants unable to remove the majority of these compounds. Concentrated animal feeding operations (CAFOs) – a major pollution source in the Black Warrior River watershed – are also a significant source of pharmaceutical contamination in waterways. At the individual level, proper disposal of medicines and personal care products is the beginning of a long-term solution to this critical issue.

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Over the past several years, pharmaceuticals have gained a great deal of attention as being one of the most significant emerging environmental contaminants of the 21st century. As of today, there is no doubt that pharmaceuticals are being detected regularly in the environment. An investigation by the Associated Press found pharmaceuticals to be present in the drinking water of at least 41 million Americans (Donn et al., 2008). Even in small concentrations, there is rising concern about potential long-term impacts to both humans and aquatic organisms as a result of the continuous environmental exposure to these compounds. It is estimated that around 250 million pounds of pharmaceutical products are produced in the U.S. annually (Donn et al., 2008). In a recent presentation given by David Pringle, campaign director for the NJ Environmental Federation, Pringle stated: “common sense dictates it’s not a good idea to drink somebody else’s medicine: we know we are being exposed to other people’s drugs through our drinking water, and that can’t be good”. Now that we know pharmaceuticals are common pollutants in our environment, many are left wondering what is to be done about it. There is still no clear solution. For those thinking bottled water is a solution, think again Bottled water is less regulated than tap water, more expensive, and is most often drawn from the same sources as tap water supplies (Pringle, 2008).

Three main classes of compounds fall under the umbrella of “pharmaceuticals”: therapeutic drugs, personal care products, and endocrine disruptors. The term “pharmaceutical” encompasses all prescription, non-prescription and over-the-counter therapeutic drugs, in addition to veterinary drugs and nutritional supplements (Kreisberg, 2007). Personal care products include all consumer chemicals typically found in fragrances, lotions, shampoos, cosmetics, sunscreens, soaps, etc (Kreisberg, 2007). The EPA (2007) defines an endocrine disruptor as “an exogenous substance that alters the function of the endocrine system and consequently causes adverse health effects in an intact organism, its progeny, or (sub)populations”. The most widely suspected endocrine disrupting chemicals are both natural and synthetic hormones, steroids, pesticides, herbicides, fungicides, plasticizers, metals, and other industrial chemicals (EPA, 2007).

Little attention has been given to the presence of these biologically-active compounds in our environment, even though their presence has been reported since the early 1970’s in the U.S. (Brun et al., 2006). This neglect is mainly due to the fact that pharmaceutical compounds tend to breakdown much more rapidly than more well-known pollutants (ex: dioxins, PCBs) in the environment (Kreisberg, 2006). The truth is that their rapid breakdown is easily offset by the exponential increase in consumer use of these products. Since these compounds are continuously discharged into sewer systems by consumers, their presence is maintained in the environment. It is because of this cycle that pharmaceuticals are now generally referred to as “pseudo-persistent” environmental contaminants (Daughton, 2007). To put it into perspective, researchers Christian Daughton and Thomas Ternes reported in the journal Environmental Health Perspectives (1999) “that the amount of pharmaceuticals and personal care products entering the environment annually is about equal to the amount of pesticides used each year”.

The main route of pharmaceuticals into the environment is via domestic sewage systems (Ternes et al., 2002). Humans excrete compounds via urine and feces, unused or expired medicines are directly flushed, and personal care products are washed off. Approximately 50-95% of each drug ingested is excreted from the body either unchanged or only partially metabolized (Buhner, 2002). Other routes include: domestic and agricultural runoff, leachate from landfills, and disposal at point-of-production (NHDES, 2010).

Concentrated animal feeding operations (CAFOs) are a significant source of pharmaceutical contamination in waterways. Many natural hormones and antibiotics are commonly used in CAFOs to boost livestock growth (Velicu & Suri, 2009). Pharmaceutical contaminants enter the water via runoff from recently applied waste and/or leakage of manure lagoons following major rain events (Burkholder et al., 2007). Many of the most frequently used pharmaceuticals by CAFOs have been detected in wastewater, groundwater and surface waters (Velicu & Suri, 2009). There are few regulations on manure waste generated by CAFOs in the U.S., even though studies have shown manure to be responsible for 90% of the total estrogen loading in the environment (Velicu & Suri, 2009). There is growing concern over the potential spread of antibiotic resistance among the microorganisms being continuously exposed to antibiotics in the environment, and the subsequent threat to human health (Kim et al., 2005). For information on CAFOs in Alabama, visit

Once pharmaceuticals reach wastewater treatment plants (WWTPs) from the sewer systems, their fate is still widely unknown. WWTPs are not designed to remove pharmaceutical compounds from influents. A preliminary study conducted by the United States Geological Survey (2002) detected one or more pharmaceutical compounds in 80% of the streams they sampled, with half of those streams containing at least 7 compounds, and one-third containing at least 10 compounds. Today, an average of 100 pharmaceuticals and personal care products are routinely detected in the U.S. municipal drinking water supply (Kreisberg, 2006). Very few of these compounds exceed water quality standards; however, the majority have no standards at all (Barber et al., 2006). Among the most commonly detected pharmaceuticals include: synthetic hormones, antibiotics, blood-lipid regulators, acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs), beta-blockers, antidepressants, and antiepileptics (Kreisberg, 2007). Because WWTPs introduce the majority of pharmaceuticals into the waterways daily, they are considered the major point-sources of contamination (Thomas & Foster, 2005). The removal efficiencies of WWTPs vary widely, averaging 60% removal of total drugs in the wastewater stream (Kreisberg, 2007). More recent studies conducted on the fate of pharmaceuticals in WWTPs found that the majority of these compounds have the potential for removal during some secondary treatment processes (Thomas & Foster, 2005).

Some scientists believe that pharmaceuticals in the environment do not pose notable problems to humans because of their presence in low concentrations (ng/L or ppt). In contrast, other scientists are concerned with the potential long-term and synergistic effects to both humans and aquatic organisms (UA, 2000). Pharmaceuticals are different than conventional pollutants because their active ingredients have been specifically designed to elicit biological responses at very small concentrations (Lishman et al., 2006). The concern is not generally focused on individual pharmaceuticals; it is the complex combinations of multiple pharmaceuticals in the environment that are of greatest concern (Kreisberg, 2006). Even though no known adverse health effects to humans can presently be attributed to pharmaceutical consumption from drinking water supplies at low concentrations, based on the precautionary principle, their presence and potential effects should not be ignored. Although little is known about human effects, many adverse effects in aquatic organisms have been directly linked to environmental exposure to pharmaceuticals.

A recent study conducted by Schultz et al. (2010), looked at the presence of antidepressants in 2 U.S. streams- Boulder Creek, CO and Fourmile Creek, IA. Of the 10 commonly found antidepressants that were measured, 8 were detected in the brain tissue of native white suckers (Catostomus commersoni). This study was able to clearly demonstrate the ease with which pharmaceuticals are taken up from an organism’s surrounding environment. In another recent study conducted by Vajda et al. (2008), reproductive disruption was found in fish living downstream from WWTPs releasing estrogen-containing effluents. Estrogen exposure was linked to gonadal intersex, altered sex ratios, reduced gonad size, disrupted ovarian and testicular development, and vitellogen (egg yolk protein) production only in the fish living downstream of the WWTP (Vajda et al., 2008). Currently the FDA only regulates pharmaceuticals for acute health effects, disregarding potential chronic effects to humans. In reality, it would take a significant amount of estrogen to kill a male fish; however, only a small concentration is needed to induce feminization in a male fish (Pringle, 2008). By extrapolating from this information, it is difficult to argue that there are no potential risks to humans from daily exposure to environmental pharmaceuticals.

A more dynamic watershed approach is needed to combat the pharmaceutical dumping in our waterways ( Evaluating the flux of pharmaceuticals through watersheds is challenging and makes it difficult to estimate the human risks associated with exposure. Many factors influence the amount and behavior of pharmaceuticals in the environment, including: amount of rainfall, land usage, wastewater discharge, hydraulic residence time, temperature, sunlight, pH, and biota present (Barber et al., 2006). Researcher Christian Daughton believes a solution for pharmaceutical pollution can be met not through a prescription regulatory program, but through a proactive and voluntary stewardship program. For more information on Daughton’s “cradle-to-cradle stewardship” initiative, visit

As of 2008, the EPA has begun actively pursuing the issues surrounding pharmaceuticals in our water. A four-pronged strategy was developed with the intention of improving science, improving public understanding, identifying partnership/stewardship opportunities, and potentially taking regulatory action ( In addition, the EPA is considering passing the first national standard for drug waste disposal aimed at the medical industry. The “Unused Pharmaceutical Safe Disposal Act of 2009” proposes legislation directing the Board of Pharmacy to: 1) design a public education campaign about unused pharmaceuticals to be implemented by retail pharmacies, 2) make recommendations to the mayors for the establishment of an unused pharmaceutical disposal program for consumers, and 3) implement a mail-in pharmaceutical return program if agreed upon by the mayors (Bill 18-239). If passed, this act would both prohibit the disposal of any pharmaceutical product via public sewer systems by health care facilities and impose civil fines for noncompliant facilities.

For additional information, visit:

Special guest author Katie Clingan is a graduate student at UAB’s School of Public Health pursuing an MPH in environmental toxicology. Katie volunteers for Black Warrior Riverkeeper as a Public Health intern (Summer 2010). At Birmingham-Southern College, Katie completed her undergraduate senior research thesis on the presence of estrogen compounds in the Cahaba River.

A special thanks to both Dr. Scot Duncan & Dr. Rob Angus for their editorial assistance on this pharmaceuticals webpage.


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