Tracking the Issue of Pharmaceuticals and
Personal Care Products (PPCPs) in the
Environment
Brandon Kernen
New Hampshire Department of Environmental Services
Brandon.Kernen@des.nh.gov
271-0660
Emerging Substances of Concern
• Global Organic Contaminants
• Pharmaceuticals and Personal Care
Products
• Endocrine Modulating Chemicals
• Nanoparticles
• Industrial Chemicals (new and recently
recognized)
Pharmaceuticals and Personal Care
Products (PPCPs)
 Includes prescription and over-the-counter (OTC)
medications, cleaning agents, cosmetics, nutritional
supplements, & skin care products
 Produced and used in larger volumes yearly
 Released via small quantity generators
 Biologically active
 Commercial labs cannot analyze
PPCPs in the Environment
• DES has been tracking and assessing this
issue for several years
• Recent headlines regarding
pharmaceuticals in drinking water confirm
the importance of our efforts and focus on
this emerging issue
PPCPs – DES Program Interest
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Drinking Water
Wastewater - Surface Water Discharges
Wastewater - Groundwater Discharges
Watershed Management – Ecological Impacts
Residuals Management
Solid Waste Management
Air – Incineration of Solid Waste
Household Hazardous Waste Management
Hazardous Waste Management
Environmental Health Program
NHDES Interests in PPCPs
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Assessing Occurrence (overcoming analytical lab issues)
Fate & Transport
Human Health/Ecological Health
Source Characterization (individual use & disposal,
vet/livestock, manufacturing)
Treatment (wastewater/drinking water)
Pollution Prevention (green chemistry, life cycle analysis, take
back programs, public education, behavior modification)
Risk Communication/Perspective
Public Education
Policy/Regulation (fed/state reg, policy, liability, nonreg)
1999-2002
1988-1994
65 years and
over
all ages
Percent of persons reporting prescription drug use in the past month
by age
1999-2002
45-64 years
1999-2002
18-44 years
1999-2002
under 18
years
1988-1994
1999-2002
1988-1994
1988-1994
1988-1994
0
10
20
30
40
50
one or two prescribed drugs
60
70
80
90
three or more prescribed drugs
Source: U.S. Center for Disease Control and Prevention. National Center for Health
Statistics. National Health and Nutrition Examination Survey.
100
Medicine Use in NH
• In 2006, fifteen millions prescriptions
were filled in New Hampshire
• 2 out of 3 people that visit a doctor
leave with a prescription
Source: New Hampshire Board of Pharmacy
NH Drug Deaths
Source: Dr. Andrews, Chief Medical Examiner for NH, 2007 PowerPoint Presentation
Drug Deaths 2000-2007 By Manner
Source: Dr. Andrews, Chief Medical Examiner for NH, 2007 PowerPoint Presentation
Reducing pharmaceuticals in the
environment would require changes in:
1) When and how medicine is prescribed and
used;
2) How pharmaceuticals are designed and
engineered so they do not persist once
released in the environment;
3) Wastewater and drinking water treatment
technologies; and
4) How unused medicines are disposed of.
Medicines in the Environment
2008 AP Study
• 28 of 35 drinking water systems in the US had
detectable levels of pharmaceuticals
U.S. Geological Survey Monitoring Study
• 139 streams analyzed in 30 states
• Contaminants identified in 80% of these streams
• 82 contaminants identified (many were
pharmaceuticals)
• Co-occurrence common; average 7 distinct
contaminants identified per stream
Kolpin, D.W. et al. 2002. “Pharmaceuticals, hormones, & other organic
wastewater contaminants in U.S. streams, 1999-2000: A national
reconnaissance.” Environmental Science & Technology. 36(6):1202-1211.
Effects on Aquatic Organisms:
Cause for Concern
 Aquatic exposure – chemicals in the aquatic
environment can result in continuous,
multigeneration exposure.
 Feminization of fish - link to estrogen exposure?
Ex: Boulder Creek, CO: female white suckers outnumber males
by > 5 to 1; 50% of males have female sex tissue
(David Norris, Univ. of Colorado at Boulder)
 Effects of antidepressants on fish and frog
development?
Ex: Lab studies show low levels of common anti-depressants,
including Prozac, Zoloft, Paxil and Celexa, cause development
problems in fish, and metamorphosis delays in frogs
(Marsha Black, Univ. of Georgia)
Top 11 Compounds in Drinking Water
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Atenolol
Atrazine
Carbamazepine
Estrone
Gemfibrozil
Meprobamate
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Naproxen
Phenytoin
Sulfamethoxazole
TCEP
Trimethoprim
Ongoing Studies in NH
• Fish Tissue and Water in the Merrimack River
(EPA)
• PPCP loading in the Merrimack River
Watershed (UNH)
• Squam Lake Association/Squam Lake
• Wastewater at a County Nursing
Home/Prison
• Water pre and post treatment from a reservoir
• Seeking funding to assess leachfield sites at
nursing homes
Squam Lake Association/NHDES Lab
Target Analytes
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Acetaminophen
Caffeine
Trimethoprim
Carbamazapine
EPA Analytical Methods
• 1694 Pharmaceuticals and Personal Care
Products in Water, Soil, Sediment, and
Biosolids by HPLC/MS/MS
• 1698 Steroids and Hormones in Water,
Soil, Sediment, and Biosolids by
HRGC/HRMS
Other Analytical Methods
Thoroughly summarized in:
“State of Knowledge of Endocrine Disruptors
and Pharmaceuticals in Drinking Water”
AWWA Research Foundation, 2008
Assessment of Medicine Disposal Options
White Paper Developed by DES
Summarizes
• Medicine use trends in the United States;
• Legal issues affecting how unused medicines may be
collected and disposed;
• Potential health and environmental issues associated
with releasing medicines to solid waste facilities and
wastewater disposal systems;
• Typical unused residential medicine disposal and
reuse practices in New Hampshire; and
• Options for managing unused medicines in New
Hampshire.
Expired Medication Disposal Habits
500 patients surveyed:
 54% disposed of
medications in the trash
Used All Prior
to Expiration
Returned to
Pharmacy
Did Not
Dispose
 35.4% flushed drugs down
the toilet or sink
 7.2% did not dispose of
medications
Flushed
Trashed
 2% used all medication prior
to expiration
 1.4% returned medications
to the pharmacy
Boehringer, S. “What’s the Best Way to Dispose of Medications?” (2004)
Unused Medicine Collection Events
• Require extensive planning to address
controlled substance, hazardous waste
and disposal requirements
• Need financial resources for pharmacists,
hazardous waste specialists and disposal
• NHDES recommended SOP available
• A guidance document is available from
Northeast Recycling Center.
DES Medicine Disposal Policies
Developed to Date
• Residential disposal policy developed
working with a workgroup of 80+
stakeholders
• Medicine collection and disposal SOP
• Draft medicine disposal policies for school
nurses
• Draft medicine disposal policies for
hospice
DES Medicine Disposal Policies
that Need to Be Developed
• Non hazardous and non controlled
substances in hospitals & institutions
• Physician offices
• Veterinarian
• Nursing homes
NH’s Household Medicine Disposal
Message
Help Prevent Pollution, Poisonings and Drug Abuse!
Dispose of your Unneeded Medication
6 Steps to Safety
1) Pour medicine into a sealable plastic bag.
2) If the medicine is a solid, add a small amount of water to dissolve it.
3) Add any undesirable substance (such as dirt, coffee grounds or
kitty litter) to the liquid medicine in the plastic bag.
4) Seal the bag and immediately dispose of it in the trash for regular
pick-up.
5) Use marker to black out any personal contact information on the
empty medicine container prior to disposing of it in the trash.
6) For more information, consult www.nh.gov/medsafety.
Do NOT flush medicine down the toilet unless accompanying product
information instructs that it is safe to do so. Don't keep unneeded
medications in the home.
For more information or in case of an accidental poisoning, call the
poison center at 1-800-222-1222.
Medicine Disposal as Solid Waste
• Addresses environmental, drug abuse and drug
poisoning concerns
• Solid Waste in NH
– 15% Incinerated
– 85% in Landfills (almost all landfills are lined and capped)
• Most medicine disposed of in a landfill will be
retained by solids or break down through chemical
processes
• Leachate at lined landfills is collected and can be
treated.
• Solid waste disposal is readily available to
households.
Marketing of the Residential
Disposal Message
• New state website (www.nh.gov/medsafety)
• News articles will be published by various
organizations
• Letters will be sent to licensed health care
workers, municipal officials and solid waste
officials
• Posters will be made available to interested
organizations
2009 International Symposium on
Pharmaceuticals in the Home and
Environment
October 18-20, 2009
Northport, Maine
http://www.mainebenzo.org/