Pharmaceuticals and Personal Care Products in the Environment:  What We Know and What We Need to Know

Traces of pharmaceuticals and personal care products (PPCPs) have been found in municipal wastewater, surface waters, groundwater and consequently drinking water.  They are known to enter the environment when eliminated through human excretion, or when washed off our skin, and when unused quantities are disposed of down the drain or in the garbage. In addition, pharmaceutical drugs excreted by farm animals can enter surface waters when manure is applied to land.

PPCPs in Water

Detection of PPCPs in water dates back to studies in the late 1970s when compounds like clofibric acid (a cholesterol-lowering drug) and salicylic acid (a metabolite of aspirin) were found in municipal sewage treatment effluent in the USA. It was not until the late 1990s, however, that a series of studies in Europe and the USA pointed to the widespread occurrence of PPCPs in sewage treatment effluents, surface waters and the North Sea.

Results from more recent studies in Canada tell the same story. Environment Canada researchers and their partners have found traces of acidic and neutral pharmaceuticals (i.e., analgesics, anti-inflammatory drugs, blood lipid regulators), birth control hormones, antibiotics, musk fragrances and antimicrobials in Canadian municipal treatment plant effluents, surface waters and drinking water. Many veterinary medicines and animal care products have been detected in agricultural watersheds.

Thanks to advances in detection and analytical methods and the expansion of monitoring programs, more light has been shed on environmental exposure to these chemicals. A key area of focus is determining the extent to which PPCPs in the environment may affect natural ecosystems and humans.

Ecological and Health Impacts

Although documented concentrations in water systems are very low (ranging from 1 ng/L or part per trillion to 1 µg/L or part per billion), continuous release of medical drugs and other compounds may have a variety of effects on non-target organisms.

Environment Canada researchers, in collaboration with other governments and academia, conduct laboratory and field studies to measure levels of PPCPs and their impact in aquatic organisms. Such impacts are measured based on identified biomarkers: for example, ecologically relevant biomarkers (those that help identify/predict physiological changes in individuals and populations), or drug-target specific biomarkers (those that measure the integrity of drug targets within an organism likely to impede the organism’s health and reproduction). Research results generally indicate that acute or short-term lethal effects are not likely to occur in the environment but that chronic or long-term effects are possible due to continuous exposure to some of these chemicals.

Low levels of PPCPs can accumulate in biological tissues of certain aquatic organisms and adversely affect their growth and reproduction. For instance, fathead minnows exposed in the laboratory to the mix of PPCPs found in Ontario municipal wastewater effluent over their lifecycle displayed a decrease in egg production and decreases in male sex characteristics. Exposure to low levels (less than 1 ng/L) of birth control pill estrogens can reduce the ability of male fish to successfully fertilize eggs.

The way that persistent pharmaceuticals can bioaccumulate and bioamplify in aquatic organisms through the food chain is also of interest. For instance, carbamazepine is transformed in invertebrates (mussels and Hydra) without producing significant oxidative stress leading to DNA damage. However, the same drug was shown to readily accumulate in algae and effectively transfer to a feeding microcrustacean, leading to toxic effects.

A growing concern for public health is the spread of antibiotic-resistant bacteria in water sources. Studies show that enteric bacteria (e.g., E. coli) from municipal wastewater sources are more resistant to antibiotics than those from pet or wildlife fecal matter. Increased resistance due to the intake of antibiotics means these drugs may no longer work to treat infectious diseases contracted through water use such as irrigation, recreation and consumption.

Options for Reducing Exposure

Information on the fate, distribution and effects of PPCPs is essential for determining the potential risk to Canadians and their environment over time, and for developing options for reducing such risk. Risk assessments are conducted jointly by Health Canada and Environment Canada under the Canadian Environmental Protection Act, 1999 (CEPA 1999). Cosmetic ingredients and pharmaceuticals make up the majority of substances notified under CEPA’s New Substance Notification Regulations.

Because people will continue to need their essential medications it is not realistic to expect a reduction in their use; however, other options are available for reducing their release into the environment.

Wastewater treatment plants are a major potential point source for PPCPs entering the aquatic environment and a major opportunity for centralized removal. Environment Canada, the Ontario Ministry of the Environment and several academics are studying how conventional and advanced wastewater treatment technologies can be modified/applied to reduce PPCPs in wastewater effluent. Research shows technologies such as ozonation, activated carbon, and tight membrane filtration to be effective; however, implementing them is costly and may not be warranted until we determine which specific PPCPs cause biological effects in Canadian environments and should be removed from effluents. These advanced technologies are already used in the treatment of drinking water to control taste and odour.

Wastewater treatment processes could also be made more efficient by sorting or regulating the amount and type of waste entering the facility. Treating industrial, nursing home and hospital wastewaters before discharge and/or regulating the composition of wastewaters entering the sewers through sewer use by-laws are some examples.

Another source of PPCPs into aquatic ecosystems is biosolids applied to agricultural land as a means of recycling nutrients and organic matter. Knowledge is still limited on the fate and transport of PPCPs in land application but research is underway on better management practices to minimize transport of biosolids during and in between applications.

Another line of attack is to prevent PPCPs from entering the wastewater stream in the first place. Increasing public awareness through ecolabelling and education, offering take-back and safe drug disposal programs, and promoting the use of alternate therapeutic choices and general health care are practices now being considered in Canada and around the world. Prudent use of veterinary drugs in agriculture, particularly antibiotics, would also minimize their release into the environment. Finally, extended producer responsibility or the life cycle management of a product can induce a shift to environmentally friendly products.

Need to Learn More

The state of knowledge on PPCPs in Canada has improved substantially in recent years. Still, many questions remain unanswered and targeted science is needed to inform decisions that will protect our health and our environment. This is the collective message of a group of scientists and regulators from across Canada who recently gathered to assess the current state of Canada’s research and to recommend research and policy directions on this emerging issue (see Pharmaceuticals and Personal Care Products in the Canadian Environment: Research and Policy Directions for more information). Key recommendations include:

• Continue research and monitoring that will help quantify major sources of PPCPs to the environment and their environmental concentrations and effects.
• Assess ecosystem vulnerability through long-term effects monitoring and whole-ecosystem studies in locations where the most serious impacts have been observed or are likely to be observed. 
• Investigate the combined effect of PPCPs at the population and ecosystem levels, while continuing to study the characteristics and effects of individual PPCPs and mixtures of these compounds.
• Develop a monitoring network to address the above needs, a specialized national inventory of research and monitoring information and activities, and a consistent framework for chemical analysis of PPCP concentrations.
• Identify and determine the cost-effectiveness of source control programs and treatment technologies.
• Enhance communication among researchers and science users such as risk assessors, regulators and wastewater managers.

Through carefully planned research and monitoring programs, information gaps can be filled and a more complete picture of the impacts of these chemicals in our aquatic environment will emerge--as will the path to prevention.