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Emerging Substances of Concern

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

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Emerging Substances of Concern

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  1. Tracking the Issue of Pharmaceuticals and Personal Care Products (PPCPs) in the EnvironmentBrandon KernenNew Hampshire Department of Environmental ServicesBrandon.Kernen@des.nh.gov271-0660

  2. Emerging Substances of Concern • Global Organic Contaminants • Pharmaceuticals and Personal Care Products • Endocrine Modulating Chemicals • Nanoparticles • Industrial Chemicals (new and recently recognized)

  3. 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

  4. 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

  5. PPCPs – DES Program Interest • 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

  6. NHDES Interests in PPCPs • 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)

  7. Source: U.S. Center for Disease Control and Prevention. National Center for Health Statistics. National Health and Nutrition Examination Survey.

  8. 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

  9. NH Drug Deaths Source: Dr. Andrews, Chief Medical Examiner for NH, 2007 PowerPoint Presentation

  10. Drug Deaths 2000-2007 By Manner Source: Dr. Andrews, Chief Medical Examiner for NH, 2007 PowerPoint Presentation

  11. Reducing pharmaceuticals in the environment would require changes in: • When and how medicine is prescribed and used; • How pharmaceuticals are designed and engineered so they do not persist once released in the environment; • Wastewater and drinking water treatment technologies; and • How unused medicines are disposed of.

  12. 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.

  13. 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)

  14. Atenolol Atrazine Carbamazepine Estrone Gemfibrozil Meprobamate Naproxen Phenytoin Sulfamethoxazole TCEP Trimethoprim Top 11 Compounds in Drinking Water

  15. 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

  16. Squam Lake Association/NHDES Lab Target Analytes • Acetaminophen • Caffeine • Trimethoprim • Carbamazapine

  17. 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

  18. Other Analytical Methods Thoroughly summarized in: “State of Knowledge of Endocrine Disruptors and Pharmaceuticals in Drinking Water” AWWA Research Foundation, 2008

  19. 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.

  20. Expired Medication Disposal Habits 500 patients surveyed: • 54% disposed of medications in the trash • 35.4% flushed drugs down the toilet or sink • 7.2% did not dispose of medications • 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)

  21. 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.

  22. 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

  23. DES Medicine Disposal Policies that Need to Be Developed • Non hazardous and non controlled substances in hospitals & institutions • Physician offices • Veterinarian • Nursing homes

  24. 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.

  25. 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.

  26. 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

  27. 2009 International Symposium on Pharmaceuticals in the Home and Environment October 18-20, 2009 Northport, Maine http://www.mainebenzo.org/

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