What are Pharmaceutical & Personal Care Products(PPCPs)?

Modern society uses products that contain various chemicals for a wide variety of personal health and hygiene uses, including preventing and combating disease, alleviating symptoms from illness and injury, personal comfort, grooming and cosmetic purposes. Pharmaceutical and Personal Care Products (PPCPs) include medicines, insect repellents, sunscreens, perfumes, soaps, fragrances, and lotions. These products, which can be found in any drug store, have the potential to enter the environment through domestic sewage and other sources. Some are endocrine disrupting compounds (or EDCs) and could possibly affect the system of glands that produces hormones that help control the body's metabolic activity and development. The following are some examples of PPCPs:

Over the Counter (OTC) Pharmaceuticals

  • Aspirin
  • Acetaminophen (Tylenol)
  • Antihistamines (Benadryl, etc.)
  • Ibuprofen

Prescription Pharmaceuticals

  • Pain medications (Codeine, Vicodin, Percodan)
  • Blood Pressure medications
  • Heart medications
  • Antibiotics

Personal Care Products

  • Lotions and creams
  • Fragrances (perfumes)
  • Sunscreens
  • Cosmetics
  • Insect repellants (DEET)

What are Endocrine Disrupting Compounds (EDCs)?

When endocrine disrupting compounds (EDCs) are released into the environment, they have the potential to interfere with the normal function of the endocrine systems of living organisms that come into contact with them. The endocrine system is a complex network of glands and hormones that regulates many essential biological functions and processes in living systems including growth, development, maturation, reproduction, and metabolism in animals, including people. The endocrine glands - including the pituitary, thyroid, adrenal, thymus, pancreas, ovary and testis - release carefully-controlled amounts of hormones into the bloodstream that act as natural chemical messengers, traveling to different parts of the body in order to control and adjust many life functions.

More than 900 chemicals are considered to be EDCs(1). The following are some common examples:

Compound: Estradiol
Function/Source: Naturally occurring hormone

Compound: Testosterone
Function/Source: Naturally occurring hormone

Compound: 17 b  estradiol
Function/Source: Naturally occurring hormone

Compound: Perchlorate
Function/Source: Military and industrial compound, naturally occurring (e.g., fertilizers from Chile)

Compound: DDT (Dichloro - Diphenyl - Trichloroethane)
Function/Source: Insecticide

Compound: DES (Diethylstilbestrol)
Function/Source: Veterinary prescriptions, advanced breast and prostate cancer, once used to prevent miscarriages

Compound: PCBs (Polychlorinated byphenyl)/Dioxins
Function/Source: Industrial compounds/combustion byproduct

Are PPCPs & EDCs considered an "emerging" environmental concern?

Yes, some of them are - even though many of these compounds have been used by people or prescribed by physicians for many years. The presence of these chemicals in the environment has come to the attention of scientists only recently because the laboratory equipment and methods used to detect them have become more sensitive. MassDEP defines emerging contaminants as:

  • a perceived or real threat to human health, public safety or the environment;
  • no published health standards or guidelines;
  • insufficient or limited available toxicological information or toxicity information that is evolving or being re-evaluated; or,
  • significant new source, pathway, or detection limit information.

Pharmaceuticals and Personal Care Products provided by U.S. Environmental Protection Agency Office of Research and Development, National Exposure Research Laboratory, Environmental Sciences Division, Environmental Chemistry Branch: Origins and Fate of PPCPs in the Environment pdf format of Origins and Fate of PPCPs in the Environment

What is MassDEP doing to evaluate PPCPs & EDCs?

MassDEP has a multi-component approach for identifying potential risks of PPCPs and EDCs to human health and the environment. This multi-component approach relies on three guiding principles:

  1. A commitment to be diligent in addressing PPCPs and EDCs,
  2. Developing and implementing a process to identify and screen emerging contaminants, including those that are PPCPs and EDCs to determine those that MassDEP should maintain an awareness of and/or actively address, and
  3. A commitment to inform all interested parties in a timely and complete manner about the progress of the efforts being undertaken.

MassDEP has taken the following steps to begin addressing emerging contaminants, including PPCPs and EDCs:

  • Established an Emerging Contaminants Work Group. The Work Group centralizes MassDEP's focus on emerging contaminants, fosters information exchange, and brings together a broad range of cross-program expertise.
  • Initiated a collaborative research project with UMass (Amherst),  AECOM and the American Water Works Association Research Foundation on the effects of different treatment technologies on removing PPCPs and EDCs in source water from public water supplies. Researchers at UMass are introducing individual PPCPs and EDCs into samples of source waters and then treating the water with ozone, chlorine, or chloramines, which are chemicals typically used to disinfect public water supplies. Levels of the PPCPs and EDCs before and after treatment are being assessed. The research team is using bioassay techniques to assess endocrine disruptve activity. Any community or utility in Massachusetts or any other state can participate in this project by contributing funding at one of three levels: Gold ($12,000), Silver ($6,000) or Bronze ($3,000). Participating communities and utilities will receive analytical results from their raw and finished water samples, as well as information on the effectiveness of additional treatment on the finished water.
  •  MassDEP is also supporting a national research project sponsored by the U.S. Geological Survey (USGS), which targeted water samples in the Merrimack River. In this study, USGS took raw water samples from the Merrimack and scanned the samples for hundreds of different PPCPs. The study also tracked PPCPs to determine their fate through the drinking water treatment process. Results from the USGS study will be available in summer 2010 and results will be published on MassDEP's web site.
  • Initiated discussions with state partners on pollution prevention programs. MassDEP is partnering with the Massachusetts Department of Public Health, the Massachusetts Water Resources Authority, and the Executive Office of Energy and Environmental Affairs to determine the best strategies to keep PPCPs and EDCs out of the environment.
  • Remains committed to involving key stakeholders including the public. In June 2008, MassDEP convened a summit of key stakeholders to facilitate the sharing of information among the private sector, government, and the public. In September 2009, MassDEP convened a forum to facilitate a discussion on the issue of PPCPs in wastewater that included wastewater treatment plants and underground septic systems. The overall goal of the forum was to identify data and research gaps that still need to be filled, and how EPA and other federal agencies can fill those gaps at the national level.

Which PPCPs or EDCs are of greatest concern?

In general, any environmental contaminant that has been shown to be or is likely to be biologically or chemically active at low concentrations is more likely to present a higher risk. MassDEP is particularly concerned about chemicals that have an impact on children's health. In 2006, Massachusetts was the first state in the nation to promulgate drinking water and cleanup standards for perchlorate - a known EDC - after it was detected in several drinking water supplies. MassDEP initiated derivation of these standards because recent scientific research showed that perchlorate , a chemical found in military munitions, blasting agents, and fireworks, could threaten human health at low concentrations by affecting thyroid hormone function, especially that of infants. Under Massachusetts' protective perchlorate drinking water standard regulation, every community and non-transient, non-community public water supply must test for it routinely.

The scientific community continues to collect data and conduct research on the human health risks posed by various PPCPs and EDCs. According to EPA, "there are no known human health effects from low-level exposures in drinking water, but special scenarios (one example being fetal exposure to low levels of medications that a mother would ordinarily be avoiding) require more investigation."(2) According to the American Water Works Association, given that even trace concentrations of PPCPs and EDCs may affect human health, and given these compounds' ubiquity, the observed effect on fish and amphibians, and their continued presence of some compounds after wastewater treatment processes, the consensus in the drinking water community is that they deserve close study and, possibly, mitigation efforts.(3)

Recent research has documented the adverse effects on aquatic species and other wildlife. There are numerous studies(4, 5, 6) indicating that alterations in fish gender (i.e., "feminization" of males) and reproductive success may be associated with exposures to PPCPs and EDCs. Aquatic organisms are more likely to be affected by these compounds because they have:

  • continual exposures
  • multi-generational exposures
  • exposure to higher concentrations of PPCPs and EDCs in untreated water

Presently, scientists are collecting more aquatic and terrestrial toxicology data to evaluate PPCPs and EDCs. Several scientific studies have been published on the endocrine disrupting effects of  insecticides and pesticides. For example, brief exposure of salmon to 1 parts per billion of the insecticide and endocrine disruptor, diazinon, is known to alter homing behavior (with implications for predation, feeding, and reproductive success). EPA is concerned that low doses of other PPCPs and EDCs may also have aquatic effects.

Are there PPCPs & EDCs in my water and if so, do they pose a risk to my health?

The U.S. Geologic Survey(7, 8) reported that PPCPs such as steroids, prescription and nonprescription drugs, antibiotics, hormones, and fragrances have been detected in water samples collected from surface waters considered susceptible to contamination from various wastewater sources, such as those downstream from intense urbanization or livestock (for more information, visit http://toxics.usgs.gov/regional/emc/index.html). To the extent that water from these sources is eventually consumed by humans, and PPCPs or EDCs are not completely removed by water treatment, there could be low amounts of these substances in some drinking water supplies. Although the concentrations of PPCPs and EDCs in drinking water supplies are at levels far below therapeutic doses, the potential effects from continuous low dose chronic exposure to these compounds in humans have not been well studied. An additional concern regarding human health is whether exposure to PPCPs and EDCs is increasing antibiotic resistance in pathogens. If your drinking water is a part of the Massachusetts Water Resource Authority (MWRA) service area, you can find out more by visiting their website.

Are there treatment technologies capable of removing these compounds?

At the national level, research is underway to determine how effectively existing drinking water treatment practices such as chlorination, carbon filtration, and ozonation remove PPCPs and EDCs (visit http://www.epa.gov/ppcp/work.html). The water treatment industry is developing and evaluating several promising new and innovative technologies that specifically target PPCPs and EDCs for removal. One example uses a catalyst called TAML(r) (iron plus tetra-amido macrocyclic ligand) to remove PPCPs and EDCs from wastewater. Another uses zeolite adsorption to remove PPCPs and EDCs.

Locally, MassDEP is participating in a study with the University of Massachusetts (Amherst) and AECOM to examine twelve PPCPs and EDCs to determine treatment efficiency as well as whether treatment produces potentially harmful "daughter" compounds. This study will also examine the potential of these chemicals, and any daughter products, to interfere with the endocrine system.

What can I do to help minimize my contribution to PPCPs & EDCs in the environment?

Reduce pharmaceutical and personal care waste

  • Encourage your health care provider to prescribe only the medication you need at precisely sufficient quantities to be effective.  Consider a trial prescription for new maintenance medications so you can find out if they work for you before getting a 30- or 90-day supply.
  • Buy Over the Counter (OTC) medications in quantities that can be used before the expiration date, typically two years from manufacture.

Household Solid Waste/Take Back Programs

  • Take advantage of community pharmaceutical take-back programs that allow the public to bring unused drugs to a central location for proper disposal. Some communities have pharmaceutical take-back programs or community solid-waste programs that allow the public to bring unused drugs to a central location for proper disposal. Where these exist, they are a good way to dispose of unused pharmaceuticals. Contact your local Board of Health to find out whether your municipality has such a program.
  • Take unused, unneeded, or expired prescription drugs out of their original containers and throw them in the trash. If possible, make the medicines as unrecognizable and unpalatable as possible to discourage accidental or intentional misuse. Put them in impermeable, non-descript containers, such as empty cans or sealable bags.

Disposal in domestic sewer (flushing)

  • Do not flush drugs down the toilet unless the label or accompanying patient information specifically instructs doing so. Many drugs are not degraded by the wastewater treatment process or in a septic system, and, consequently, are released into the environment.
  • The exception to this rule are the medications that the Food and Drug Administration (FDA) advises to be flushed down the toilet instead of thrown in the trash because of their high abuse potential. These medicines include:

Actiq (fentanyl citrate)
Daytrana Transdermal Patch (methylphenidate)
Duragesic Transdermal System (fentanyl)
OxyContin Tablets (oxycodone)
Avinza Capsules (morphine sulfate)
Baraclude Tablets (entecavir)
Reyataz Capsules (atazanavir sulfate)
Tequin Tablets (gatifloxacin)
Zerit for Oral Solution (stavudine)
Meperidine HCl Tablets
Percocet (Oxycodone and Acetaminophen)
Xyrem (Sodium Oxybate)
Fentora (fentanyl buccal tablet)

Visit http://www.whitehouse.gov/ondcp for more information.

The 2007 report Investigating Emergent Contaminants - Pharmaceutical Impacts and Possible Solutions prepared by Leah Bowe as part of a research project funded by the Rappaport Institute for Greater Boston, Kennedy School of Government, Harvard University:
Report on Investigating Emergent Contaminants: Pharmaceutical Impacts & Possible Solutions - 2007 pdf format of 2007 Report: Investigating Emergent Contaminants
doc format of 2007 Report: Investigating Emergent Contaminants

Where can I get more information about PPCPs & EDCs?

For More Information:

There are many resources to help you learn more about the various aspects of pharmaceuticals in the environment.

General

EPA's information and approach on PPCPs and EDCs in the environment. 
PPCPs: http://www.epa.gov/ppcp/
Endocrine disruptors:
http://www.epa.gov/endo/

California's efforts on addressing PPCPs and EDCs.
http://www.dtsc.ca.gov/AssessingRisk/PPCP/index.cfm

The Northeast Waste Management Officials Association's (NEWMOA) efforts on addressing PPCPs and EDCs.
http://www.newmoa.org/prevention/chemicalspolicy/workshops/pharmaceuticals.cfm

Occurrence

Summarizes the results of the USGS River and Stream study.
http://pubs.acs.org/doi/abs/10.1021/es011055j

Water-quality data collected during 1999 and 2000 as part of the first nationwide reconnaissance of the occurrence of pharmaceuticals, hormones, and other organic wastewater contaminants.
http://toxics.usgs.gov/pubs/OFR-02-94/

Results of a study conducted by USGS, in cooperation with the Massachusetts Department of Environmental Protection, to determine the occurrence of 14 commonly used human-health pharmaceutical compounds and fecal-indicator bacteria in Merrimack River water used a drinking water source.
http://pubs.usgs.gov/sir/2011/5192/

Human and Ecological Health Effects

Information about EPA's Endocrine Disruptor Screening Program and the agency's approach for screening and testing chemicals for potential endocrine effects.
http://www.epa.gov/endo/

Environmental Fate

An overview of the USGS Emerging Contaminants Project
http://toxics.usgs.gov/regional/emc/index.html

Results of Sweden's environmental assessment of a selected sample of drug compounds.
http://www.janusinfo.org/imcms/GetDoc?meta_id=7238

Pharmaceutical Industry & Other Efforts to Manage Pharmaceuticals in the Environment

AstraZeneca: http://www.astrazeneca.com/Responsibility/The-environment/Pharmaceuticals-in-the-environment

EPA's PPCP Frequent Questions: http://www.epa.gov/ppcp/faq.html

References

1. Institute for Environment and Health. Chemicals Purported to be Endocrine Disruptors: A Compilation of Published Lists.. IEH Web Report W20. March 2005.

2. EPA Web Site (August 20, 2007)

3. AWWA Web Site (August 20, 2007)

4. Palace, V.P., Wautier, G., Evans, R.E., Blanchfield, P.J., Mills, K.H., Chalanchuk, S.M., Godard, D., McMaster, M.E., Tetreault, G.R., Peters, L.E., Vandenbyllaardt, L., and Kidd, K.  2006. Biochemical and Histopathological Effect in Pearl Dace (Margariscus margarita) Chronically Exposed to a Synthetic Estrogen in a Whole Lake Experiment. Environmental Toxicology and Chemistry. 25: (4) 1114 - 1125.

5. Schultz, R.I., Skillman, A., Nicolas, J.M., Cyr, D.G.,  and Nagler, J.J. 2003. Short-term Exposure to Ethynylestradiol Decreases the Fertility of Sexually Maturing Male Trout (Oncorhynchus mykiss). Environmental Toxicology and Chemistry. 22: (6) 1272 - 1280.

6. Zillioux, E.J., Johnson, I.C., Kiparissis, Y., Metcalfe, C.D., Wheat, J.V., Ward, S.G., and Liu, H.  2001. The Sheephead Minnow as an in Vivo Model for Endocrine Disruption in Marine Teleosts: A Partial Life-Cycle Test with Ethynylestradial. Environmental Toxicology and Chemistry. 20: (9) 1968 - 1978.

7. Barnes, Kimberlee, Kolpin, Dana W., Meyer, Michael T., Thurman, E. Michael, Furlong, Edward T., Zaugg, Steven D. and Barber, Larry B., U.S. Geological Survey, Water Quality Data for Pharmaceuticals, Hormones, and Other Organic Wastewater Contaminants in U.S. Streams, 1999-2000. Open-File Report 02-94, 2002.

8. Dana W. Kolpin, Edward T. Furlong, Michael T. Meyer, E. Michael Thurman, Steven D. Zaugg, Larry B. Barber, and Herbert T. Buxton. Pharmaceuticals, Hormones, and Other Organic Wastewater Contaminants in U.S. Streams, 1999-2000: A National Reconnaissance. 2002.