Preventing pill pollution: keeping drugs and toiletries of the environment. (Environews Science Selections).

For two decades, evidence has been growing that residues from pharmaceuticals and personal care products (PPCPs) are continually contaminating the environment. Although details of the environmental health impacts are likely to remain sketchy for some time, it's not too early to begin minimizing the potential for damage, says Christian Daughton of the U.S. Environmental Protection Agency National Exposure Research Laboratory in Las Vegas, Nevada, in a mini-monograph [EHP 111:757-774; 775-785]. Daughton hopes this first comprehensive overview of the issue will spur discussion among the many disparate players involved in PPCPs' life cycle--manufacturers, health care professionals, hazardous waste managers, drug enforcement officials, sewage treatment plant operators, water utility managers, funeral directors, veterinarians, homeland security officials, consumers, and many more. Many of these players historically have considered neither the ramifications of PPCP use nor opportunities for improvement in their production and consumption.

Daughton sets the stage for his arguments by outlining the problem, as revealed by research in the past two decades, and concluding that the myriad possible biological actions of PPCPs in air, soil, water, and groundwater are simply too complex to accurately predict. Furthermore, because some adverse health effects from PPCPs (particularly hormonally active drugs) appear to be quite possible, actions to minimize these effects should be considered. Doing so not only might reduce environmental health impacts, but also could lead to substantial cost reductions for industry and consumers, and could reduce medical problems, he says.

Daughton suggests dozens of reasonable technological, marketplace, and policy changes that could begin to steer industry, consumers, and government in a more beneficial direction. For example, he says, improved packaging could extend shelf life and reduce the amount of a product that expires and must be discarded unused. Studies could focus on improving drug absorption so that smaller doses are needed and less is excreted. And sewage overflows into storm sewers and surface waters also could be curbed. Answers to pollution from personal care products are less clear, because there has been so little research on them. But lotions, shampoos, fragrances, mouthwashes, sunscreens, and other products likely playa critical role in environmental contamination, Daughton says, because they are used in such large quantities and they readily wash off.

The pharmaceutical field also could benefit from more basic knowledge about PPCPs. For instance, basic data such as the amount of PPCPs manufactured and used is unknown, as are some of the basic facts regarding how much is metabolized, excreted, washed off, or otherwise directly disposed and leached into the environment--and possibly back into our bodies--in an altered form.

Despite such information gaps, several countries have already implemented programs that contain portions of Daughton's suggestions. Canada, Australia, France, and Italy allow consumers to return unused drugs, for instance, which reduces the load on sewage treatment systems and landfills.

If problems are to be headed off, the process should begin soon, says Daughton. He notes that the Institute of Medicine has documented a 17-year gap from the time new medical knowledge and practices are developed to the time they are widely assimiliated into practice.