Water worries: drugs are turning up in drinking water and causing bizarre mutations.

From inter-sex fish in the Potomac River to frog mutations in Wisconsin, federal officials are spending this summer studying the effects of pharmaceuticals such as pain killers and depression medicine on the environment, because the drugs have turned up in America's drinking water.

The cumulative effect of trace amounts of pharmaceuticals and personal-care products in the water on humans isn't yet known, but the Environmental Protection Agency (EPA) is taking preventative measures. Pharmaceuticals have already been linked to behavioral and sexual mutations in fish, amphibians and birds, according to EPA studies.

Better sensors have revealed that trace amounts of pharmaceuticals, including narcotics, birth control, anti-depressants and other controlled substances, are in the drinking water and in U.S. rivers, lakes and streams. The growing public debate on pharmaceuticals in water will heat up this summer as experts on both sides of the issue try to convince the public that it's either much ado about nothing or another example of humans ignoring early warning signs such as deformed frogs--the amphibian considered the canary in the coal mine when it comes to water issues.

The EPA suspects that part of the problem is consumers flushing old and unwanted drugs down toilets or drains. Americans are taking more drugs than ever--especially the aging baby boomer generation. Pharmaceuticals were found in 80 percent of the samples taken during a U.S. Geological Survey and EPA study of 139 streams in 30 states. Many of America's wastewater treatment plants are not designed to remove pharmaceuticals and personal care products, the EPA says.

A 1999 (EPA and German) study of pharmaceutical and other personal-care products concluded the "undetectable effects on aquatic organisms are particularly worrisome because effects could accumulate so slowly that major change goes undetected until the cumulative level of these effects finally cascades to irreversible change---change that would otherwise be attributed to natural adaptation or ecologic succession."

Meanwhile, federal officials continue to study the human health effects of the pharmaceutical compounds found in water known as endocrine disruptors, including possible links to neurological problems in children and increased incidence of some cancers. Federal officials are investigating a wide range of fish health problems in Cheasapeake Bay and its watershed. Several studies of the Potomac and Shenandoah rivers have revealed inter-sex fish, a wide range of "abnormalities in which both male and female characteristics are present within the same fish."

The abnormalities include nine male smallmouth bass from the Potomac River near Sharpsburg, Maryland (about 60 miles upstream from Washington) that developed female eggs inside their sex organs. Inter-sex bass were also found in a study three years earlier, after fish kills about 170 miles upstream in the South Branch of the Potomac in Hardy County, West Virginia.

The suspected causes include "previously banned compounds ... such as DDT and chlordane, natural and anthropogenic hormones, herbicides, fungicides, industrial chemicals and an emerging group of compounds that may act as endocrine disruptors," according to a 2006 summary of the various studies prepared by the U.S. Geological Survey. Other studies have linked endocrine disruptors to possible cancer in humans.

A recent survey of "cancer in Hardy County, where some residents get drinking water from the South Branch, found rates of cancer of the liver, gallbladder, ovaries and uterus that were higher than the state average" according to the Washington Post.

Officials are investigating whether there is a link between the increased cancer rates, river water and altered fish including the possible connection to wastewater discharges containing trace pharmaceuticals. This is disconcerting to residents of metro Washington, D.C., because the Potomac River is the main source (75 percent) of drinking water for 3.6 million residents, including the Maryland and Virginia suburbs.

Regulatory issues won't be tackled for years to come, but the EPA isn't waiting for more study results before taking action. The EPA is educating the public and funding pharmaceutical programs by concerned groups and state and local government agencies.

In the short term, numerous grassroots and government pharmaceutical collection projects have sprung up worldwide from police stations to pharmacies to church parking lots.

One of the larger efforts was held in April in northern Michigan. A coalition called the Earth Keepers opened 19 free drop-off sites over a 400-square-mile area, geographically the largest one-day pharmaceutical collection in U.S. history. Funded by the EPA, Thrivent Financial and others, the faith-based collection involved 400 volunteers from more than 140 churches and temples, university students, an American Indian tribe and two nonprofit environmental groups.

The nonprofit Superior Watershed Partnership arranged the technical side of the collection including law enforcement officers and pharmacists at all collection sites because of strictly enforced federal laws governing controlled substances with potential for abuse like narcotic pain medicine.

"The Earth Keeper network is one of the most effective tools for addressing Great Lakes pollution," said Carl Lindquist, director of the Superior Watershed Partnership. "The pharmaceutical collection was a proactive approach to a serious environmental issue that is just getting national attention."

The U.S. Fish and Wildlife Service and the American Pharmacists Association recently launched "SMARxT DisPOSAL" a public education project about pharmaceuticals and fish that includes a traveling awareness show, brochures and a website for consumers and health professionals. The campaign will visit select U.S. cities this fall and be expanded in 2008.

Studies show that pharmaceuticals in the environment break down fairly quickly but get replenished at an alarming rate because of increased American drug use. America's huge healthcare network is addressing the problem of improperly disposed pharmaceuticals by education and "green chemistry"--encouraging drug companies to develop medications that break down more quickly.

Hospitals for a Healthy Environment (H2E) held a pharmaceutical waste management summit in May for its members including 1,600 hospitals that run 4,000 clinics and long-term care facilities. Hazardous chemical incinerators are used by many hospitals to dispose of unused pharmaceuticals. Industry experts say these incinerators have scrubbers and are closely monitored, yet incineration of medical waste "is highly problematic" and other solutions are needed.

"Incinerators are not the solution, but we knew we had to get pharmaceuticals out of sewers because waste water treatment plants are not capturing it," says Laura Brannen, H2E executive director. Green chemistry and a careful reduction in the amount of pharmaceuticals used by hospitals are among the "lifecycle approach" to solutions that Brannen supports.

Hazardous chemical waste management is heavily regulated, but pharmaceutical cleanup hasn't kept pace, according to H2E. "The current EPA regulations were designed to handle 55 gallon drums of chemicals out of industries," Brannen says. "The EPA needs to reassess their regulations ... they [haven't] updated the list of hazardous chemicals in pharmaceuticals in over 20 years. We must address the source--using less and making what we do use as environmentally preferable as possible. If we are only dealing with the pharmaceutical waste at the back door we are going to be buried."

In communities without pharmaceutical collection programs, the EPA is also concerned about diversion--unused drugs being stolen out of trash cans. They recommend crushing pills or capsules and mixing the drugs with cat litter or coffee grounds. The recreational use of prescription medicines is now the second worst drug problem facing American teenagers, according to the White House Office of National Dug Control Policy.

The White House says 6.4 million Americans admit abusing prescription drugs and most say they got the pharmaceuticals from friends or relatives. Pharmaceutical collections are one of several tools being used to reduce the problem by 15 percent over three years.

"While EPA continues to research the effects of pharmaceuticals in water sources, one thing is clear: improper drug disposal is a prescription for environmental and societal concern," says EPA Administrator Stephen L. Johnson. "Following these new guidelines will protect our nation's waterways and keep pharmaceuticals out of the hands of potential abusers."

CONTACTS: Hospitals for a Healthy Environment, [phone], www.h2e -online.org; EPA Endocrine Disruption Studies, www.epa.gov/endocrine; Earth Keepers, [phone], www.superiorwatersheds.org; Proper Pharmaceutical Disposal, Office of National Drug Control Policy, www.ondcp.gov/drugfact/factsht/ proper_disposal.html.