Lake Erie is a vital resource to Ohio, supplying drinking water, recreational opportunities and employment to millions of people. The lake is weathering its fair share of problems, from harmful algal blooms to industrial pollution, but it also faces new potential threats to its health. One of those threats is quickly gaining more attention from scientists, and it’s also one that residents can play a large role in addressing: contamination from pharmaceutical products.
Pharmaceuticals and personal care products (PPCPs) are a collection of compounds used for medical or cosmetic purposes: everything from antibiotics and antidepressants to sunscreen and insect repellants can be included in this designation. PPCPs are considered contaminants of emerging concern, meaning their impacts on an aquatic ecosystem and its residents aren’t well studied, but early research suggests that a closer look is warranted.
Dr. Xiaozhen (Jen) Mou, associate professor of biological sciences at Kent State University, is one of the scientists working on PPCP contamination in Lake Erie waters. Together with Dr. Laura Leff, professor and chair of biological sciences at Kent State, Mou is investigating the occurrence of PPCPs in water sources and treated waters in four northeast Ohio water treatment plants.
“There’s not a lot of research on the long-term impacts of the PPCP compounds at very low concentrations,” said Mou. “We know those pharmaceutical compounds are treating diseases at pretty high concentrations, but hundreds of different compounds are all together in this pool, and we don’t know how they interact with each other.”
An additional concern is about chronic exposure to small doses of a wide range of compounds over a long period of time. “In small animals and invertebrates we do see some impacts even at very low concentrations, where some of the animals might develop tumors or behavior problems, so there’s the potential that these compounds can be a problem for humans or wildlife,” Mou explained.
For now, Mou’s work focuses on establishing a baseline of eleven common pharmaceutical and personal care compounds – mostly antibiotics, anti-seizure medications, anti-inflammatories, insect repellants and hormones such as those used in birth control – found in both source and treated waters from drinking water treatment plants.
Samples from four northeast Ohio water treatment plants show that current water treatment protocols remove a large percentage of the studied pharmaceuticals, but in most cases where a compound was present, some percentage of it remained in finished drinking water.
Mou and her team want to continue this research at more water treatment plants, and they are actively seeking funding to do so. In addition, they are trying to draw connections between antibiotics and the presence of antibiotic resistance genes in bacteria found in the water. If gene expression is connected to the levels of antibiotic contamination, they may be able to develop a relatively simple test to quickly detect very low concentrations of antibiotics in water samples.
“It’s not necessarily that we have to be panicked now, but if we can be proactive, it won’t be a problem for the future,” Mou said. “But if we ignore it and don’t try to figure out whether it’s going to be a real threat, we might feel sorry about that later.”
So How Do We Get It Out?
To help not just researchers but also the public be more conscious of PPCP contamination, and to advocate for more effective ways to reduce or prevent that contamination, social scientists pick up where the biochemists and microbiologists leave off.
Dr. Victoria Campbell-Arvai, Assistant Research Scientist at the University of Michigan, conducted online surveys and focus groups with people in Ohio’s Lake Erie watershed to gain insight into their PPCP disposal knowledge and habits. She also gathered input on what barriers people face when wanting to dispose of unused medications properly, and how those barriers should best be addressed.
Currently, information about proper disposal of unused medications is hard to find and sometimes even contradictory. While most websites start by suggesting takeback events at pharmacies or secure disposal sites like law enforcement offices, the U.S. FDA recommends flushing medications if takeback events aren’t available. The Ohio EPA , in turn, strongly encourages use of takeback events and advises against flushing.
“So right there you have contradictory messages,” Campbell-Arvai said. “In the FDA’s view, it’s better to flush potentially addictive medications like opioids than to have them fall into the wrong hands. But people in the focus groups were also asking why we’re giving this message about flushing if it’s going to end up in the Great Lakes, and you’re just kicking the problem down the road.”
Focus group participants agreed that information about proper medication disposal needed to be presented in clear, simple language, and that having to click through multiple links and web pages to get to the correct information is problematic. They also emphasized that making correct disposal options easy and convenient is essential to getting more people to participate.
While disposal events can be expensive, they’re also the best way to remove unwanted pharmaceuticals from circulation. Holding events more frequently, in more convenient locations and with better advertising would likely go a long way to increase people’s participation in proper disposal practices. Public events and the advertising they require also tend to raise awareness about the problems unwanted medications can cause, so that even if people don’t participate in any one event, they may be more likely to pay attention to, and participate in, future events.
In addition to more frequent takeback events, people in the focus groups also suggested more consistent, simplified messaging around the impacts of improper medication disposal on both human health and the environment. While people are generally aware that flushing medications isn’t a good approach, trash disposal is still common, so messaging that emphasizes the importance of returning unused medications to drop boxes or events was another common suggestion emerging from this project.
To the researcher’s surprise, however, having a favorable attitude toward the use of takeback events wasn’t strongly linked to actual participation in those events.
“In the United States, there’s pretty low behavioral compliance in terms of proper disposal practices, which basically means returning unused medications to a secure drop box or a takeback event,” Campbell-Arvai said. “But in a country like Sweden, 90 percent of citizens either intend to or have returned their unused and unwanted pharmaceuticals to a pharmacy or takeback event. So the potential is there; people will do it if provided the opportunity.”
Federal funding and logistical help from pharma companies in Sweden support holding more takeback events, but Campbell-Arvai also suspects that a big part of the puzzle are the strong social norms for proper medication disposal. Focusing on the idea that other people in the community are participating in takeback events, and drawing active connections between proper disposal methods and the health of Lake Erie, could be one way to develop those same social norms in the U.S.
“This problem can be solved,” Campbell-Arvai said. “It’s not one of those insurmountable challenges, it’s just about putting in place a system that will make it easy and obvious for people to properly dispose of their unused and unwanted pharmaceuticals.”