Study Traces PPCP Problem To Households

Lots of drug use happens at home, not just at hospitals, a new study suggests.

That distinction matters for the water sector because drugs work their way through the digestive tract and into wastewater. Wastewater treatment processes are not always adequate for removing pharmaceuticals from the supply, which means the drugs wind up back in environmental waters. The pattern has policymakers watching this issue closely. It could ultimately lead to new regulations for utilities.

So, where are all the drugs coming from before they wind up in the sewage system? A new study from researchers at Leuphana University published in the journal Environment International examines this question.

It turns out households are the top source of pharmaceuticals in wastewater, the study says. By comparison, health facilities, including hospitals, are meager contributors of pharmaceutical pollution. They discharge small amounts of drug pollution at a local level, the university announced in a statement.

“Even the consumption of painkillers in hospitals only accounts for a relatively small share of total consumption which is of only 22 percent in the case of Metamizole, the most widely used painkiller. Considerable quantities were only identified in the consumption of the sedative Clomethiazole by hospitals, as well as neuroleptic quetiapine and the antidepressant Moclobemide by nursing homes. In a regional perspective, specific [pharmaceutical ingredients] like these can, therefore, be ascribed to certain health-care facilities as emission sources,” the report said.

Manuel Herrmann, a lead author on the study, explained the significance of the findings.

"Our study has shown that consumption patterns provide at least as accurate a picture of wastewater pollution by individual substances as wastewater measurements themselves,” he said. "However, with respect to the measurement procedure, our method combines the advantages of being far less complex and less costly. Thus, contamination can easily be predicted, and policy and management can react appropriately and promptly."

Here is how the study was carried out:

[A research team] analyzed drug consumption data from a hospital, a psychiatric clinic, and a nursing home in southwestern Germany. Based on the thus-determined consumption patterns, the researchers identified 50 frequently administered substances, which are generally and particularly associated with discharge to wastewater. In a second step, the researchers compared the average of the three-year total consumption of these drugs by health-care establishments with the total annual consumption of selected substances by German households. To do so, they used the German Arzneiverordnungsreport (Drug Prescription Report), published annually, which lists all the drugs, which patients on the public health scheme are prescribed by German doctors' surgeries.

PPCPs are not a new issue in the water industry. "It has long been known that there are trace amounts of PPCPs (pharmaceutical and personal care products) that escape our wastewater treatment plants and end up in waterways, including drinking water sources," Water Online previously reported.

"Though unregulated, PPCPs are on the EPA’s radar via the Third Contaminant Candidate List (CCL3) and the Unregulated Contaminant Monitoring Rule (UCMR) — precursors to possible regulatory action," the report said.

A few additional highlights described in the new study:

• Drug usage patterns in specific health institutions (HIs) differs from hospitals.
• In psychiatric hospitals and nursing homes mainly neurological drugs are consumed.
• Mass balance helps to identify drug emissions from HIs.
• The total drug contribution of HIs is low compared to households (national scales).
• HIs can be more important for drug emission than households (regional scales).

For more coverage of the PPCP scourge, visit Water Online’s Contaminant Removal Solutions Center.