Bryant Sears, working in a Teflon suit and wearing goggles and rubber gloves, sorts leftover medicines and contaminated packaging at Abbott Northwestern Hospital in Minneapolis. The massive amount of pharmaceuticals being flushed by the health industry is worsening the problem of minute concentrations of pharmaceuticals in the nation's drinking water supplies.

U.S. hospitals and long-term care facilities annually flush millions of pounds of unused pharmaceuticals down the drain, pumping contaminants into America’s drinking water, according to an ongoing Associated Press investigation.

These discarded medications are expired, spoiled, over-prescribed or unneeded. Some are simply unused because patients refuse to take them, can’t tolerate them or die with nearly full 90-day supplies of multiple prescriptions on their nightstands.

Few of the country’s 5,700 hospitals and 45,000 long-term care homes keep data on the pharmaceutical waste they generate. Based on a small sample, though, the AP was able to project an annual national estimate of at least 250 million pounds of pharmaceuticals and contaminated packaging, with no way to separate out the drug volume.

One thing is clear: The massive amount of pharmaceuticals being flushed by the health services industry is aggravating an emerging problem documented by a series of AP investigative stories – the commonplace presence of minute concentrations of pharmaceuticals in the nation’s drinking water supplies, affecting at least 46 million Americans.

Researchers are finding evidence that even extremely diluted concentrations of pharmaceutical residues harm fish, frogs and other aquatic species in the wild. Also, researchers report that human cells fail to grow normally in the laboratory when exposed to trace concentrations of certain drugs.

The original AP series in March prompted federal and local legislative hearings, brought about calls for mandatory testing and disclosure, and led officials in more than two dozen additional metropolitan areas to analyze their drinking water.

And while most pharmaceutical waste is unmetabolized medicine that is flushed into sewers and waterways through human excretion, the AP examined institutional drug disposal and its dangers because unused drugs add another substantial dimension to the problem.

“Obviously, we’re flushing them – which is not ideal,” acknowledges Mary Ludlow at White Oak Pharmacy, a Spartanburg, S.C., firm that serves 15 nursing homes and assisted-living residences in the Carolinas.

Such facilities, along with hospitals and hospices, pose distinct challenges because they handle large quantities of powerful and toxic drugs – often more powerful and more toxic than the medications people use at home. Tests of sewage from several hospitals in Paris and Oslo uncovered hormones, antibiotics, heart and skin medicines and pain relievers.

Hospital waste is particularly laden with both germs and antibiotics, says microbiologist Thomas Schwartz at Karlsruhe Research Center in Germany.

The mix is a scary one.

In tests of wastewater retrieved near other European hospitals and one in Davis County, Utah, scientists were able to link drug dumping to virulent antibiotic-resistant germs and genetic mutations that may promote cancers, according to scientific studies reviewed by the AP.

Researchers have focused on cell-poisoning anticancer drugs and fluoroquinolone class antibiotics, like anthrax fighter ciprofloxacin.

At the University of Rouen Medical Center in France, 31 of 38 wastewater samples showed the ability to mutate genes. A Swiss study of hospital wastewater suggested that fluoroquinolone antibiotics also can disfigure bacterial DNA, raising the question of whether such drug concoctions can heighten the risk of cancer in humans.

Pharmacist Boris Jolibois, one of the French researchers at Compiegne Medical Center, believes hospitals should act quickly, even before the effects are well understood. “Something should be done now,” he said. “It’s just common sense.”

Estimating the problem

Some contaminated packaging and drug waste are incinerated; more is sent to landfills. But it is believed that most unused pharmaceuticals from health care facilities are dumped down sinks or toilets, usually without violating state or federal regulations.

The Environmental Protection Agency told assembled water experts last year that it believes nursing homes and other long-term care facilities use sewer systems to dispose of most of their unused drugs. A water utility surveyed 45 long-term care facilities in 2006 and calculated that two-thirds of their unused drugs were scrapped this way, according to the National Association of Clean Water Agencies.

An internal EPA memo last year included pharmaceuticals on a list of “major pollutants of concern” at health care businesses. Still, few medical centers keep comprehensive records of drugs they cast down toilets or into landfills. When data are kept, drugs and tainted packaging are combined in the same totals.

In an attempt to quantify the problem, the AP examined records in Minnesota, where state regulators have pushed hospital administrators to keep closer track than elsewhere. Fourteen facilities were surveyed, in a range of settings from rural to urban. The AP projected those annual totals onto the national patient population for hospitals and adjusted for the relatively lower pharmaceutical use of Minnesotans. Since long-term care facilities generate more drug waste than hospitals, the AP conservatively doubled the number.

That calculation produced an estimate of at least 250 million pounds of annual drug waste from hospitals and long-term care centers, further complicated by the fact experts say drugs might account for only up to half of pharmaceutical waste, while the rest is packaging.

The AP estimate excludes many other sources of health industry drug waste, from doctors’ to veterinary offices. Smaller medical offices typically dispose of expired samples and unwanted drugs like ordinary consumers – with little forethought.

EPA weighs rules

The EPA is considering whether to impose the first national standard for how much drug waste may be released into waterways by the medical services industry, but Ben Grumbles, the EPA’s top water administrator, says a decision won’t be made until next year, at the earliest.

So far, regulators have done little more than politely ask the medical care industry to stop pouring drugs into the wastewater system. “Treating the toilet as a trash can isn’t a good option,” says Grumbles.

Some think it’s time to do more than ask. “It’s strange that we have rules about the oil from your car; you’re not allowed to simply flush it down the sewer,” says U.S. Rep. Tim Murphy, R-Pa. “So why do we let these drugs, without any kind of regulation, continue to be flushed away in the water supply?”

Landfills are one alternative. At least they don’t empty directly, and immediately, into waterways like some sewage.

Marjorie E. Powell, a lawyer for the Pharmaceutical Research and Manufacturers of America, says landfills are “more environmentally friendly,” while EPA spokeswoman Roxanne Smith contends that landfilling of hazardous pharmaceutical waste “poses little threat to the public.”

Still, Grumbles acknowledges that landfills, while safer, are not a permanent solution. That’s because pharmaceuticals can eventually reach waterways from landfills through leaks or intentional releases of treated seepage known as leachate.

Already, researchers have detected trace concentrations of drugs – including the pain reliever ibuprofen and seizure medicine carbamazepine – in seepage or groundwater near landfills.

Environmental professionals outside government are reaching a consensus that incinerators are the best disposal method.