Overview of Pharmaceuticals and Personal Care Products (PPCPs) and Water Quality

What are PPCPs?

Pharmaceuticals and personal care products (PPCPs) are a group of potential water pollutants that are categorized as contaminants of emerging concern. Contaminants of emerging concern are those that need more research about how they move through the environment, where they end up (environmental fate and transport), and how they might impact the environment and human health.

Pharmaceuticals consist of the products used to prevent or treat disease in humans and animals. They include prescription and over-the-counter drugs such as antibiotics, anti-inflammatory drugs, pain killers, antidepressants, beta blockers, blood lipid regulators, cytostatic drugs, and many more  (Figure 1):

We use personal care products to clean and adorn ourselves, often to improve the quality of our daily lives (Figure 2). They include products such as: detergents, deodorants, fragrances, insect repellants, moisturizers, shampoos, sunscreens, toothpastes, and more

The term PPCPs refers broadly to these diverse classes of prescription medications, over-the-counter drugs, and the non-medical cosmetic and cleaning products we use. Although PPCPs have been used for many years, only recently have they been found and measured in the environment, thanks to the advancements in the tools and methods that can detect them.

How do they get into the environment?

PPCPs can be introduced into the environment throughout their manufacture, consumer use, and disposal cycle. This can happen directly or indirectly through wastewater discharges, land application of human and animal waste to farmland, and disposal at landfills. 

Wastewater

Wastewater is one of the most significant sources of PPCPs in the environment. Our bodies do not always completely use up or metabolize administered medications. Household wastewater can therefore contain a wide variety of pharmaceuticals excreted through urine or feces. Similarly, personal care products or topically applied drugs get washed off during bathing and cleaning and are also found in the household waste stream. Other sources from household settings include flushing expired or unused medications and disposing of unused personal care products down the drain. PPCPs in wastewater may also originate from industrial sources, hospitals, long-term care facilities, and landfill leachate.

Typical wastewater treatment plant processes do not fully break down PPCPs and remove them from wastewater. Treated wastewater, commonly known as effluent, is released into surface water (streams, rivers, and lakes), or is irrigated onto agricultural or forested land to reuse nutrients and improve groundwater levels. Treated wastewater can therefore introduce a mixture of PPCPs into the environment. The types and concentrations of PPCPs detected in wastewater effluent can vary from one wastewater treatment plant to another. Even within the same treatment plant, PPCPs in treated wastewater can vary across the seasons of the year. The variability is caused by multiple things, including the characteristics of water when it arrives at the treatment plant, seasonal use of different PPCPs (e.g., sunscreen in the summer), the technologies used to treat the wastewater, environmental and weather conditions (e.g., temperature), and the individual chemical properties of the PPCPs present in wastewater (Wang & Wang, 2016). 

Septic systems treat wastewater in much of rural Pennsylvania. They rely mostly on septic tank microorganisms and soil’s filtering capacity to break down and remove PPCPs. Just like wastewater treatment plants, PPCPs that don’t break down completely in septic tanks are dispersed in the soil (in drain fields, sand mounds, etc.), where additional removal can occur as the septic effluent moves through the soil to recharge groundwater. While some PPCPs can be effectively filtered through the soil, those that do not break down easily can persist (Yang et al., 2016). They can then contaminate adjacent groundwater and private wells in addition to nearby streams, ponds, and other surface waters. Factors that can influence the amount of PPCPs found in private wells include the use of PPCPs in that home, septic system design and maintenance, soil types, private well construction and features, and the well location (upstream vs downstream) and separation distance from septic components (Kibuye et al., 2019; Schaider et al., 2016).

Land Application of Biosolids and Animal Manure

Many farms amend the soil with biosolids or livestock manure, reusing essential nutrients to grow productive crops. Because animals also excrete administered medications, manure from livestock or poultry production can contain veterinary pharmaceuticals. Biosolids are a nutrient-rich byproduct of household wastewater treatment. Some PPCPs accumulate in the solids portion of wastewater known as sludge. Sludge undergoes further physical and chemical treatment to produce the biosolids. Although land-applied biosolids are required to meet U.S. Environmental Protection Agency's (US EPA) pollutant and pathogen standards, there are currently no regulatory standards for PPCPs that persist in biosolids.

 When applied to farms, some PPCPs in biosolids and manure can break down to lower their concentrations in the environment. However, PPCPs that require long periods of time to break down can persist in the soil, leach to groundwater, be absorbed by plants, or be washed off via surface runoff to nearby surface water. These pathways are influenced by the chemical properties of the PPCPs, among other environmental factors and site characteristics.

Occurrence of PPCPs in Water

Various studies have documented PPCPs in wastewater, surface water, groundwater, treated drinking water, soil, as well as plant tissue and in aquatic organisms. PPCPs are detected at trace concentrations in the parts per trillion (ppt) or ng/L to parts per billion (ppb) or µg/L ranges in the environment (Figure 3).

A U.S. Geological Survey (USGS) study in 1999-2000, the first of its kind, sampled 139 streams in 30 states to investigate the presence of PPCPs (Kolpin et al., 2002). Sampled streams were located downstream of human and agricultural wastewater discharges. This study found that over 80% of streams had at least one PPCP (Kolpin et al, 2002). From 2006-2009, the USGS and Pennsylvania Department of Environmental Protection (PA DEP) collected data on PPCPs and other emerging contaminants in Pennsylvania waters (Reif et al., 2012). Sampling sites included streams used as drinking water sources that tested positive for a wide range of emerging contaminants, but pharmaceuticals were the most frequently detected class. Reif et al. also detected veterinary antibiotics in groundwater wells used to supply livestock. Similarly, when private wells with potential septic system impact within central PA were sampled for seven pharmaceuticals, at least one compound was detected at each well (Kibuye et al., 2019).

In general, the presence of PPCPs in surface or groundwater sources has been linked to the distance from potential contaminant sources. Concentrations of PPCPs detected in surface water sources are further influenced by factors such as surface water level during drought and rainy conditions, seasonal use of different PPCPs (e.g., sunscreen in the summer), and specific chemical properties of the individual PPCPs (Kibuye et al., 2020; Reif et al., 2012). Factors like drinking water well depth and the separation distance from potential sources, such as septic systems, are linked to groundwater detection of PPCPs. Therefore, shallow groundwater in private wells may be more impacted, especially if septic systems are not maintained properly or are malfunctioning.

PPCPs in surface water and groundwater used as drinking water sources can cause concerns about drinking water quality. A joint USGS and US EPA study monitored PPCPs in drinking water sources and treated drinking water from 29 public drinking water treatment plants across the US (Furlong et al., 2017; Glassmeyer et al., 2017). The researchers found that PPCPs were present in treated water; however, concentrations and overall number of detected PPCPs were lower in treated water than in untreated source water. These findings indicate that drinking water treatment processes can remove PPCPs from water; however, some are incompletely removed and can be present at low concentrations (ppt ranges) in drinking water distributed to consumers. Private well users are responsible for treating their drinking water and can also be exposed to PPCPs if the water well is contaminated with PPCPs. Point-of-use drinking water treatment, such as activated carbon and reverse osmosis systems, has been shown to lower PPCPs in water. Overall concentrations in treated drinking water for both public and private water systems are expected to vary based on source water quality characteristics, types, and level of PPCPs in untreated water, as well as overall performance of the water treatment methods used.

Environmental and Human Health Concerns

The occurrence of pharmaceuticals in the environment is of concern because they remain active even at trace concentrations. As a result, bacteria and other pathogens can develop drug resistance. This can present public health problems because it can lead to the development of illnesses that are resistant to treatment.

 Some ingredients in PPCPs are known or suspected endocrine-disrupting compounds that can negatively affect the normal function of hormone systems in living things. Endocrine-disrupting compounds can negatively impact growth, development, and reproduction in wildlife, domestic animals, and humans (Tijani et al., 2013). However, risk assessment studies indicate that PPCPs pose a greater risk to aquatic organisms than to human health (Ziylan-Yavas et al., 2022).

Humans are primarily exposed to trace amounts of PPCPs through drinking water. Other exposure can also occur from sources such as agricultural products and fish that contain PPCPs. Based on the evaluation of currently available data, the World Health Organization (WHO) concluded that adverse human health effects are unlikely as a result of chronic exposure to pharmaceuticals through drinking water (WHO, 2012). Since humans can be exposed to mixtures of PPCPs through drinking water and other routes, various studies have emphasized the need for more research and a more reliable human health risk assessment of PPCPs (Ziylan-Yavas et al., 2022).

Regulations

There are currently no state or federal regulatory standards for PPCPs in wastewater, biosolids, surface water, and groundwater sources, treated drinking water, as well as bottled water. Some pharmaceuticals and hormones are, however, included in the U.S. EPA Contaminant Candidate List (CCL) 3 and CCL 4 as contaminants known to occur in public water systems that may need regulation under the Safe Drinking Water Act (SDWA). The CCL is a list of unregulated contaminants that are being explored for possible regulation under the SDWA and is published every five years. Following research and data collection on the contaminants, US EPA makes a regulatory determination whether to develop drinking water standards for at least five of the contaminants in the CCL. This process can take several years. For additional information on CCL, visit: Basic Information on the CCL and Regulatory Determination.

The Food and Drug Administration (FDA) regulates cosmetic personal care products and their ingredients. In September 2016, the FDA banned nineteen over-the-counter antimicrobial ingredients, including triclosan and triclocarban. Antimicrobials are chemicals that kill or slow the growth of pathogens. More details on this final rule are available here: FDA issues final rule on safety and effectiveness of antibacterial soaps. Triclosan and triclocarban have been used for many years as ingredients in home, beauty, and personal care products that are marketed as antibacterial or antimicrobial. This ban was placed following research that indicated they had no added benefit in consumer products but posed ecological and human health risks since they were known endocrine-disrupting compounds.

What actions can you take?

Reduce Your Use of Endocrine Disrupting Compounds in Personal Care Products

As consumers, we can reduce our use of products containing ingredients that pose ecological impacts, such as endocrine-disrupting compounds. Researchers at Penn State developed an Endocrine-Disrupting Compound Footprint Calculator that is publicly available and can be used to estimate a household’s footprint. Through this tool, users can enter the personal care products they use. The calculator will provide a report showing the distribution (by mass) of the products contributing to their endocrine-disrupting compounds footprint. The results from the tool can be used to make decisions on the products a household or individual can minimize in order to reduce their footprint. To learn more about the tool visit: Endocrine-Disrupting Compounds (EDC) Footprint Calculator.

Properly Dispose of Medications

Do not dispose of expired or unused medications by flushing. Instead, take advantage of drug take-back programs near you. Law enforcement officials collect and incinerate controlled and non-controlled substances, preventing their introduction into aquatic systems. The Pennsylvania Department of Drug and Alcohol Programs has a tool that can be used to locate drug take-back programs near you. This can be found here: Find a drug take-back location. Your local pharmacist may also have a drug take-back program that you can take advantage of.

Maintain Your Septic System

As a septic system owner, proper operation and maintenance of your septic system can go a long way in protecting your private well and nearby surface and groundwater sources. Pump your septic tank every 3-5 years and have your entire system inspected periodically to determine if septic components are functioning properly. To find a certified septic system service provider near you, visit the Pennsylvania Septage Management Association - Find a Local Provider tool.

Explore Your Drinking Water

If your drinking water is supplied by a public water system and you are concerned about PPCPs in your drinking water, you can contact your water utility to learn more about your drinking water, find out whether they have PPCPs monitoring data, or if they can provide any recommendations for you. If you get your drinking water from a private well, spring, or cistern, you are responsible for your own drinking water testing and treatment. Some of the PA DEP-accredited laboratories may have capabilities to test for PPCPs in drinking water. To lower levels in drinking water, some point-of-use drinking water treatment devices, such as reverse osmosis and activated carbon systems, have been shown to remove PPCPs in water. Treatment efficiency varies based on the compound, initial concentrations in untreated water, as well as overall operation and maintenance of the system. All point-of-use devices require periodic maintenance. Follow the manufacturer’s operation and maintenance guide as well as component replacement schedules to ensure that the devices continue to work as expected over time. 

References

Furlong, E. T., Batt, A. L., Glassmeyer, S. T., Noriega, M. C., Kolpin, D. W., Mash, H., & Schenck, K. M. (2017). Nationwide reconnaissance of contaminants of emerging concern in source and treated drinking waters of the United States: Pharmaceuticals. Science of the Total Environment, 579, 1629–1642. doi.org/10.1016/j.scitotenv.2016.03.128

Glassmeyer, S. T., Furlong, E. T., Kolpin, D. W., Batt, A. L., Benson, R., Boone, J. S., Conerly, O., Donohue, M. J., King, D. N., Kostich, M. S., Mash, H. E., Pfaller, S. L., Schenck, K. M., Simmons, J. E., Varughese, E. A., Vesper, S. J., Villegas, E. N., & Wilson, V. S. (2017). Nationwide reconnaissance of contaminants of emerging concern in source and treated drinking waters of the United States. Science of the Total Environment, 581–582, 909–922. doi.org/10.1016/j.scitotenv.2016.12.004

Kibuye, F. A., Gall, H. E., Elkin, K. R., Swistock, B., Veith, T. L., Watson, J. E., & Elliott, H. A. (2019). Occurrence, Concentrations, and Risks of Pharmaceutical Compounds in Private Wells in Central Pennsylvania. Journal of Environmental Quality, 48(4), 1057–1066. doi.org/10.2134/jeq2018.08.0301

Kibuye, F. A., Gall, H. E., Veith, T. L., Elkin, K. R., Elliott, H. A., Harper, J. P., & Watson, J. E. (2020). Influence of hydrologic and anthropogenic drivers on emerging organic contaminants in drinking water sources in the Susquehanna River Basin. Chemosphere, 245. doi.org/10.1016/j.chemosphere.2019.125583

Kolpin, D. W., Furlong, E. T., Meyer, M. T., Thurman, E. M., Zaugg, S. D., Barber, L. B., & Buxton, H. T. (2002). Pharmaceuticals, hormones, and other organic wastewater contaminants in U.S. streams, 1999-2000: A national reconnaissance. Environmental Science and Technology, 36(6), 1202–1211. doi.org/10.1021/es011055j

Reif, A. G., Kent Crawford, J., Loper, C. A., Proctor, A., Manning, R., & Titler, R. (2012). Occurrence of Pharmaceuticals, Hormones, and Organic Wastewater Compounds in Pennsylvania Waters, 2006-09.

Schaider, L. A., Ackerman, J. M., & Rudel, R. A. (2016). Septic systems as sources of organic wastewater compounds in domestic drinking water wells in a shallow sand and gravel aquifer. Science of the Total Environment, 547, 470–481. doi.org/10.1016/j.scitotenv.2015.12.081

Tijani, J. O., Fatoba, O. O., & Petrik, L. F. (2013). A review of pharmaceuticals and endocrine-disrupting compounds: Sources, effects, removal, and detections. Water, Air, and Soil Pollution, 224(11). doi.org/10.1007/s11270-013-1770-3

Wang, J., & Wang, S. (2016). Removal of pharmaceuticals and personal care products (PPCPs) from wastewater: A review. In Journal of Environmental Management (Vol. 182, pp. 620–640). Academic Press. doi.org/10.1016/j.jenvman.2016.07.049

World Health Organization (WHO). (2012). Pharmaceuticals in drinking water.

Yang, Y. Y., Toor, G. S., Wilson, P. C., & Williams, C. F. (2016). Septic systems as hot-spots of pollutants in the environment: Fate and mass balance of micropollutants in septic drainfields. Science of the Total Environment, 566–567, 1535–1544. doi.org/10.1016/j.scitotenv.2016.06.043

Ziylan-Yavas, A., Santos, D., Flores, E. M. M., & Ince, N. H. (2022). Pharmaceuticals and personal care products (PPCPs): Environmental and public health risks. In Environmental Progress and Sustainable Energy (Vol. 41, Issue 4). John Wiley and Sons Inc. doi.org/10.1002/ep.13821