Policy and Position Statements


Pharmaceuticals and Personal Care Products in Drinking Water


I. ASTHO Supports a Comprehensive Approach to Addressing Pharmaceuticals and Personal Care Products in the Environment

The presence of pharmaceuticals and personal care products (PPCPs), such as cosmetics, fragrances, and skin care products, in the natural environment is cause for concern and requires attention. In particular, the presence of PPCPs within community water supplies raises questions regarding public health and community safety, prompting an examination of existing systems of product disposal and drinking water protection.

Advances in analytical methodology have led to the detection of PPCPs in some community water supplies. The majority of PPCPs enter the environment via the domestic wastewater system through human and animal excretion. A secondary source of PPCPs in the environment is the direct flushing of these products down toilets and sinks. To date, the human health effects of trace levels of PPCPs in drinking water systems remain largely unknown; however, numerous studies are underway to better understand potential impacts on humans and the environment.1 Current national regulatory standards for drinking water do not incorporate monitoring, reporting, or limiting the presence of PPCPs in drinking water. The absence of comprehensive health effects data related to the presence of PPCPs in drinking water poses a challenge for public health agencies both in terms of assessing the need to undertake protective measures and communicating to the community their potential level of exposure.2,3

II. Within This Context, ASTHO Recommends:

  • ASTHO recommends the pursuit of a comprehensive approach to addressing the presence of PPCPs in the environment and the assessment and minimization of risk of harmful health effects associated with exposure in the community water supply and the broader environment.
  • ASTHO recommends action that ensures public health protection and addresses concerns with the presence of PPCPs in the environment. These include: 1) minimizing or removing PPCPs from the environment; 2) better understanding the health effects of PPCPs in water; and 3) communicating known and unknown risks to the community.

Minimizing or Removing PPCPs from the Environment

  • ASTHO urges federal agencies to create a national framework of policies and programs that address the safe and proper disposal of unused PPCPs and that evaluate the cost of current disposal patterns to state and local governments. Coordination at all levels of government, as well as partnership with the pharmaceutical industry, is essential in removing barriers and establishing state-based programs for the proper collection and disposal of unused pharmaceuticals from individuals. Such proper collection can reduce environmental impacts and prevent poisoning-related death and injury.
  • ASTHO encourages state and local health agencies to partner with law enforcement agencies or other relevant programs to conduct drug take-back programs or allocate certain days where the public can bring unused pharmaceuticals to designated waste sites for proper disposal.
  • ASTHO encourages states to work with nursing homes to reduce their pharmaceutical waste and properly dispose of unused medicines.
  • ASTHO urges greater investment in research on human and agricultural wastewater treatment technology that could minimize or remove PPCPs from the environment.
  • ASTHO urges relevant agencies to consider the reduction or elimination of pharmaceuticals in feedlots and other veterinary settings on a routine basis.

Better Understanding of Health Effects and Occurrence of PPCPs in Water

  • ASTHO urges the U.S. Environmental Protection Agency (EPA), in cooperation with CDC and the National Institute of Environmental Health Sciences, to invest in a public health research agenda for PPCPs in water.
  • ASTHO supports the U.S. Geological Survey's ongoing efforts to develop and test methods for characterizing PPCPs in water.
  • ASTHO recommends that a national organization, such as the National Academy of Sciences, compile the information in existing health risk studies to better inform states and other stakeholders about the current level of knowledge associated with: 1) exposure levels; 2) toxicity; 3) potential hormonal activity; and 4) persistence in the environment of low concentration mixtures of PPCPs and other chemicals that are known to disrupt the body's normal functions (e.g., endocrine-disrupting compounds).
  • ASTHO urges federal action and support to monitor the levels of PPCPs in the environment and the variety of ways PPCPs enter into the environment, including monitoring of PPCPs among the 30 contaminants captured in EPA's Unregulated Contaminant Monitoring Rule whenever PPCPs meet the criteria for inclusion on that list. Improving our understanding of PPCP behavior in the environment will help states and territories implement programs, such as source water protection programs, and treatment technologies that prioritize and target pathways associated with human exposure to PPCPs and potential health effects.
  • ASTHO recommends that EPA continue to include PPCPs and associated health effects and occurrence data as priority considerations in its review for inclusion of these contaminants, whenever appropriate, on the Contaminant Candidate List and subsequent determinations for drinking water contaminant regulations.

Communicating Known and Unknown Risks to the Community

  • ASTHO encourages EPA, the Food and Drug Administration, and other federal agencies to help state and territorial health agencies develop key messages and implement programs for increasing public awareness and promoting behavior that will prevent PPCPs from entering the environment and minimize their environmental impact. Public outreach and education are essential for informing and engaging the public, healthcare providers, and veterinarians as to the impact of PPCPs on the environment and human health.
  • ASTHO supports outreach efforts targeting diverse stakeholders, including physicians, veterinarians, wastewater professionals, and the public, that aim to provide education on the environmental and public health implications of pharmaceuticals on human health and the environment.4

Approval History

ASTHO position statements relate to specific issues that are time sensitive, narrowly defined, or are a further development or interpretation of ASTHO policy. Statements are developed and reviewed by appropriate Policy Committees and the ASTHO Executive Committee. Position statements are not voted on by the full ASTHO membership.

Environmental Health Committee Review and Approval: March 2013
Board of Directors Review and Approval: June 2013
Position Expires: June 2016

For further information about this position statement, please contact ASTHO Environmental Health Policy staff at environmentalhealth@astho.org.


  1. U.S. Environmental Protection Agency. "EPA PPCP Research." Available at http://www.epa.gov/ppcp/work.html. Accessed 06-01-2013.
  2. U.S. Environmental Protection Agency. "Drug Disposal & Stewardship: Ramifications for the Environment and Human Health." Overview of research conducted at the U.S. EPA, Office of Research and Development (ORD), National Exposure Research Laboratory (NERL), Environmental Sciences Division (ESD), Las Vegas, Nevada. Available at http://www.epa.gov/ppcp/projects/disposal.pdf. Accessed 05-01-2013.
  3. Christian G. Daughton. "Pharmaceuticals as Environmental Pollutants: the Ramifications for Human Exposure." Las Vegas, NV: National Exposure Research Laboratory, Environmental Protection Agency. 2008. Available at http://www.epa.gov/nerlesd1/bios/daughton/EoPH2008.pdf. Accessed 05-01-2013.
  4. Herbert T. Buxton and Dana W. Kolpin. "Pharmaceuticals, Hormones, and Other Organic Wastewater Contaminants in U.S. Streams." Reston, VA: U.S. Geological Survey. 2002. Available at http://toxics.usgs.gov/pubs/FS-027-02/pdf/FS-027-02.pdf. Accessed 04-30-2013.