Abstract
Americans fill upward of four billion prescriptions for pharmaceuticals each year, and many of those pharmaceuticals eventually make their way into the environment. Hundreds of different active pharmaceutical ingredients (APIs) are detected in ambient waters and source water used for drinking water in the U.S. Very few of these drugs have health-based guidance values that suggest a safe level for individuals exposed in the ambient environment through drinking water. The Minnesota Department of Health (MDH) has developed a novel method to derive screening-level human health guidance values for APIs. This method was designed for rapid evaluation and relies on Food and Drug Administration (FDA)-approved drug labels and limited additional public data resources for necessary information. MDH developed an analytical framework using traditional and novel uncertainty and adjustment factors specific to the information available for APIs. This framework, along with an estimated lowest therapeutic dose (LTD), was used to derive screening reference dose (sRfD) values. Water screening values (WSV) were then derived using the sRfD, a relative source contribution factor (RSC), and a water intake rate for infants to represent a highly exposed population. MDH used this new method to derive water screening values for 119 APIs that are commonly prescribed and/or commonly monitored in Minnesota waters, including antibiotics, antidepressants, steroids, and other classes of drugs. The derived WSVs can be used to provide context to environmental detections, prioritize APIs for further health-based guidance development, prioritize APIs for future environmental monitoring studies, and inform the development or refinement of analytical methods.
Highlights
In the past twenty-five years, the portion of the United States population that uses at least one prescription pharmaceutical has risen approximately ten percent
Many pharmaceuticals are commonly detected in potential drinking water sources and treated drinking water, yet very few of these drugs have established water guidance values that inform the probability of certain health risks associated with large populations consuming water containing prescription drugs [7]
Labels were identified in DailyMed [15] for these five drugs, but it was discovered during the assessment that the active pharmaceutical ingredients (APIs) was either recently discontinued for use or the label was too outdated to provide all of the necessary information needed for assessment
Summary
In the past twenty-five years, the portion of the United States population that uses at least one prescription pharmaceutical has risen approximately ten percent. From 2011–2014, nearly half of all Americans used at least one prescription medication, and nearly a quarter used three or more [1]. The rapid growth in pharmaceutical use has contributed to increased detection of pharmaceuticals in the environment [3,4,5,6]. Many pharmaceuticals are commonly detected in potential drinking water sources and treated drinking water, yet very few of these drugs have established water guidance values that inform the probability of certain health risks associated with large populations consuming water containing prescription drugs [7]. Pharmaceuticals enter the environment through a variety of pathways, including improper disposal down household drains and toilets, disposal into
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