Pharmaceutical-drug contamination of groundwater, rivers, lakes and other waterways is a growing problem as millions of Americans flush unused or expired medications down toilets or discharge them in body waste. Throw in additional discharges by healthcare facilities, and it's no wonder that researchers have identified traces of pharmaceutical drugs in the drinking-water supplies of 40 million Americans.

To understand the scope of this problem, consider the following statistics released by the U.S. Centers for Disease Control and Prevention (CDC): From 1998 to 2008, the number of Americans taking at least one prescription drug in the past month increased from 44 to 48 percent. The use of two or more drugs increased from 25 to 31 percent. The use of five or more drugs rose from 6 to 11 percent.

Moreover, in 2007 and 2008, one out of every five children and nine out of 10 older Americans reported using at least one prescription drug in the past month. By anyone's standards, that's a lot of medications – and they're all drugs septic systems and sewage treatment plants were never designed to treat.

What does this mean for septic-system pumpers? Plenty, according to Adrienne Esposito, the executive director of Citizens Campaign for the Environment, a New York City-based not-for-profit group that works to protect public health and natural resources. Here's her take on the problem, and how pumpers can be part of the solution:

Pumper: When did this problem emerge?

Esposito: In 1999 and 2000, the United States Geological Survey (USGS) looked at surface waters in rivers and streams. It found 80 percent of the rivers and streams tested contained low levels of pharmaceutical drugs, such as antibiotics – that's the big one – as well as hormones and steroids. That was a big wakeup call for America. It was long suspected, but that was the first time the government did such testing.

Pumper: Characterize the scope of the problem.

Esposito: We're finding these materials in low levels in waterways across the nation. The concern is that it's such an unknown. It raises some medical concerns, such as (increased) antibiotic resistance and hormone disruption. For instance, what if you're ingesting hormonal drugs, but don't need them, what is the impact? It might disrupt hormonal development in ways we don't yet understand. And what are the synergistic effects of getting a combination of low-dose drugs you don't need? It's all unknown. But the bottom line is that constant, low-level exposure of pharmaceutical drugs may have impacts on humans.

Pumper: Do any studies back up these contentions?

Esposito: A recent Stony Brook Institute study of Jamaica Bay, a famous wildlife refuge in (the New York City borough of) Queens, looked at treated sewage effluent and its effects on marine life – specifically winter flounder. It found that in Jamaica Bay, flounder are experiencing feminization. The ratio of females to males is 10:1. Normally it's closer to 50/50. Why? The study's author found compounds from pharmaceuticals are disrupting hormone activities.

And in Suffolk County in eastern Long Island, the USGS and county health department officials took 70 groundwater samples about five years ago, and 28 of them contained pharmaceuticals, with most containing more than one. Most common were anti-epileptic drugs and common antibiotics.

In addition, sewage plants aren't designed – nor do we have the technology yet – to filter out these drugs. People who think there's a safety net are gravely mistaken.

Pumper: If it's only trace amounts, why is it a big deal?

Esposito: Today, it may be only trace amounts, but tomorrow, who knows? Ignorance isn't bliss, in this case – ignorance is dangerous. If you're mixing baby formula with water, you only want water in there, not Lipitor or contraceptives. When I make my morning honey and tea, that's all I want in there, not Viagra. If I'm making a choice (to take medications), that's one thing. If not, it's quite another story.

Pumper: We've heard anecdotal stories from septic system maintainers saying pharmaceuticals make bacteria less effective in the tank, which has a detrimental impact on the system. Is there evidence to prove this?

Esposito: Nobody knows the answer to that. It's an emerging issue.

Pumper: What steps has the U.S Food and Drug Administration (FDA) taken to curb this problem?

Esposito: There's been no real action. We had to dig to find even guidance documents that advise Americans how to dispose of unused drugs. We can't do much about drugs that pass through the human body. But there's one issue we can address immediately: Require the safe disposal of pharmaceuticals, as well as do more public education about not flushing unwanted drugs.

Pumper: How should people dispose of medications?

Esposito: The FDA recommends incineration. Some New York municipalities are setting up drop-off areas or holding drop-off-drugs days (similar to hazardous-waste disposal days). You need a police presence because some drugs are narcotics based ... it gets complicated. You can't just bring them to a pharmacist because you need a chain of control.

As part of Operation Medicine Cabinet, Suffolk County offers drop-off lock boxes at each police precinct. They're accessible 24/7 because precincts are open all the time. When the box fills up, police take it to an incinerator. It's been very convenient and well used by the public. In the first four months, more than 800 pounds of drugs were collected, then burned at a local incinerator.

And in Suffolk County, all healthcare facilities – hospitals, hospices, nursing homes and long-term care facilities – are required by law to annually submit plans for safe disposal of unused and/or expired medications.

(Visit www.fda.gov/ForConsumers/ConsumerUpdates/ucm101653.htm for more information about FDA drug-disposal guidelines.)

Pumper: What can septic service operators do about the problem?

Esposito: The best thing they can do is educate their customers. We're not advocating that people stop taking prescription drugs, but we don't want them to throw them down the toilet.

Pumpers could develop a simple brochure or flier and distribute it to customers. They could be wonderful partners in public education. Pumpers have a lot of good one-on-one contact with members of the public and great knowledge about this issue, and would be a very meaningful partner.

Pumper: Where can they obtain information about the issue to develop a simple education program?

Esposito: They could get information from our website: www.citizenscampaign.org and type in "pharmaceutical disposal" in the search field. There doesn't have to be a big cost involved. People instinctively know they shouldn't flush them, but they're not always sure. So if we could reinforce that instinct with education, we could really make a difference.

Pumper: Could doing this enhance a pumper's community standing and differentiate them from competitors?

Esposito: I think it would illustrate that pumpers also are caretakers of the water supply and public health. It would upgrade them into being a green business, which could provide a competitive advantage. You can't underestimate peoples' values and their interest in protecting their community. I think people would see (an education program) as a meaningful contribution to protecting the things they love: their families and their world.

Pumper: What else could septic pumpers do to be advocates on this issue?

Esposito: They could be a source for a local newspaper story, or partner with a local advocate group or community health department. Any substantive contribution to educating the public about this health problem will help – before it becomes a crisis.

Pumper: Have you heard any individual septic-system contractors or related professional associations taking any action on public education?

Esposito: No – this article would be the first. But we're looking for the first one to step up and become a leader on the issue.