Drug Waste Creates Disaster Zone in Andhra India

The Times of India
27 Jan 2009

PATANCHERU: When researchers analyzed vials of treated wastewater from a plant where about 90 Indian drug factories dump their residues, they were shocked.

Powerful antibiotic was being spewed into one stream each day to treat every person in a city of 90,000.

And it's not just ciprofloxacin. The supposedly cleaned water was a floating soup of 21 different active
pharmaceutical ingredients, used in generics for treatment of hypertension, heart disease, chronic liver ailments, depression, gonorrhea, ulcers and other ailments. It is the highest levels of pharmaceuticals ever detected in the environment, researchers say.

These factories, located on NH-9, just 28km from Hyderabad, produce drugs for much of the world. The result: Some of Andhra's poor are unwittingly consuming an array of chemicals that may be harmful, and could lead to the proliferation of drug-resistant bacteria.

"If you take a bath there, then you have all the antibiotics you need for treatment," said chemist Klaus Kuemmerer, a German exper t on drug resistance in the environment. "If you just swallow a few gasps of water, you're treated for everything. The question is ― for how long?"

"We don't have any other source, so we're drinking it," said R Durgamma, a mother of four, sitting on the steps of her mud home, a few miles downstream from the Patancheru treatment plant. High drug concentrations were recently found in her well water.

"When the local leaders come, we offer them water and they won't take it."

Patancheru became a hub for largely unregulated chemical and drug factories in the 1980s, creating what is described locally as an "ecological sacrifice zone" with its pharmaceutical waste. Since then, India has become one of the world's leading exporters of pharmaceuticals, and the US which spent $1.4 billion on Indian-made drugs in 2007, is its largest customer.

Last year, it was reported that trace concentrations of pharmaceuticals had been found in drinking water provided to at least 46 million Americans. But the wastewater downstream from the Indian plants contained 150 times the highest levels detected in the US.

Some locals long believed drugs were seeping into their drinking water, and new data from the study by Joakim Larsson, an environmental scientist at the University of Gothenburg, Sweden, has confirmed their suspicions.

Ciprofloxacin, the antibiotic, and the popular antihistamine cetirizine had the highest levels in the wells of six villages tested. Both drugs measured far below a human dose, but the results were still alarming.


The consequences of the India studies are worrisome.


Researchers are finding that human cells fail to grow normally in the laboratory when exposed to trace concentrations of certain pharmaceuticals. Some waterborne drugs also promote antibiotic-resistant germs, especially when, as in India, they are at times mixed with bacteria in human sewage.

The discovery of this contamination raises two key issues for researchers and policy makers: the amount of pollution and its source. Experts say one of the biggest concerns for humans is whether the discharge from the wastewater treatment facility is spawning drug resistance.

"Environmental protections are being met at Patancheru," says Rajeshwar Tiwari, who heads the area's pollution control board. And while he says regulations have tightened since Larsson's initial research, screening for pharmaceutical residue at the end of the treatment process is not required.

Possibly complicating the situation, Larsson's team also found high drug concentration levels in lak es upstream from the treatment plant, indicating potential illegal dumping ― an issue both Indian pollution officials and the drug industry acknowledge has been a past problem, but they say is practised much less now.

"I'll tell you, I've never seen concentrations this high before. And they definitely ... are having some biological impact, at least in the effluent," said Dan Schlenk, an ecotoxicologist from the University of California, Riverside, who was not involved in the India research.

And even though the levels recently found in village wells were much lower than the wastewater readings, someone drinking regularly from the worst-affected reservoirs would receive more than two full doses of an antihistamine in a year.

"Who has a responsibility for a polluted environment when the Third World produces drugs for our well being," Larsson asked scientists at a recent environmental research conference.

M Narayana Reddy, president of India's Bulk Drug Manufacturers Association, disputes Larsson's initial results: "I have challenged it," he said. "It is the wrong information provided by some research person."

Reddy acknowledged the region is polluted, but said that the contamination came from untreated human excrement and past industry abuses. He echoed pollution control officials, saying villagers are supposed to drink clean water piped in from the city or hauled in by tankers which a court ordered the industry to provide. But locals complain of insufficient supplies and some say they are forced to use wells.

"We are using these drugs (traces of which are found in water here), and the disease is not being cured. There is resistance going on there," said Dr A Kishan Rao, a medical doctor and environmental activist who has treated people for more than 30 years near the drug factories. He says he worries most about the long-term effects on his patients potentially being exposed to constant low levels of drugs. And then there's the variety, the mixture of drugs that aren't supposed to interact. No one knows what effects that could cause.

"It's a global concern," he said. "European countries and the US are protecting their environment and importing the drugs at the cost of the people in developing countries."

A spokesman for the Pharmaceutical Research and Manufacturers of America, representing major US drugmakers, said they could not comment about the Indian pollution because the Patancheru plants are making generic drugs and their members are branded. A spokesman for the Generic Pharmaceutical Association said the issues of Indian factory pollution are "not within the scope of the activities" of their group.

At the Patancheru water treatment plant, the process is outdated, with wastewater from the 90 bulk drug makers trucked to the plant and poured into a cistern. Solids are filtered out, then raw sewage is added to biologically break down the chemicals. The wastewater, which has been clarified but is still contaminated, is dumped into the Iska Vagu stream that runs into the Nakkavagu and Manjira, and eventually into the Godavari.

"I'm frustrated. We have told them so many times about this problem, but nobody does anything," said Syed Bashir Ahmed, 80, casting a makeshift fishing pole while crouched in tall grass along the river bank near the bulk drug factories. "The poor are helpless. What can we do?"

Margie Mason is the AP Medical Writer.