Nearly half of Americans took at least one prescription drug in the past 30 days,but chances are most of them did not give much thought to where those drugs came from. Unbeknownst to many, most drugs taken by Americans are not made in the U.S. but, rather, come from bulk drug manufacturing facilities in places like China and India.
Hyderabad, India, is one particularly prolific city for these bulk drug manufacturers, producing 50 percent of India’s drug exports. The U.S. Food and Drug Administration (FDA) and other international regulatory bodies like the European Medicines Agency require such manufacturers to follow Good Manufacturing Practices (GMP) to ensure drug safety, but there is a glaring omission from these guidelines: They do not consider the environment.
As such, massive amounts of pharmaceutical waste — perhaps thousands of tons a day — are entering waterways near the facilities and, according to new research published in the journal Infection, resulting in the development of multidrug-resistant pathogens.
High Concentrations of Antimicrobials Detected Near Drug Manufacturing Facilities
In November 2016, researchers from Germany’s University of Leipzig collected water samples from “the direct environment of bulk drug manufacturing facilities, the vicinity of two sewage treatment plants, the Musi River and habitats in Hyderabad and nearby villages.” Twenty-eight sampling sites were surveyed, and the water samples were analyzed for 25 anti-infective pharmaceuticals as well as multidrug-resistant pathogens and certain resistance genes.
All of the samples were contaminated with antimicrobials, including high concentrations of moxifloxacin, voriconazole, and fluconazole as well as increased concentrations of eight other antibiotics in area sewers. Some of the samples contained antimicrobials at levels up to 5,500 times higher than the environmental regulation limit. What’s more, more than 95 percent of the samples also contained multidrug-resistant bacteria and fungi.
The researchers called this contamination with antimicrobial pharmaceuticals “unprecedented” and blamed it on “insufficient wastewater management by bulk drug manufacturing facilities, which seems to be associated with the selection and dissemination of carbapenemase-producing pathogens.”
India Has Become a ‘Hot Spot’ of Antimicrobial Resistance
Large environmental contaminations, including those leading to resistant organisms, have repeatedly been identified around bulk drug manufacturing plants in India and China. The study explained: “Particular bulk drug manufacturing plants in Hyderabad, South India, have been shown to dump waste into their surroundings or fail to treat manufacturing discharges appropriately, resulting in the contamination of rivers and lakes.
“The substantial quantities of antibiotic pollution, combined with runoff from agriculture and human waste, facilitate the growth of MDR [multidrug-resistant] bacteria in water bodies and sewage treatment plants. Consequently, India has become a hot spot of drug resistance, with drastic clinical consequences.”
They note that more than 56,000 newborn babies die in India each year due to drug-resistant infections. This is not a problem contained to India, of course, since “multidrug-resistance can move around the world within a flight time of only a few hours.” They even stated that if you visit India or another country with a high prevalence of antibiotic resistance, you’ll likely return home colonized by resistant bacteria which may be transmitted to others, including those in your household.
Big Pharma’s Greed Further Destroying the Environment
Many drug companies have located their manufacturing facilities in countries like China and India simply because production costs are low, and despite the fact that these countries also tend to have far less rigorous water treatment protocols. For example, in Patancheru, India, it was previously found that 90 different pharmaceutical companies discharge 400,000 gallons daily into the local water treatment plant, and less than 25 percent of this waste water undergoes treatment. As reported by Forbes: “Researchers from Sweden have studied the area around Hyderabad for a number of years, publishing a series of reports since 2007 ..
The worst pollutant was ciprofloxacin, with concentrations up to 31 mg/L and in only one day totaling ’44 kg, which is equivalent to Sweden’s entire consumption over [five] days or, expressed in another manner, sufficient to treat everyone in a city with 44 000 inhabitants.’
These researchers also found that the effluent was toxic to many organisms, and that it promoted resistance genes. Almost  percent of DNA samples from downstream sites sampled had resistance genes.”
Aside from direct ingestion, contaminated wastewater also finds its way onto crop fields via irrigation and sludge (biosolids) used as fertilizer. This makes it easy for drug-resistant genes to spread throughout the global environment. According to a U.S. Centers for Disease Control and Prevention report, E.coli bacteria resistant to multiple drugs have even been found in the Arctic, brought there by migrating birds.
Incorrect Disposal of Medications Responsible for ‘Micro-Contamination”
Low levels of pharmaceutical pollution, including antibiotics, have been detected worldwide, according to the study authors. Even in the U.S., it’s estimated that 80 percent of U.S. waterways contain pharmaceutical pollution and the Alliance for the Great Lakes supports making pharmaceutical companies shoulder some of the cost for disposal of medications. The major source of environmental “micro-contamination” is thought to come from incorrect usage and disposal of medications.
The FDA recommends disposing of unused medications via medicine take-back programs or using U.S. Drug Enforcement Agency-authorized collectors, which are available throughout the U.S. If these aren’t available, mix the medication with dirt, kitty litter or coffee grounds (this is to discourage ingestion by animals or children) then place it in a sealed bag or container and throw it in your trash.12
Industrial Agriculture Also Responsible for Spread of Antibiotic Resistance
“The development and global spread of antimicrobial resistance present a major challenge for pharmaceutical producers and regulatory agencies,” the Infection researchers noted, and this is in part because there are so many contributing factors. Another major one, however, is the use of antibiotics in food animals, which is driving rates of antibiotic resistance sky-high.
Eighty percent of the antibiotics used in the U.S. are used by industrial agriculture for purposes of growth promotion and preventing diseases that would otherwise make their concentrated animal feeding operations (CAFOs) unviable.
With animals packed into tight quarters, fed unnatural diets and living in filth, disease flourishes. Low doses of antibiotics are added to feed as a matter of course, not only to stave off inevitable infectious diseases, but also because they cause the animals to grow faster on less food.
“But there is a terrifying downside to this practice,” Scientific American reported. “Antibiotics seem to be transforming innocent farm animals into disease factories.”13 The antibiotics may kill most of the bacteria in the animal, but remaining resistant bacteria is allowed to survive and multiply.
You can be exposed to the resistant bacteria by eating contaminated meat or consuming produce grown in contaminated soil or exposed to contaminated water. It’s becoming clear, however, that the deadly resistant microbes may be spreading far easier and wider than has been previously realized.
With Drug Resistance Spreading, How Can You Stay Safe?
Research published in Clinical Infectious Diseases revealed that current workers at hog farms are six times more likely to carry multi-drug resistant MRSA than those without exposure to CAFO pigs.14 They also observed active infections caused by livestock-associated Staphylococcus aureus (LA-SA). Worse still, aerosolized MRSA has been detected in the air inside and downwind of a pig CAFO, as well as in animal feed.15
Also revealing, people who have close proximity to pig CAFOS and areas where CAFO pig manure is applied to crop fields are more likely to be infected with MRSA, adding to the “growing concern about the potential public health impacts of high-density livestock production.”16
Even carbapenem-resistant enterobacteriacea (CRE), bacteria resistant to the class of antibiotics called carbapenems,17 have been detected in a U.S. pig farm.18 So, with drug resistance spreading rapidly in food, water and air, what can you do to stay safe? According to the authors of the featured study:19
“Regulations must be imposed on the manufacturing process of finished drugs as well as active pharmaceutical ingredients to require strict compliance with environmental laws, adequate modernization of manufacturing units and treatment plants, and international labeling of the origin of medicines in a manner clearly visible for pharmacists, physicians and consumers.”
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