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California May Begin Recycling Pharmaceuticals Culled From Wastewater For Its Medi-Cal Patients

Published August 20, 2012

Since 2007 a water treatment plant tucked away in the northern hills of San Diego has cleaned, filtered and purified used toilet water for human consumption.  The $13 million dollar plant has supplied millions of gallons of water per week to thirsty Orange County residents.

The plant’s very existence is a triumph over one of the most stubborn problems facing the nation’s water managers: how to filter waste from otherwise usable water?

Now Gov. Jerry Brown wants state engineers to solve a more complex problem: how to filter usable drug compounds from water for reuse by Medi-Cal patients?

The governor’s challenge is based upon a reality often overlooked in water reclamation.  Along with 500,000 metric tons of human stools that pass through the reclamation plant are traces of pharmaceutical drugs that – if separated – are worth millions.  “We estimate every day $50 million of intact drug compounds pass through our plant,” said Marcia Steiner, the deputy director of San Diego’s public utility agency.  Gov. Brown wants to harness these molecules and use them to cut Medi-Cal’s $2.1 billion – and rising – expenditure on pharmaceutical drugs for Californians.

Drug compounds exist in the reclaimed water supply because when humans urinate or excrete stools, much of the medicines they take are not broken down before elimination.  Isolating intact drug molecules, however, is a highly technical task compared to ridding water of much larger waste bacteria.  “The only way we know of to cull drug compounds from water is by centrifuge,” said Cal. State Northridge Prof. of Molecular Physics and consultant to the California Water Task Force Edward Pike.  “In theory, we could force the waste water through a series of centrifuges to extract molecules of interest,” he said. 

The centrifuge technique would be much like the one used to isolate more fissible uranium compounds for nuclear weapons.  The water would be spun at high speeds.  Because pharmaceutical molecules have greater mass than water molecules, they would be forced to the outer edge of the centrifuge.

“What we would get is a pharmaceutical ‘cocktail’,” said UCLA professor of pharmacology Eugene L. Banks, who is performing a feasibility study for Gov. Brown’ s Medi-Cal task force on recycling drugs.  “We do not know, at this time, how to separate Paxil from Viagra from Vicodin,” sad Banks.  The solution is to match patients with the demographics of the water source.  “We might give schizophrenics treatment from water from Oakland and depressives water from Beverly Hills,” said Banks.

A potluck drug capsule?  Medical professionals are not convinced of the inherent uncertainties in such a plan.  “Medi-Cal beneficiaries deserve better,” said Dr. Andrew Fine, a Santa Marino general practitioner that treats Medi-Cal patients.  “Medicine is hard enough without guesswork,” he said.

“We might give schizophrenics treatment from water from Oakland and depressives water from Beverly Hills,” said Banks.

Banks put a better spin on the plan.  “Already Californians are drinking these compounds, and this plan would redirect the compounds to those that can use them,” he said.

Any drug recovery plan would be far in the future.  If the feasibility study is successful, Orange County would not consider beginning construction of centrifuges until 2015 at the earliest, according to Banks.

Additionally, questions remain concerning California’s right to reclaim drugs for which it has not paid any money to the manufacturer.  Pharmaceutical companies may object that they sold their drugs to end users for a single use.  Until recently, harvesting drug compounds from human waste seemed like hardly a possibility so company license agreements contain no applicable language.  Legal authorities say the fair use doctrine has never been applied to the re-use of drug compounds, so these cases could filter through the legal system in a number of ways.