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http://ap.google.com/article/ALeqM5hGsoyElv4ZL879LW6z2aZS0Pix7AD8VA14500

AP probe finds drugs in drinking water
BY Jeff Donn, Martha Mendoza and Justin Pritchard / Mar 9, 2008

A vast array of pharmaceuticals -- including antibiotics, anti-
convulsants, mood stabilizers and sex hormones -- have been found in
the drinking water supplies of at least 41 million Americans, an
Associated Press investigation shows.

To be sure, the concentrations of these pharmaceuticals are tiny,
measured in quantities of parts per billion or trillion, far below the
levels of a medical dose. Also, utilities insist their water is safe.

But the presence of so many prescription drugs -- and over-the-counter
medicines like acetaminophen and ibuprofen -- in so much of our
drinking water is heightening worries among scientists of long-term
consequences to human health.

In the course of a five-month inquiry, the AP discovered that drugs
have been detected in the drinking water supplies of 24 major
metropolitan areas -- from Southern California to Northern New Jersey,
from Detroit to Louisville, Ky.

Water providers rarely disclose results of pharmaceutical screenings,
unless pressed, the AP found. For example, the head of a group
representing major California suppliers said the public "doesn't know
how to interpret the information" and might be unduly alarmed.

How do the drugs get into the water?

People take pills. Their bodies absorb some of the medication, but the
rest of it passes through and is flushed down the toilet. The
wastewater is treated before it is discharged into reservoirs, rivers
or lakes. Then, some of the water is cleansed again at drinking water
treatment plants and piped to consumers. But most treatments do not
remove all drug residue.

And while researchers do not yet understand the exact risks from
decades of persistent exposure to random combinations of low levels of
pharmaceuticals, recent studies -- which have gone virtually unnoticed
by the general public -- have found alarming effects on human cells and
wildlife.

"We recognize it is a growing concern and we're taking it very
seriously," said Benjamin H. Grumbles, assistant administrator for
water at the U.S. Environmental Protection Agency.

Members of the AP National Investigative Team reviewed hundreds of
scientific reports, analyzed federal drinking water databases, visited
environmental study sites and treatment plants and interviewed more
than 230 officials, academics and scientists. They also surveyed the
nation's 50 largest cities and a dozen other major water providers, as
well as smaller community water providers in all 50 states.

Here are some of the key test results obtained by the AP:

_Officials in Philadelphia said testing there discovered 56
pharmaceuticals or byproducts in treated drinking water, including
medicines for pain, infection, high cholesterol, asthma, epilepsy,
mental illness and heart problems. Sixty-three pharmaceuticals or
byproducts were found in the city's watersheds.

_Anti-epileptic and anti-anxiety medications were detected in a
portion of the treated drinking water for 18.5 million people in
Southern California.

_Researchers at the U.S. Geological Survey analyzed a Passaic Valley
Water Commission drinking water treatment plant, which serves 850,000
people in Northern New Jersey, and found a metabolized angina medicine
and the mood-stabilizing carbamazepine in drinking water.

_A sex hormone was detected in San Francisco's drinking water.

_The drinking water for Washington, D.C., and surrounding areas tested
positive for six pharmaceuticals.

_Three medications, including an antibiotic, were found in drinking
water supplied to Tucson, Ariz.

The situation is undoubtedly worse than suggested by the positive test
results in the major population centers documented by the AP.

The federal government doesn't require any testing and hasn't set
safety limits for drugs in water. Of the 62 major water providers
contacted, the drinking water for only 28 was tested. Among the 34
that haven't: Houston, Chicago, Miami, Baltimore, Phoenix, Boston and
New York City's Department of Environmental Protection, which delivers
water to 9 million people.

Some providers screen only for one or two pharmaceuticals, leaving
open the possibility that others are present.

The AP's investigation also indicates that watersheds, the natural
sources of most of the nation's water supply, also are contaminated.
Tests were conducted in the watersheds of 35 of the 62 major providers
surveyed by the AP, and pharmaceuticals were detected in 28.

Yet officials in six of those 28 metropolitan areas said they did not
go on to test their drinking water -- Fairfax, Va.; Montgomery County
in Maryland; Omaha, Neb.; Oklahoma City; Santa Clara, Calif., and New
York City.

The New York state health department and the USGS tested the source of
the city's water, upstate. They found trace concentrations of heart
medicine, infection fighters, estrogen, anti-convulsants, a mood
stabilizer and a tranquilizer.

City water officials declined repeated requests for an interview. In a
statement, they insisted that "New York City's drinking water
continues to meet all federal and state regulations regarding drinking
water quality in the watershed and the distribution system" --
regulations that do not address trace pharmaceuticals.

In several cases, officials at municipal or regional water providers
told the AP that pharmaceuticals had not been detected, but the AP
obtained the results of tests conducted by independent researchers
that showed otherwise. For example, water department officials in New
Orleans said their water had not been tested for pharmaceuticals, but
a Tulane University researcher and his students have published a study
that found the pain reliever naproxen, the sex hormone estrone and the
anti-cholesterol drug byproduct clofibric acid in treated drinking
water.

Of the 28 major metropolitan areas where tests were performed on
drinking water supplies, only Albuquerque; Austin, Texas; and Virginia
Beach, Va.; said tests were negative. The drinking water in Dallas has
been tested, but officials are awaiting results. Arlington, Texas,
acknowledged that traces of a pharmaceutical were detected in its
drinking water but cited post-9/11 security concerns in refusing to
identify the drug.

The AP also contacted 52 small water providers -- one in each state,
and two each in Missouri and Texas -- that serve communities with
populations around 25,000. All but one said their drinking water had
not been screened for pharmaceuticals; officials in Emporia, Kan.,
refused to answer AP's questions, also citing post-9/11 issues.

Rural consumers who draw water from their own wells aren't in the
clear either, experts say.

The Stroud Water Research Center, in Avondale, Pa., has measured water
samples from New York City's upstate watershed for caffeine, a common
contaminant that scientists often look for as a possible signal for
the presence of other pharmaceuticals. Though more caffeine was
detected at suburban sites, researcher Anthony Aufdenkampe was struck
by the relatively high levels even in less populated areas.

He suspects it escapes from failed septic tanks, maybe with other
drugs. "Septic systems are essentially small treatment plants that are
essentially unmanaged and therefore tend to fail," Aufdenkampe said.

Even users of bottled water and home filtration systems don't
necessarily avoid exposure. Bottlers, some of which simply repackage
tap water, do not typically treat or test for pharmaceuticals,
according to the industry's main trade group. The same goes for the
makers of home filtration systems.

Contamination is not confined to the United States. More than 100
different pharmaceuticals have been detected in lakes, rivers,
reservoirs and streams throughout the world. Studies have detected
pharmaceuticals in waters throughout Asia, Australia, Canada and
Europe -- even in Swiss lakes and the North Sea.

For example, in Canada, a study of 20 Ontario drinking water treatment
plants by a national research institute found nine different drugs in
water samples. Japanese health officials in December called for human
health impact studies after detecting prescription drugs in drinking
water at seven different sites.

In the United States, the problem isn't confined to surface waters.
Pharmaceuticals also permeate aquifers deep underground, source of 40
percent of the nation's water supply. Federal scientists who drew
water in 24 states from aquifers near contaminant sources such as
landfills and animal feed lots found minuscule levels of hormones,
antibiotics and other drugs.

Perhaps it's because Americans have been taking drugs -- and flushing
them unmetabolized or unused -- in growing amounts. Over the past five
years, the number of U.S. prescriptions rose 12 percent to a record
3.7 billion, while nonprescription drug purchases held steady around
3.3 billion, according to IMS Health and The Nielsen Co.

"People think that if they take a medication, their body absorbs it
and it disappears, but of course that's not the case," said EPA
scientist Christian Daughton, one of the first to draw attention to
the issue of pharmaceuticals in water in the United States.

Some drugs, including widely used cholesterol fighters, tranquilizers
and anti-epileptic medications, resist modern drinking water and
wastewater treatment processes. Plus, the EPA says there are no sewage
treatment systems specifically engineered to remove pharmaceuticals.

One technology, reverse osmosis, removes virtually all pharmaceutical
contaminants but is very expensive for large-scale use and leaves
several gallons of polluted water for every one that is made
drinkable.

Another issue: There's evidence that adding chlorine, a common process
in conventional drinking water treatment plants, makes some
pharmaceuticals more toxic.

Human waste isn't the only source of contamination. Cattle, for
example, are given ear implants that provide a slow release of
trenbolone, an anabolic steroid used by some bodybuilders, which
causes cattle to bulk up. But not all the trenbolone circulating in a
steer is metabolized. A German study showed 10 percent of the steroid
passed right through the animals.

Water sampled downstream of a Nebraska feedlot had steroid levels four
times as high as the water taken upstream. Male fathead minnows living
in that downstream area had low testosterone levels and small heads.

Other veterinary drugs also play a role. Pets are now treated for
arthritis, cancer, heart disease, diabetes, allergies, dementia, and
even obesity -- sometimes with the same drugs as humans. The inflation-
adjusted value of veterinary drugs rose by 8 percent, to $5.2 billion,
over the past five years, according to an analysis of data from the
Animal Health Institute.

Ask the pharmaceutical industry whether the contamination of water
supplies is a problem, and officials will tell you no. "Based on what
we now know, I would say we find there's little or no risk from
pharmaceuticals in the environment to human health," said
microbiologist Thomas White, a consultant for the Pharmaceutical
Research and Manufacturers of America.

But at a conference last summer, Mary Buzby -- director of
environmental technology for drug maker Merck & Co. Inc. -- said:
"There's no doubt about it, pharmaceuticals are being detected in the
environment and there is genuine concern that these compounds, in the
small concentrations that they're at, could be causing impacts to
human health or to aquatic organisms."

Recent laboratory research has found that small amounts of medication
have affected human embryonic kidney cells, human blood cells and
human breast cancer cells. The cancer cells proliferated too quickly;
the kidney cells grew too slowly; and the blood cells showed
biological activity associated with inflammation.

Also, pharmaceuticals in waterways are damaging wildlife across the
nation and around the globe, research shows. Notably, male fish are
being feminized, creating egg yolk proteins, a process usually
restricted to females. Pharmaceuticals also are affecting sentinel
species at the foundation of the pyramid of life -- such as earth worms
in the wild and zooplankton in the laboratory, studies show.

Some scientists stress that the research is extremely limited, and
there are too many unknowns. They say, though, that the documented
health problems in wildlife are disconcerting.

"It brings a question to people's minds that if the fish were
affected ... might there be a potential problem for humans?" EPA
research biologist Vickie Wilson told the AP. "It could be that the
fish are just exquisitely sensitive because of their physiology or
something. We haven't gotten far enough along."

With limited research funds, said Shane Snyder, research and
development project manager at the Southern Nevada Water Authority, a
greater emphasis should be put on studying the effects of drugs in
water.

"I think it's a shame that so much money is going into monitoring to
figure out if these things are out there, and so little is being spent
on human health," said Snyder. "They need to just accept that these
things are everywhere -- every chemical and pharmaceutical could be
there. It's time for the EPA to step up to the plate and make a
statement about the need to study effects, both human and
environmental."

To the degree that the EPA is focused on the issue, it appears to be
looking at detection. Grumbles acknowledged that just late last year
the agency developed three new methods to "detect and quantify
pharmaceuticals" in wastewater. "We realize that we have a limited
amount of data on the concentrations," he said. "We're going to be
able to learn a lot more."

While Grumbles said the EPA had analyzed 287 pharmaceuticals for
possible inclusion on a draft list of candidates for regulation under
the Safe Drinking Water Act, he said only one, nitroglycerin, was on
the list. Nitroglycerin can be used as a drug for heart problems, but
the key reason it's being considered is its widespread use in making
explosives.

So much is unknown. Many independent scientists are skeptical that
trace concentrations will ultimately prove to be harmful to humans.
Confidence about human safety is based largely on studies that poison
lab animals with much higher amounts.

There's growing concern in the scientific community, meanwhile, that
certain drugs -- or combinations of drugs -- may harm humans over
decades because water, unlike most specific foods, is consumed in
sizable amounts every day.

Our bodies may shrug off a relatively big one-time dose, yet suffer
from a smaller amount delivered continuously over a half century,
perhaps subtly stirring allergies or nerve damage. Pregnant women, the
elderly and the very ill might be more sensitive.

Many concerns about chronic low-level exposure focus on certain drug
classes: chemotherapy that can act as a powerful poison; hormones that
can hamper reproduction or development; medicines for depression and
epilepsy that can damage the brain or change behavior; antibiotics
that can allow human germs to mutate into more dangerous forms; pain
relievers and blood-pressure diuretics.

For several decades, federal environmental officials and nonprofit
watchdog environmental groups have focused on regulated contaminants --
pesticides, lead, PCBs -- which are present in higher concentrations
and clearly pose a health risk.

However, some experts say medications may pose a unique danger
because, unlike most pollutants, they were crafted to act on the human
body.

"These are chemicals that are designed to have very specific effects
at very low concentrations. That's what pharmaceuticals do. So when
they get out to the environment, it should not be a shock to people
that they have effects," says zoologist John Sumpter at Brunel
University in London, who has studied trace hormones, heart medicine
and other drugs.

And while drugs are tested to be safe for humans, the timeframe is
usually over a matter of months, not a lifetime. Pharmaceuticals also
can produce side effects and interact with other drugs at normal
medical doses. That's why -- aside from therapeutic doses of fluoride
injected into potable water supplies -- pharmaceuticals are prescribed
to people who need them, not delivered to everyone in their drinking
water.

"We know we are being exposed to other people's drugs through our
drinking water, and that can't be good," says Dr. David Carpenter, who
directs the Institute for Health and the Environment of the State
University of New York at Albany.


The AP National Investigative Team can be reached at investigate (at)
ap.org

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http://www.washingtonpost.com/wp-dyn/content/article/2008/03/09/AR2008030900952_pf.html

NYC: Traces of Sedatives in NYC Water
BY Jeff Donn / March 9, 2008

NEW YORK -- Locals say this city makes the world's best bagels from
the best water, piped in from rustic reservoirs up to 150 miles north.
Yet few know of a secret ingredient in their source water: a dash of
pharmaceuticals.

Research studies have turned up minute amounts of more than 15 drugs
or their byproducts in several pristine-looking rivers, a reservoir,
and aqueducts feeding the country's biggest water system.

Though barely measurable, these pharmaceuticals are present in a
variety worthy of a medicine cabinet: drugs for aches, infections,
seizures and high blood pressure; hormones for menopause; the active
ingredient in a popular sedative; and caffeine _ all bound for the
city that never sleeps.

How did they reach waterways? The vast watershed, while mainly rural,
stretches almost from Pennsylvania to Connecticut and encompasses lots
of human activity. Human and veterinary medicines are excreted or
discarded, and eventually enter source waters mostly through
residential sewage or farm runoff.

And while these waters are processed at wastewater treatment plants
upstate, much of the pharmaceutical residue passes right through,
studies show.

It's unknown how much lingers each day by the time 1.1 billion gallons
reach the faucets of more than 9 million people in the city and
northern suburbs via a century-old network of aqueducts and tunnels.

The New York City Department of Environmental Protection, which runs
the city's water system, responded to an Associated Press survey of
water utilities, saying it has not tested its drinking water for
pharmaceuticals, despite the findings in its watershed.

The tests that detected pharmaceuticals in the upstate source waters
were conducted by the U.S. Geological Survey and New York State
Department of Health.

City water officials declined repeated requests for an interview and
issued only a brief general statement: "New York City's drinking water
continues to meet all federal and state regulations regarding drinking
water quality in the watershed and the distribution system" _
regulations that do not address pharmaceuticals in trace amounts.

As in other cities, human health risks from trace pharmaceuticals are
uncertain, since concentrations in New York source waters are way
below medical doses and undergo dilution as they mix with fresh water
en route to the city.

Already, though, troubling studies indicate that traces of
pharmaceuticals may be harming fish in New York City's Jamaica Bay,
within sight of Manhattan's skyscrapers. Researcher Anne McElroy at
Stony Brook University has found feminized male flounder there, and
she links them to high levels of the female hormone estrone or other
estrogenic chemicals discovered in the waterway.

Estrogen also has been found in the city's watershed in recent years.
Upstate, the geological survey and state health agency also detected
the heart medicine atenolol; anti-seizure drugs carbamazepine and
primidone; relaxers diazepam and carisoprodol; infection fighters
trimethoprim, clindamycin, and sulfamethoxazole; pain relievers
ibuprofen, acetaminophen and codeine; and remains of caffeine and
nicotine.

Despite all that, the federal government considers the New York City
system to be so clean that it need not filter most of its water, as
most big cities are required to do. When the filtering waiver was
extended last year, Mayor Michael R. Bloomberg exulted: "I've always
thought that New York City has some of the best water around, and now
we've got confirmation from Washington."

However, filtration is meant mainly to remove germs, and the federal
government hasn't required any testing of pharmaceuticals in source or
drinking water. Though it lacks conventional treatment plants with
filtering processes, New York City does disinfect and add chemicals to
its drinking water. Plus, it is building a filtration plant for water
from its Croton watershed _ its smallest and closest source.

Patrick Phillips, a geological survey hydrologist who has studied
drugs in the city's watershed, says recent sewage treatment upgrades
probably catch some, though the systems aren't designed to. The city
also is building a plant to disinfect with ultraviolet radiation the
water taken from the major, upstate sectors of the watershed. Research
shows that ultraviolet can degrade some pharmaceuticals.

"I think both the state and the city are aware that these things could
be an issue and you could be proactive about it," Phillips says.

Few New Yorkers seem aware of their possible presence. The AP
contacted more than two dozen water-testing companies across the
metropolitan area, and none had ever been asked to check for
pharmaceuticals.

Douglas LeVangie, a sales executive at Simpltek, says even the
company's home water tests for disease-causing germs sell modestly in
New York City, with its global reputation for wholesome water.

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http://www.washingtonpost.com/wp-dyn/content/article/2008/03/09/AR2008030901739.html?sid=ST2008030901877

The Drugs in the Area's Water / March 10, 2008

Tests revealed that some of the Washington area's drinking water
contained trace amounts of these drugs:

Caffeine: a stimulant found in food and drinks.
Carbamazepine: an anti-convulsive to reduce epileptic seizures and a
mood stabilizer for treating bipolar disorders.
Ibuprofen: an over-the-counter anti-inflammatory medication.
Monensin: an antibiotic administered to cattle.
Naproxen: an anti-inflammatory drug commonly found in Aleve.
Sulfamethoxazole: an antibiotic that can be used to treat infections
in humans and animals.
Triclocarban: a disinfectant found in antibacterial soaps.

SOURCE: Washington Aqueduct

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http://www.washingtonpost.com/wp-dyn/content/story/2008/03/09/ST2008030901877.html?sid=ST2008030901877

Area Tap Water Has Traces of Medicines
Tests Find 6 Drugs, Caffeine in D.C., Va.
BY Carol D. Leonnig / March 10, 2008

The Washington area's drinking water contains trace amounts of six
commonly used drugs that typically turn up in wastewater and cannot be
filtered out by most treatment systems.

The pharmaceuticals -- an anti-seizure medication, two anti-
inflammatory drugs, two kinds of antibiotics and a common disinfectant
-- were found in very small concentrations in the water supply that
serves more than 1 million people in the District, Arlington County,
Falls Church and parts of Fairfax County. But scientists say the
health effects of long-term exposure to such drugs are not known.

Pharmaceuticals, along with trace amounts of caffeine, were found in
the drinking water supplies of 24 of 28 U.S. metropolitan areas
tested. The findings were revealed as part of the first federal
research on pharmaceuticals in water supplies, and those results are
detailed in an investigative report by the Associated Press set to be
published today.

In addition to caffeine, the drugs found in water treated by the
Washington Aqueduct include the well-known pain medications ibuprofen
and naproxen, commonly found in Aleve. But there were also some lesser-
known drugs: carbamazepine, an anti-convulsive to reduce epileptic
seizures and a mood stabilizer for treating bipolar disorders;
sulfamethoxazole, an antibiotic that can be used for humans and
animals in treating urinary tract and other infections; and monensin,
an antibiotic typically given to cattle. In addition, the study
uncovered traces of triclocarban, a disinfectant used in antibacterial
soaps.

That the drugs were found so commonly nationwide highlights an
emerging water dilemma that the public rarely considers. The drugs we
use for ourselves and animals are being flushed directly into
wastewater, which then becomes a drinking water source downstream.
However, most wastewater and drinking water treatment systems,
including Washington's, are incapable of removing those drugs.

And although the chemicals pose no immediate health threat in the
water, the health effects of drinking these drug compounds over a long
period is largely unstudied. Some scientists said there is probably
little human health risk; others fear chronic exposure could alter
immune responses or interfere with adolescents' developing hormone
systems.

Washington's water regulators and utility officials say they are not
alarmed by the findings because the drugs are found at such low levels
-- parts per trillion, a tiny fraction of the amount in a medical
dose. But they do view these "emerging contaminants" with concern.

"What concerns me is we're finding pharmaceuticals in the river that
we rely upon for drinking water," said Thomas P. Jacobus, general
manager of the Washington Aqueduct. "If we can't get them out, we have
to find a way to neutralize them if we find there's a health effect
from them."

Jacobus said the aqueduct leadership will recommend in the next few
months likely upgrades for water treatment to deal with an array of
newly identified and increasing contaminants in the water. The
aqueduct uses chlorine, which kills a wide group of bacteria and
breaks down some chemicals but cannot disrupt pharmaceuticals. Studies
show ozone water treatment is the most effective in zapping such
drugs.

The U.S. Geological Survey and the U.S. Department of Agriculture have
been screening Washington's and other cities' water supplies for
pharmaceuticals in the first research project on pharmaceuticals in
the water. The Washington Aqueduct, an arm of the U.S. Army Corps of
Engineers, does not regularly screen for caffeine or pharmaceuticals,
nor do most water utilities.

The drugs discovered in testing over the past two years typically get
into the water supply because they pass through a user's body and are
flushed downstream. The U.S. Environmental Protection Agency is
studying some pharmaceuticals for their impact on public health but
has not set safety standards for any of the drugs.

"We recognize it is a growing concern, and we're taking it very
seriously," Benjamin H. Grumbles, the EPA's assistant administrator
for water, said of the drugs' presence.

There is no clear evidence of a human health threat from such low
levels of pharmaceuticals. But scientists warn that, because there has
been very little study of the long-term or synergistic effects of this
kind of drug exposure, water providers and regulators need to exercise
caution. Although experts agree that aquatic life are most at risk
from exposure to the drugs in rivers and streams, researchers are
concerned about what they don't know about human health effects.

In other findings from its reporting, the AP said officials in
Montgomery County and Fairfax have found numerous pharmaceuticals in
their environmental watersheds but do not test their drinking water
supplies for the same chemical compounds.

Nationwide, the AP reported that researchers found anti-depressants,
antacids, synthetic hormones from birth control pills, and many other
human and animal medicines in the water. In San Francisco, tests found
a sex hormone. In New York, the water tested positive for heart
medicines and a prescription tranquilizer.

-

http://www.dailynews.com/news/ci_8516128

At least one pharmaceutical was detected in tests of treated drinking
water supplies for 24 major metropolitan areas, according to an
Associated Press survey of 62 major water providers and data obtained
from independent researchers.

Only 28 tested drinking water. Three of those said results were
negative; Dallas says tests were conducted, but results are not yet
available. Thirty-four locations said no testing was conducted.

Here's the list of California metropolitan areas, grouped by
categories - those with positive test results, including the number of
pharmaceuticals detected and some examples of specific drugs found,
locations where tests were negative, locations where tests were not
conducted and a location with pending results:

TESTED POSITIVE

Concord: 2 (meprobamate and sulfamethoxazole)
Long Beach: 2 (meprobamate and phenytoin)
Los Angeles: 2 (meprobamate and phenytoin)
Riverside County: 2 (meprobamate and phenytoin)
San Diego: 3 (ibuprofen, meprobamate and phenytoin)
San Francisco: 1 (estradiol)
Southern California: 2 (meprobamate and phenytoin)

DID NOT TEST

Fresno: no testing
Oakland: no testing
Sacramento: no testing
San Jose: no testing
Santa Clara: no testing

At least one pharmaceutical or byproduct was detected in testing
within the watersheds of 28 major metropolitan areas, according to an
AP survey of 62 major water providers and data obtained from
independent researchers.

Test protocols varied widely. Some researchers tested for more drugs
than others. Thirty-five areas said they tested. Four said tests were
negative, and three said they were awaiting results. Twenty-seven
locations said they had not tested watershed supplies.

Here's the list of the California areas where pharmaceuticals were
detected, with the number found and some examples.

Concord: (unspecified drugs)
Long Beach: 9 (unspecified drugs)
Los Angeles: 9 (unspecified drugs)
Riverside County: 9 (unspecified drugs)
San Diego: 12 (clofibrate, clofibric acid, ibuprofen and nine
unspecified)
San Francisco: 1 (estrone)
Santa Clara: (unspecified drugs)
Southern California: 9 (unspecified drugs)

- The Associated Press