Metformin and other pharmaceuticals widespread in wadeable streams of the southeastern United States

Pharmaceutical contaminants are growing aquatic-health concerns and largely attributed to wastewater treatment facility (WWTF) discharges. Five biweekly water samples from 59 small Piedmont (United States) streams were analyzed for 108 pharmaceuticals and degradates using high-performance liquid chromatography and tandem mass spectrometry. The antidiabetic metformin was detected in 89% of samples and at 97% of sites. At least one pharmaceutical was detected at every site (median of 6, maximum of 45), and several were detected at ≥10% of sites at concentrations reported to affect multiple aquatic end points. Maximal cumulative (all detected compounds) concentrations per site ranged from 17 to 16000 ng L^–1. Watershed urbanization, water table depth, soil thickness, and WWTF metrics correlated significantly with in-stream pharmaceutical contamination. Comparable pharmaceutical concentrations and detections at sites with and without permitted wastewater discharges demonstrate the importance of non-WWTF sources and the need for broad-scale mitigation. The results highlight a fundamental biochemical link between global human-health crises like diabetes and aquatic ecosystem health.