One pharmacy in Virginia has the best solution to a large part of the pharma water emissions problem. It collects unused or expired medications from its customers, then has them incinerated. More, from the Washington Post. This type of program, on the grass roots level, could have a big impact on reducing levels of API's and drugs in the municipal water supplies (as for the rest, improved yields and process efficiencies are the answer). Although incentives would be needed--after all, how many consumers do you know who take the extra steps required to dispose of hazardous household waste, properly?