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Pharmaceuticals in the Environment:

A Threat to the Health of Ecosystems, Animals, and Humans

Pharmaceutical pollution can be found on all continents. Pharmaceuticals can enter the environment throughout their life cycle and cause serious damage to ecosystems and contribute to antimicrobial resistance (AMR). There are many actors across the pharmaceutical value chain, who with the support of improved regulation, must all take action to effectively reduce this environmental and health threat.

Pharmaceuticals have a Global Presence

More than 700 pharmaceutical agents or their metabolites have been detected in the environment1 across the world. These pharmaceutical residues are found in both soil and water systems, including surface and groundwater used for drinking water. In the environment, drugs can have harmful effects on animal and plant life-threatening whole ecosystems. There are also questions about how humans can be affected by continuous, long-term exposure to low concentrations in drinking water. In 2015, the potential adverse effects associated with exposure to environmentally persistent pharmaceutical pollutants2 (EPPPs) on human health and the environment were recognised within the Strategic Approach to International Chemicals Management (SAICM) global policy framework. In 2020, the UN Environment’s Assessment Report on Issues of Concern recommended expanding the scope of EPPPs to include pharmaceuticals in the environment. Therapeutic classes of particular concern in the environment are anti-inflammatory drugs and sedatives consumed in large quantities, cytostatics that are cytotoxic by design, synthetic hormones that can act as endocrine disruptors, and antibiotics. Negative effects include renal failure in vulture populations, detrimental impact on the genetic material of aquatic organisms, reproductive failure in fish, and inhibition of the growth of certain aquatic species.

The Threat of Antimicrobial Resistance

The biggest concern of pharmaceuticals in the environment, however, is the contribution to the development and spread of antimicrobial resistance (AMR), a serious health and development threat that makes infections increasingly difficult or impossible to treat. It is estimated that AMR causes the direct deaths of 1.27 million people3 worldwide every year. Without effective action, AMR’s death toll could spiral up to 10 million people annually by 2050.4 Increasing AMR linked to the discharge of drugs and particular chemicals into the environment has been described by UN Environment as one of the most worrying health threats today.5 The main pollutant sources that exacerbate AMR6 include poor sanitation, sewage, and waste effluent; effluent and waste from pharmaceutical production, healthcare facilities, and animal production; as well as antimicrobial use and manure in crop production. In 2022, the One Health Leaders Group on AMR, which brings together world leaders and experts to accelerate political action on AMR, called for a reduction in antimicrobial discharges from food systems,7 manufacturing facilities, and human health systems into the environment. Their recommendations include strengthening governance and oversight, improving surveillance and data availability, improving discharge management, and promoting research and development.

Main Pathways into the Environment

Pharmaceuticals can reach the environment throughout their life cycle, during manufacturing, excretion, and disposal. Wastewater treatment plants, which are primarily designed to eliminate biodegradable substances, have varying capacities to eliminate pharmaceutical substances in wastewater and even a low removal efficiency for most drugs. In addition, they do not capture diffuse sources of pharmaceutical solutions such as surface run-off from agriculture. Excretion after consumption is considered the most common entry pathway for pharmaceuticals into the environment with 30%–90% of orally administered drugs8 being excreted as an active substance in the urine and feces of animals and humans. Waste from unused medicine is another important problem, representing 10% of wastewater pollution9 with patients flushing medication down the toilets or sink.