The environmental effects of pharmaceutical and personal care products (PPCPs) has been of concern since at least the 1990s. PPCPs include substances used by individuals for personal health or cosmetic reasons and the products used by agribusiness to boost growth or health of livestock. More than twenty million tons of PPCPs are produced every year. The European Union has declared that pharmacological residues with the potential for contamination of water and the soil are "priority substances".
PPCPs have been detected in waters throughout the world. More research is needed to evaluate the risks of toxicity, persistence, and bioaccumulation, but current research shows that personal care products affect the environment and other species, such as coral reefs and fish. PPCPs encompass environmental persistent pharmaceutical pollutants (EPPPs) and are one type of persistent organic pollutants. They are not removed in conventional sewage treatment plants but require a fourth treatment stage which not many plants have.
In 2022, the most comprehensive study of pharmacological pollution of the world's rivers showed that it threatens "environmental and/or human health in more than a quarter of the studied locations". It investigated 1052 sampling sites along 258 rivers in 104 countries, representing pollution of rivers serving 470 million people. It showed that "the most contaminated sites were in low- to middle-income countries and were associated with areas with poor wastewater and waste management infrastructure and pharmaceutical product manufacture" and listed the most frequently detected and concentrated pharmaceutical products.
Overview Since the 1990s, water pollution by pharmaceutical products has been an environmental issue of concern. Many public health professionals in the USA began writing reports of pharmaceutical product contamination in waterways in the 1970s." Most pharmacological agents are deposited in the environment through human consumption of pharmaceutical product and excretion of their active ingredients, and are often filtered ineffectively by municipal sewage treatment plants, which are not designed to manage them. Once in the water, they can have diverse subtle effects on organisms, although research is still limited. Pharmacological agents may also be deposited in the environment through improper disposal, run-off from sludge fertilizer and reclaimed wastewater irrigation, and leaky sewer pipes. In 2009, an investigative report by Associated Press concluded that US manufacturers had legally released 271 million pounds of compounds used as medicines into the environment, 92% of which were the industrial chemicals phenol and hydrogen peroxide, which are also used as antiseptics. It could not distinguish between drugs released by manufacturers as opposed to the pharmaceutical industry. It also showed that an estimated 250 million pounds of pharmaceutical products and contaminated packaging were discarded by hospitals and long-term care facilities.Donn J. (2009). Tons of Released Drugs Taint U.S. Water. AP. The series of articles led to a hearing conducted by the US Senate Subcommittee on Transportation Safety, Infrastructure Security, and Water Quality. This hearing was designed to address the amounts of pharmacological contaminants in US drinking water. This was the first time that pharmaceutical companies were questioned about their waste disposal methods. "No federal regulations or laws were created as a result of the hearing." "Between 1970 and 2018 more than 3000 pharmacological chemicals were manufactured, but only 17 are screened or tested for in waterways." Alternatively, "There are no studies designed to examine the effects of pharmaceutical contaminated drinking water on human health." In parallel, the European Union is the second biggest consumer in the world (24% of the world total) after the USA, and in most EU Member States around half of unused human medicinal products are not collected to be disposed of properly. In the EU, 30-90% of orally administered doses are estimated to be excreted as active substances in the urine.
The term environmental persistent pharmaceutical pollutants (EPPP) was suggested in the 2010 nomination of pharmaceutical products and the environment as an emerging issue to Strategic Approach to International Chemicals Management (SAICM) by the International Society of Doctors for the Environment (ISDE).
Safe disposal Depending on the sources and ingredients, there are various ways in which the public can dispose of pharmaceutical and personal care products in acceptable ways. The most environmentally safe disposal method is to take advantage of community drug take-back programs that collect drugs at a central location for proper disposal. Several local public health departments in the United States have initiated these programs. In addition, the United States Drug Enforcement Administration (DEA) periodically promotes local take-back programs, as well as the National Take Back Initiative.
Take-back programs in the US are funded by state or local health departments or are volunteer programs through pharmacies or health care providers. In recent years, the proposition that pharmaceutical manufacturers should be responsible for their products "from the cradle to the grave" has been gaining attention. Where there is no local take-back program, the U.S. Environmental Protection Agency (EPA) and the Office of National Drug Control Policy suggest in a 2009 guidance that consumers do the following: take the prescription drugs out of their original containers mix drugs with cat litter or used coffee grounds place the mixture into a disposable container with a lid, such as a sealable bag cover up any personal identification with a black marker that is on the original pill containers place these containers in the bag with the mixture, seal them, and place them in the trash.
The intent of the recommended practices is that the chemicals would be separated from the open environment, especially water bodies, long enough for them to naturally break down.
When these substances find their way into water, it is much more difficult to deal with them. Water treatment facilities use different processes in order to minimize or eliminate these pollutants. This is done by using sorption where suspended solids are removed by sedimentation. Another method used is biodegradation, and through this method microorganisms, such as bacteria and fungi, feed on or break down these pollutants thus eliminating them from the contaminated media.
Types
Pharmaceuticals, or prescription and over-the-counter medications made for human use or veterinary or agribusiness purposes, are common PPCPs found in the environment. There are nine classes of pharmaceuticals included in PPCPs: hormones, antibiotics, lipid regulators, nonsteroidal anti-inflammatory drugs, beta-blockers, antidepressants, anticonvulsants, antineoplastics, and diagnostic contrast media.
Personal care products have four classes: fragrances, preservatives, disinfectants, and sunscreen agents. These products may be found in cosmetics, perfumes, menstrual care products, lotions, shampoos, soaps, toothpastes, and sunscreen. These products typically enter the environment when passed through or washed off the body and into the ground or sewer lines, or when disposed of in the trash, septic tank, or sewage system.
Traces of illicit drugs can be found in waterways and may even be carried by money.
Routes into the environment
More attention has been devoted since 2016 to PPCPs in the environment. Two causes may contribute to this: either PPCPs are really increasing in the environment owing to widespread use and/or analytical technology is better able to detect PPCPs in the environment. These substances enter the environment directly or indirectly. Direct methods include contamination of surface water by hospitals, households, industries, or sewage treatment plants. Direct contamination can also affect the sediment and soil.
It is generally assumed (albeit poorly verified) that the production of pharmaceutical products in industrialised countries is well controlled and not harmful to the environment, owing to the local legal restrictions that are usually required to permit production. However, a substantial fraction of the global production of pharmaceutical products takes place in low-cost production countries like India and China. Recent reports from India show that such production sites may emit very large quantities of e.g. antibiotics, yielding higher concentrations of the drugs in local surface waters than those found in the blood of patients during treatment.
The major route whereby pharmacological residues from pharmaceutical products reach the aquatic environment is most probably by excretion from patients undergoing pharmacological treatment. Since many pharmacological substances are not metabolized in the body they may be excreted in biologically active form, usually via the urine. Furthermore, many pharmacological substances are not fully taken up from the intestine (following oral administration in patients) into their bloodstream. The fraction not taken up into the bloodstream will remain in the gut and eventually be excreted via the feces. Hence, both urine and feces from treated patients contain pharmacological residues. Between 30 and 90% of an orally administered dose is generally excreted as active substance in the urine.
An additional conttribution to environmental pollution from pharmaceutical producs is improper disposal of unused or expired pharmaceutical residues. In European countries take-back systems for such residues are usually in place (although not always used to full extent), while in the USA there are only voluntary local initiatives. Although most of the waste goes to incineration, and people are asked to throw unused or expired pharmaceutical products into their household waste, investigations in Germany showed that up to 24% of liquid pharmaceutical products and 7% of tablets or ointments are disposed always or at least "rarely" via the toilet or sink.
Proper destruction of pharmaceutical products should yield products without any pharmacological or ecotoxic activity. Furthermore, the residues should not act as components in the environmental formation of new products. Incineration at a high temperature (>1000 degrees Celsius) is considered to fulfill the requirements, but even after incineration residual ashes should be properly disposed of.
Pharmaceutical products used in veterinary medicine, or as additives to animal feeds, pose a different problem, since they are excreted into the soil or possibly open surface waters. It is well known that such excretions may affect terrestrial organisms directly, leading to extinction of exposed species (e.g. dung-beetles). Lipid-soluble pharmacological residues from veterinary use may bind strongly to soil particles, with little tendency to leak out to ground water or to local surface waters. More water-soluble residues may be washed out in rain or melting snow and reach both ground water and surface water streams.
Presence in the environment