The presence of pharmaceuticals in waterways is becoming a globally recognised problem with more and more research being carried out to uncover the ‘complete picture’.
Several relevant journal articles have been referenced within this article and are linked accordingly. We encourage you to engage with the links and read these articles in full, they are extremely interesting and will allow for a deeper understanding of the problem at hand. Most of these articles are free/open access.
One of the largest and most comprehensive studies to date was completed by PNAS (Proceedings of the National Academy of Sciences of the United States of America) in February 2022 and is linked here: Pharmaceutical pollution of the world’s rivers | PNAS The study details the severity of the problem in a global context. It outlines the presence of pharmaceuticals in waterways globally and compares their varying levels across countries and continents. The study’s results are shocking, with Active Pharmaceutical Ingredients (APIs) detected in every single continent, including sites tested in Antarctica.
This study, among many others, is proof of the fact that this is a real, expansive, and ever-increasing problem facing nations worldwide, including Australia. The evidence suggests that these numbers are only growing as production, demand, use and subsequent waste of pharmaceuticals increases. An Australian study linked here: A diverse suite of pharmaceuticals contaminates stream and riparian food webs | Nature Communications detected over 60 pharmaceutical compounds in aquatic invertebrates and riparian spiders in six streams near Melbourne.
Studies have conclusively proved that Pharmaceuticals have contaminated several ecosystemic compartments i.e. the hydrosphere (surface water, groundwater, drinking water); the geosphere; and the biosphere – see more info here: Pharmaceuticals in hospital wastewater: Their ecotoxicity and contribution to the environmental hazard of the effluent – ScienceDirect
We know there are many mechanisms by which drugs enter waterways:
- through pharmaceutical manufacturing;
- human consumption and subsequent metabolites;
- or (increasingly) through incorrect disposal of waste into; solid general waste, or directly into sewage systems.
Wastewater tested around hospitals and healthcare facilities has proved to be significantly contaminated with pharmaceuticals that are actively harming the environment and ecosystems.
The study linked above discusses this and highlights the fact that Hospital wastewater is almost always left untreated, discharged into urban wastewater streams and then into wastewater treatment plants that are not designed to remove complex compounds like pharmaceuticals.
This is specifically relevant to drugs like Propofol, that are highly aqua toxic and persist in the environment.
Propofol is increasingly appearing in wastewater around hospitals, which becomes concerning because it is not biodegradable in water, it has a high potential for bioaccumulation, it is highly toxic to aquatic organisms and may cause long-term adverse effects. See journal article here:
The PBT index (Persistence, Bioaccumulation and Toxicity) is used to rank the relative polluting potential of a given drug. This scale ranks up to 9 (9 being the most harmful). On this scale, Propofol sits at 9, meaning that it is one of the most environmentally harmful drugs at current. https://journals.lww.com/co-anesthesiology/pages/articleviewer.aspx?year=2020&issue=08000&article=00018&type=Fulltext
- One study concluded that 45% of all liquid anaesthetic waste was made up by propofol https://journals.lww.com/anesthesia-analgesia/fulltext/2012/05000/propofol_wastage_in_anesthesia.26.aspx
- A study across 12 northern Italian hospitals estimated that propofol wastage would be 158 L annually across the sites. https://journals.lww.com/anesthesia-analgesia/Fulltext/2021/05000/Evaluation_of_Drug_Wastage_in_the_Operating_Rooms.34.aspx
- Estimates from several studies suggest that approximately 20-60% of propofol is wasted. A study by the University of Pennsylvania suggested a waste figure of 51% Propofol Waste Reduction in the Operating Room (upenn.edu)
All the available evidence consistently proves that pharmaceuticals and APIs are undoubtedly evident in our waterways, and furthermore, in the wildlife that live in and near them. This then leads to the subsequent question, what impact does this have?
Pharmaceuticals contain ecologically disrupting compounds that have dangerous implications for vertebrates and invertebrates alike.
Studies of wildlife show that API’s and Pharmaceuticals are:
- Changing reproductive behaviours
- Impacting fight/flight response
- Causing sex changes
- Impacting nesting behaviour
- Suppressing individualist behaviour
- Changing Shoaling behaviour
- Pharmaceuticals and personal care products (PPCPs) are ecological disrupting compounds (EcoDC) | Elementa: Science of the Anthropocene | University of California Press (ucpress.edu)
- Emerging wastewater contaminant metformin causes intersex and reduced fecundity in fish – ScienceDirect
- Journals articles — Bob Wong Lab
This list is limited and only represents a fraction of the issues that are occurring because of Pharmaceutical pollution. For example, because of the presence of the NSAID Diclofenac in the environment, vulture populations worldwide are in mass decline and 15 different species are threatened with extinction. India alone has lost 99% of the population of three species of vultures as a result of this drug.
Drug debacle: Endangered vulture population still under threat (downtoearth.org.in)
This issue has many facets and action must be taken globally to ensure pharmaceuticals are properly managed and disposed of. In sectors such as healthcare, where there is such a high volume of drug wastage, appropriate protocols need to be implemented to ensure drugs do not end up in waterways, either through slow leeching in landfill or direct disposal into sewage systems via drains.
All the available evidence suggests that pharmaceuticals are present in waterways, even in the most remote locations in the world. Furthermore, it is proven that these pharmaceuticals are having a profound impact on wildlife.
Ensuring we take substantial action as individuals and institutions is the only ethical and appropriate response to this issue.
To learn more about DrugWaste International’s solutions to drug waste in healthcare, visit www.drugwaste.com.au. Our DrugWaste Bin is an innovative product used to dispose of dangerous drugs in a legally compliant, safe, and cost-effective way is a challenge for hospitals, day surgeries, general practitioners, aged care, veterinarians, and laboratories across Australia.
