Pharmaceutical ingredients have been detected in the environment – on every continent. The same properties that make pharmaceuticals effective increase the risk of undesired effects in the environment.

Pharmaceutical residues in the environment are a growing concern. Active pharmaceutical ingredients (APIs) are a wide and diverse group of compounds. They are designed to cure, treat, and prevent diseases and their benefits to humans are undisputable. The consumption of medicines and improper waste management, however, also exposes other organisms to APIs.

Most active pharmaceutical ingredients are designed to affect biological organisms at low concentrations. Toxicity is an important and inbuilt property of many pharmaceuticals, such as antibiotics and cytostatics. Furthermore, APIs have to be persistent enough to reach the target organ and to produce the desired medicinal effect. These properties make pharmaceuticals effective. At the same time, they increase the environmental risk of undesired effects on non-target species.

Active pharmaceutical ingredients have been detected in the environment on every continent.”

Active pharmaceutical ingredients have been detected in the environment on every continent (aus der Beek et al., 2016). In 2017 UNESCO and the Baltic Marine Environment Protection Commission (HELCOM) compiled information about pharmaceutical residues in the Baltic Sea region. It became clear that in the Baltic Sea region APIs such as carbamazepine and primidone are also widely detected in environmental samples.

 

Lauri Äystö, Researcher, the Circular Economy Solutions unit, the Finnish Environment Institute and former CWPharma Activity Leader, and Noora Perkola, Leading Researcher and Group Manager, the Circular Economy Solutions unit, the Finnish Environment Institute and former CWPharma Project Leader. Photo: © Kai Widell / Finnish Environment Institute

 

A dozen risk APIs identified

While the report by UNESCO and HELCOM compiled the information available by 2014, it also identified several knowledge gaps. In our project CWPharma, funded by the EU program Interreg Baltic Sea Region, we aimed to fill in these gaps. The project was a collaboration between leading environmental organizations, waterworks associations and operators, research organizations and medicinal authorities in seven countries in the Baltic Sea region.

We identified 12 risk APIs where concentrations in the environment exceed the predicted no-effect concentrations.”

During 2017–2020 the CWPharma project worked to identify the APIs that cause the highest environmental risks in the Baltic Sea region, and to find the best ways to decrease the API emissions into the environment.

With extensive sampling and testing, we identified 12 risk APIs where concentrations in the environment exceed the predicted no-effect concentrations. These substances include e.g., the non-steroidal anti-inflammatory diclofenac, antibiotics clarithromycin, ofloxacin and doxycycline, as well as the hormones norethisterone and estrone (Ek Henning et al., 2020).

 

Left: The CWPharma project screened active pharmaceutical ingredients in six river basin districts to get a better picture of their sources, emissions and environmental concentrations in the Baltic Sea region. Twelve out of 75 studied pharmaceuticals were identified as a risk to the environment. Photo © Katri Siimes / CWPharma Project. Right: The Baltic Sea. Photo: iStock

 

Enhanced wastewater treatment can help but has its price tag

Pharmaceuticals consumed and excreted by humans are usually flushed into the sewer network and then further to a centralized wastewater treatment plant. Thus, one of the most effective ways to reduce pharmaceutical load on the environment is to enhance wastewater treatment. Technologies that can remove pharmaceutical residues already exist. These technologies include e.g., oxidation using ozone and sorption using activated carbon, which are already used in some of the wastewater treatment plants in the Baltic Sea region. For instance, ozonation is already in operation in Linköping, Sweden and Kalundborg, Denmark.

The studies in the CWPharma project show that the loads of two high risk APIs, namely diclofenac and clarithromycin, could be significantly reduced by wider use of ozonation technology.”

The studies in the CWPharma project show that the loads of two high risk APIs, namely diclofenac and clarithromycin, could be significantly reduced by wider use of ozonation technology. Diclofenac and clarithromycin Baltic Sea loads could be reduced by approximately 70%, if ozonation was added to the process in all the wastewater treatment plants that serve more than 50,000 persons (Äystö and Stapf, 2020). The recent EU proposal for updated Urban Wastewater Treatment Directive would require technology that can remove micropollutants, such as pharmaceutical residues, from wastewater treatment plants that serve 100,000 persons or more. While enhanced wastewater treatment has the potential to reduce the environmental loads of several problematic APIs and other contaminants, it increases treatment costs. It also increases the greenhouse gas emissions caused by the treatment. The annual global warming potential of implementing enhanced technologies in all wastewater treatment plants of more than 50,000 connected persons was estimated to be 370,000 t CO2eq (Äystö and Stapf, 2020), which is approximately 0.6% of the total greenhouse gas emissions from the Baltic States (Crippa et al. 2021).

Our estimation is that if all wastewater generated within the Baltic Sea region was treated using a conventional activated sludge process, the loads of certain APIs, such as ibuprofen, could be decreased drastically.”

According to our studies in the CWPharma project, the Baltic Sea environment pharmaceutical burden could be reduced also by simply increasing the sewer network coverage. In all the countries in the Baltic Sea region, the vast majority of domestic wastewater is treated. However, there are still some countries, such as Russia, where the fraction of treated domestic wastewater is still as low as 67% (UNICEF and WHO, 2019). We all know that untreated wastewater released into the environment raises hygienic concerns, but it also increases API load into the environment. Our estimation is that if all wastewater generated within the Baltic Sea region was treated using a conventional activated sludge process, the loads of certain APIs, such as ibuprofen, could be decreased drastically (Äystö and Stapf, 2020).

Read more: Nordic solutions for handling pharma waste

Making environmentally wise prescriptions easier

Due to their undisputable benefits, APIs cannot be banned in the same way as some industrial chemicals or pesticides. However, there are attempts to decrease the use of environmentally problematic substances, without compromising patient safety or the quality of care.

In Sweden an environmental classification of pharmaceutical substances (janusinfo.se and fass.se) has been in place for nearly 20 years, helping doctors and pharmacists to make environmentally wise choices whenever possible. A similar system is in place also in Norway and has recently been implemented in Finland.

Environmental classification could optimally result in pharmaceuticals with high environmental burden being replaced with less problematic ones. Reducing the consumption of environmentally risky pharmaceuticals would directly reduce their load into the environment. Moreover, it could relieve the pressure for enhanced wastewater treatment.

 

Waste management and separate collection practices for unused pharmaceuticals vary within the Baltic Sea region. In countries such as Finland and Sweden, separate collection works well, but there are also countries like Russia and Poland where separate collection functions poorly or does not exist at all, writes the authors. Photo: iStock

 

Another economically reasonable way of reducing pharmaceutical load into the environment is to reduce the amount of unused pharmaceuticals. This would also help to cut the price tag of waste management. Unused pharmaceuticals unnecessarily increase API load into the environment during their production and waste management. Furthermore, society pays reimbursement costs also for the medicines that will not be used.

Waste management and separate collection practices for unused pharmaceuticals vary within the Baltic Sea region. In countries such as Finland and Sweden, separate collection works well (Louhisalmi et al., 2020 and Mehtonen et al., 2020), but there are also countries like Russia and Poland where separate collection functions poorly or does not exist at all.

Read more: Danish technology purifies pharmaceutical wastewater sustainably

Work on many fronts

The effects of pharmaceuticals in the environment are acknowledged widely, and actions towards better emission management are already taking place. Recent developments in this area include two important directive proposals by the European Commission.

Recent developments in this area include two important directive proposals by the European Commission.”

Firstly, a group of APIs have been proposed as priority substances in the Water Framework Directive. This would bring along legally binding environmental quality standards (“safe concentrations”) for surface waters, and in some cases for groundwater as well. This change would speed up actions to reduce API emissions into the environment, as exceeding the environmental quality standards would mandate countries to act.

Secondly, there is the proposal for the updated Urban Wastewater Treatment Directive. This update would require the implementation of further wastewater treatment steps to eliminate micropollutant emissions (APIs included), along with increased micropollutant monitoring schemes.

Better understanding of the environmental risks related to pharmaceutical residues has spurred a growing interest in green pharmacy, which can already be seen in university curriculums.”

Better understanding of the environmental risks related to pharmaceutical residues has spurred a growing interest in green pharmacy, which can already be seen in university curriculums. This new generation of professionals will attempt to combine environmental friendliness and API design.

The currently ongoing and proposed actions will decrease the environmental load of APIs in the future. Meanwhile, we can all do our best  to treat our pharmaceutical waste properly and avoid unnecessary medication.

 

This Commentary was originally written by Noora Perkola and Lauri Äystö for NLS magazine No 01 2023, out March 2023.

 

 

About the authors:

 

Noora Perkola and Lauri Äystö. Photo: © Kai Widell / Finnish Environment Institute

 

Noora Perkola: PhD Noora Perkola works as a Leading Researcher and Group Manager at the Circular Economy Solutions unit of the Finnish Environment Institute. She was the CWPharma Project Leader.

Lauri Äystö: MSc Lauri Äystö works as a researcher on contaminants at the Circular Economy Solutions unit of the Finnish Environment Institute. In CWPharma he worked as an activity leader. Since then, he has acted as the leader of the Baltic Sea Pharma Platform, a EUSBSR flagship focusing on pharmaceuticals in the Baltic Sea Region environment.

 

 

3 X Links

Project CWPharma website: cwpharma.fi/en-US
Web Map Application: CWPharma – Pharmaceutical emissions to the Baltic Sea. Finnish Environment Institute 2020
Baltic Sea Pharma Platform: syke.fi/projects/BalticPharma