There’s Something in the Water

A recent study from the University of York, UK, found traces of 29 different drug compounds within two local rivers (1). The drugs detected included antidepressants, antibiotics, painkillers, and treatments for diabetes and epilepsy. The levels were in themselves low, but the team are concerned about the long-term impact of the emissions. How can the potential consequences for human (and environmental) health be better understood? And what can pharma do to help? We spoke to Alistair Boxall, Professor in Environmental Science at the University of York, about his quest to find out more.

Many studies have been done on pharmaceuticals emitted into the environment, but this one looked at emissions over time and in different locations. Why?

We know that pharmaceutical active ingredients occur in the environment, but our understanding of how concentrations vary in space and time is less developed. We need this understanding to allow us to properly assess the risks of these molecules to aquatic organisms. A key finding of our study is that concentrations of some active ingredients in rivers can be explained based on knowledge of what doctors in an area are prescribing at the time, and of river flows. We have also had some surprises; for example, in an earlier study looking at a wider range of pharmaceuticals, we detected some compounds that aren't prescribed in the UK; during periods of heavy rainfall we see elevated concentrations of compounds not usually detected, possibly due to inputs from combined sewer overflows which bypass wastewater treatment; and we detected some APIs in drinking water at similar concentrations to what we see in the river (although this data isn't published).

For human health, I think we need well thought through and long-term epidemiological studies. This will require a better understanding of spatial and temporal variations in exposure to APIs. For the environmental effects, lab work is needed on the reproduction and behavior of organisms, and this information needs to be combined with modelling approaches to extrapolate to effects on populations and communities. For antibiotics, we need to better understand the importance of environmental exposure for the problem of anti-microbial resistance.

What sources are these drug traces likely to be coming from?

In York, we think the main source is from patient use, with a small amount arising from inappropriate disposal of medicines. In monitoring we are doing elsewhere, for example in Nigeria, manufacturing inputs appear to be a major contributor. Veterinary inputs are also possible – although in our work, few of the compounds we look for are used in veterinary medicine. 

Is there anything pharma companies can do to help prevent these emissions?

Absolutely – some of the measures companies can take include introducing better treatments in their factories, or if obtaining actives from a supplier, they could ensure they only obtain materials from companies with good environmental standards. Longer term, they could move towards developing more environmentally benign medicines to replace the most environmentally risky molecules. Technological developments such as personalized medicine and nanomedicine, which will reduce patient doses, will also help reduce the environmental impact of medicine.

Do you think pharma companies also have a role to play in educating patients about safe disposal?

Yes. We recently ran a public survey in York and found that only about 16 percent of people know that we have a medicine take back scheme here in the UK. While better use of this scheme may not have a massive impact on the concentrations we detect, better awareness will mean that people become more mindful of the environmental issues around the medicines we use.

What next steps would you like to see to tackle drug traces in the environment? Who needs to get involved?

In Europe and North America, I suspect that only a small proportion of the 1,500 or so active ingredients we use are causing environmental harm. We need to develop ways in which we can identify these molecules so that mitigation efforts can focus on the compounds that really matter. This will require better sharing of data by industry and academia, and the development of approaches for prioritizing active ingredients in terms of their environmental risk. This is something we are already working on in the Innovative Medicines Initiative’s Intelligence-led Assessment of Pharmaceuticals in the Environment (iPiE) project, which involves 13 pharmaceutical companies and ten research and regulatory organizations.

Elsewhere, such as areas of Asia and Africa, the problem of pharmaceuticals pollution will be more acute due to things like disease pressures, a lack of connectivity to the wastewater network, and poorer regulation. We need to understand the implications for human health and the environment, and then industry, governments, academics and the NGO community need to work together to solve the problem.