POLICY HIGHLIGHT

S

Pharmaceutical Residues
in Freshwater

Hazards and Policy Responses

Pharmaceutical Residues
in Freshwater
Hazards and Policy Responses

“A combination of promoting hygiene practices to reduce the incidence of
infection and disease, encouraging sustainable pharmaceutical design and

production, spreading awareness of responsible pharmaceutical use and

disposal, and improving environmental monitoring and risk assessment

of pharmaceuticals, are critical steps to achieving the dual sustainable

development goals of improving health and protecting the environment.”

Rodolfo Lacy

Director of the Environment Directorate, OECD

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OECD POLICY HIGHLIGHTS Pharmaceutical residues in freshwater: Hazards and policy responses . 1

The OECD (2019) report Pharmaceutical Residues
in Freshwater: Hazards and Policy Responses
calls for a better understanding of the effects
of pharmaceutical residues in the environment,
greater international collaboration and
accountability distribution, and policy actions to
prevent and remedy emerging concerns. Laboratory
and field tests show traces of oral contraceptives causing
the feminisation of fish and amphibians, and residues of
psychiatric drugs altering fish behaviour. Antimicrobial
resistance, linked to the overuse of antibiotics, has rapidly
escalated into a global health crisis.

Unless adequate measures are taken to manage
the risks, pharmaceutical residues will increasingly
be released into the environment as ageing populations, advances in healthcare, and
intensification of meat and fish production spur the demand for pharmaceuticals worldwide.
The report outlines a collective, life-cycle approach to managing pharmaceuticals in the
environment. A policy mix of source-directed, use-orientated and end-of-pipe measures,
involving several policy sectors, can help to improve health and protect the environment.

Pharmaceuticals are an important element of medical and
veterinary practice, and their beneficial effects on human
and animal health, food production and economic welfare
are widely acknowledged. However, an area where we
lack a common understanding is what happens when
these pharmaceuticals are constantly discharged into the
environment, through pharmaceutical manufacturing,

consumption

and excretion, and improper disposal of
unused or expired products.

Pharmaceuticals in the environment are a challenge to
manage for the following reasons:

2 . OECD POLICY HIGHLIGHTS Pharmaceutical residues in freshwater: Hazards and policy responses

Number of pharmaceuticals
detected in surface water,
groundwater, tap water,
and/or drinking water

0 or no data

1-3

4-10

11-30

31-100
101-200

1The challenge of managing pharmaceuticals in water
l Pharmaceuticals are designed to interact with a

living system and produce a pharmacological
response at low doses, which makes them
of environmental concern even at low
concentrations. When exposed to non-target
organisms in the environment, unintentional
harmful impacts may occur.

l Pharmaceuticals are designed to be stable in
order to reach and interact with target molecules.
This means that either they are very slow to
degrade or their constant use leads to continuous
release into the environment at rates exceeding
degradation rates.

Source: (aus der Beek et al., 2016).

HIGH ENVIRONMENTAL
CONCENTRATIONS OF
PHARMACEUTICALS DETECTED

Extremely high pharmaceutical
concentrations (in the order of mg/l),
have been detected in industrial effluents
and recipient streams in China, India,
Israel, Korea and the USA (Larsson, 2014).

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OECD POLICY HIGHLIGHTS Pharmaceutical residues in freshwater: Hazards and policy responses . 3

Number of pharmaceuticals
detected in surface water,
groundwater, tap water,
and/or drinking water
0 or no data
1-3
4-10
11-30
31-100
101-200

2000
ACTIVE PHARMACEUTICAL
INGREDIENTS
About 2,000 active pharmaceutical
ingredients are being administered
worldwide in prescription medicines,
over-the-counter therapeutic drugs and
veterinary drugs (Burns et al., 2018).

30-90

%

ORAL DOSES EXCRETED AS ACTIVE
SUBSTANCES

Pharmaceuticals administrated to
humans or animals are excreted via urine
and faeces, with 30 to 90% of oral doses
generally excreted as active substances
(BIO Intelligence Service, 2013).

l Conventional wastewater treatment plants
are not designed to, nor do they fully, remove
pharmaceuticals from wastewater. Furthermore,
veterinary pharmaceuticals used in agriculture and
aquaculture can enter water bodies directly or via
surface runoff (diffuse pollution).

l For most wildlife, exposure to pharmaceuticals in
the environment could be long-term, potentially
occurring via multiple exposure routes, and
involving mixtures of substances.

Source: W

4 . OECD POLICY HIGHLIGHTS Pharmaceutical residues in freshwater: Hazards and policy responses

2Sources and trends of pharmaceuticals in the environment
Pharmaceuticals are present in the environment as a consequence of
pharmaceutical production and formulation, patient use, use in food
production and improper disposal of unused or expired products (Figure 1).

The presence of pharmaceuticals in freshwater and terrestrial ecosystems
can result in the uptake of pharmaceuticals into wildlife, and have the
potential to bioaccumulate. Humans can subsequently be exposed
through drinking water, and ingestion of pharmaceutical residues in plant
crops, fish, dairy products and meat.

The concentrations and impacts of pharmaceuticals in the environment
depend on a combination of variables, including their use and the toxicity,
degradation, persistence and mobility properties of the pharmaceutical;
source and timing of pollution; wastewater treatment plant technology,
operation and removal efficiency; agriculture and veterinary practices; and
the sensitivity of the receiving environment and exposure history (Figure 2).

Figure 1. Major pathways of release of human and veterinary
pharmaceuticals into the environment

1/3
OF PRESCRIPTION ITEMS BECOME
WASTE IN THE UNITED STATES

In the United States, it is estimated
that about one-third of the four billion
prescription items annually become waste
(Product Stewardship Council, 2018).

6.5
PHARMACEUTICAL INDUSTRY
ANNUAL GROWTH RATE

Projected growth rate of the
pharmaceutical industry: 6.5% per year by
2022 (UN Environment, 2019).

%

CLIMATE CHANGE TO INCREASE RISK
OF DISEASE

Millions of people are predicted to be
newly at risk to mosquito-borne and
tick-borne diseases under climate change.
(Cavicchioli et al., 2019).

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OECD POLICY HIGHLIGHTS Pharmaceutical residues in freshwater: Hazards and policy responses . 5

Figure 2. A typology for pharmaceuticals in the environment

Sources

• Pharmaceutical
manufacturing
plants

• WWTPs
– Municipal
– Hospitals
– Industry

• Agriculture
(particularly
intensive
livestock
farming)

• Aquaculture
• Septic tanks
• Waste

management
facilities
(landfills).

Pathways

• Point source
(WWTP
discharge)

• Diffuse
source (i.e.
agricultural
runoff,
leaching of
septic tanks to
groundwater).

Concentration
patterns

• Continuous
(e.g. WWTPs)

• Seasonal
(linked with
farming
practices and
with seasonal
influenza
and allergies,
water
flow and
temperature)

• Intermittent
(linked with
rainfall events,
stormwater
overflow,
irrigation
patterns and
pandemics).

Pharmaceutical
properties

• Persistence
– Half life
– Solubility
– Metabolites
– Transformation
products

• Bioaccumulation
• Toxicity

– Individual effects
– Population
effects
– Additive effects
– Mixture effects

• Mobility

Receiving
environment
type (sinks)

• Rivers
• Lakes
• Groundwater
• Soil
• Sediment
• Coastal zones

Oceans

Concentration, context-
dependent factors

• Medical, agriculture and
veterinary practices

• Illicit drug use
• Consumption rates
• Pharmaceutical properties
• Disposal and waste

management practices
• WWTP technology, operation

and removal efficiency
• Receiving environment type
• Climate
• Drainage characteristics
• Water flow variations
• Sunlight, temperature
• Presence of other pollutants
• Exposure history
• Disturbance regime
• Food web structure

Note: WWTPs: wastewater treatment plants.

Pharmaceuticals in the environment are expected to rise with an increase in
pharmaceutical consumption. The use of pharmaceuticals will increase as:

l populations age and life-spans increase;

l economies grow – particularly in emerging economies – and with
it, an increasing ability and expectation to treat ageing-related and
chronic diseases;

l clinical practices evolve – recommendations of earlier treatement,
higher dosages or prolonged treatment;

l livestock and aquaculture practices are intensified;

l new pharmaceuticals are engineered;

l climate change exacerbates existing diseases. Non-communicable
diseases (e.g. cardiovascular disease and mental illness) and respiratory,
water-borne, vector-borne and food-borne toxicants and infections are
expected to become more common as climate change intensifies.

67
PROJECTED INCREASE IN LIVESTOCK
ANTIBIOTICS WORLDWIDE BY 2030

Projected increase in antibiotics
administered to livestock animals in feed:
67% worldwide by 2030 (from 2015 levels)
(Van Boeckel et al., 2015). Much of this
increase will come in emerging economies.

%

43-67
INCREASE IN PHARMACEUTICAL
USAGE, GERMANY

In Germany, pharmaceutical usage is
projected to increase by 43-67% by the
year 2045 (from a baseline of 2015). An
ageing population is thought to be the
main driver (Civity, 2017).

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6 . OECD POLICY HIGHLIGHTS Pharmaceutical residues in freshwater: Hazards and policy responses

3Impacts of pharmaceuticals in the environment on human and freshwater ecosystem health
The presence of pharmaceuticals in the environment
has raised concerns among drinking water regulators,
governments, water suppliers and the public. Certain
pharmaceuticals have been proven in laboratory
experiments to cause unintended, undesired adverse
effects on aquatic organisms, including mortality, as well
as changes to physiology, behaviour and reproduction.
Of greatest concern are: hormones, antibiotics, analgesics,
antidepressants and anticancer pharmaceuticals used for
human health; and hormones, antibiotics and parasiticides
used as veterinary pharmaceuticals.

For example, active substances in oral contraceptives
have caused the feminisation of fish and amphibians;
psychiatric drugs, such as fluoxetine have altered fish
behaviour making them less risk-averse and vulnerable to

predators, and the over-use and discharge of antibiotics
to water bodies exacerbates the problem of antimicrobial
resistance. A summary of ecosystem health impacts of
pharmaceuticals in the environment are presented in
Table 1.

The impacts of other pharmaceuticals in the environment
are less well-known; the vast majority of pharmaceuticals
have not been evaluated for their long-term toxicity,
occurrence or fate in the environment, and it is therefore
difficult to generalise the risk they may give rise to.

In real life, substances are not isolated in the environment;
instead they occur mixed together and in combination
with other contaminants. There is growing evidence that
mixtures of pharmaceuticals possess a joint toxicity greater
(i.e. additive effects) than individual toxicities.

Table 1. Examples of measured effects of certain pharmaceutical residues on aquatic organisms in laboratory studies

Therapeutic group Examples of Pharmaceutical Impact and effected organisms

Analgesics Diclofenac, Ibuprofen
Organ damage, reduced hatching success (fish)
Genotoxicity, neurotoxicity and oxidative stress (mollusk)
Disruption with hormones (frog)

Antibiotics – Reduced growth (environmental bacteria, algae and aquatic plants)

Anti-cancer
Cyclophosphamide1, Mitomycin C,
Fluorouracil

Genotoxicity

Antidiabetics Metformin Potential endocrine-disrupting effects (fish)

Anti- convulsants Carbamazepine, Phenytoin, valproic acid Reproduction toxicity (invertebrates), development delay (fish)

Antifungals
Ketoconazole, Clotrimazole
Triclosan

Reduced growth (algae, fish), reduced algae community growth

Antihistamines
Hydroxyzine, Fexofenadine,
Diphenhydramine

Behaviour changes, growth and feeding rate (fish)
Behaviour changes and reproduction toxicity (invertebrates)

Antiparasitics Ivermectin Growth and reduced reproduction (invertebrates)

Beta blockers Propranolol Reproduction behaviour (fish), reproduction toxicity (invertebrates)

Endocrine disrupting
pharmaceuticals

E2, EE2, Levonorgestrel Disruption with hormones causing reproduction toxicity (fish, frogs)

Psychiatric dugs
Fluoxetine, Sertraline, Oxazepam,
Citalopram, Chlorpromazine

Behaviour changes – feeding, boldness, activity, sociality (fish)
Disruption with hormones (fish)
Behaviour changes – swimming and cryptic (invertebrates)
Reproduction toxicity and disruption with hormones (invertebrates)

Note: 1 Transformation of Cyclophosphamide and Ifosfamide; E2: 17β- estradiol (natural steroidal oestrogen); EE2: 17α- ethinylestradiol (synthetic
oestrogen).

OECD POLICY HIGHLIGHTS Pharmaceutical residues in freshwater: Hazards and policy responses . 7

Box 1. Antimicrobial resistance: an urgent, global health crisis

Antimicrobial resistance (AMR) is a global health crisis with the potential for enormous health, food security
and economic consequences. AMR is the ability of a microbe to resist the effects of medication that could once
successfully destroy or inhibit the microbe.

Drug resistant infections already cause an estimated 700,000 deaths each year globally. If no action is taken, this is
projected to increase to 10 million per year by 2050 – that is more than the number of people dying from cancer. A
continued rise in AMR is projected to lead to a reduction of 2-3.5% in GDP globally, with a cumulative cost of up to
USD 100 trillion.

The mis- and over-use of antibiotics is an important contributing factor of AMR; up to 50% of the antibiotics prescribed
for human use are considered unnecessary. The number is even greater in the agriculture and aquaculture sectors,
where they are mainly administered as a growth promoter and as a substitute for good hygiene. The environment
becomes a reservoir for resistant genes, as well as an arena for the development and spread of resistance to pathogens.

Sources: (IACG, 2018), (OECD, 2018), (Review on Antimicrobial Resistance, 2015).

10
OF PHARMACEUTICAL PRODUCTS
HAVE A POTENTIAL ENVIRONMENTAL
RISK

An estimated 10% of pharmaceutical
products have a potential environmental
risk (Küster and Adler, 2014).

13
OF WASTEWATER TREATMENT PLANTS
IN THE UNITED KINGDOM HAVE HIGH
PHARMACEUTICAL CONCENTRATIONS
IN EFFLUENT

In the United Kingdom, ethinyloestradiol,
diclofenac, ibuprofen, propranolol and
the macrolide antibiotics are present
at high enough concentrations in the
effluent of 890 wastewater treatment
plants (13% of all plants) to cause adverse
environmental effects in surface waters
(Comber et al., 2018).

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8 . OECD POLICY HIGHLIGHTS Pharmaceutical residues in freshwater: Hazards and policy responses

There are several mitigation options for water quality
improvement in the pharmaceutical life cycle, including
improvements in the design, authorisation, production,
use, solid waste and wastewater treatment. A focus on
preventive options early in the pharmaceutical life cycle,
may deliver the most long-term, cost-effective and
large-scale benefits.

A selection of key mitigation policy options across the
pharmaceutical life cycle are presented in Table 2. France,
Germany, the Netherlands, Sweden and the United Kingdom
have started a multi-sector dialogue to tackle the problem.
At the EU level, a “Strategic Approach to Pharmaceuticals
in the Environment” identifies actions for stakeholders
throughout the pharmaceutical life cycle with an emphasis
on sharing good practices, on cooperating at international
level, and on improving understanding of the risks.

OVER-PRESCRIPTION,
SELF-MEDICATION & MIS-DIAGNOSIS
INCREASE PHARMACEUTICALS IN
THE ENVIRONMENT

Over-prescription, self-medication
(over-the-counter pharmaceuticals)
and misdiagnosis of symptoms can
increase the amount of pharmaceuticals
in the environment.

88
OF HUMAN PHARMACEUTICALS ARE
WITHOUT ENVIRONMENTAL TOXICITY
DATA

88% of human pharmaceuticals do not
have comprehensive environmental
toxicity data. Whilst pharmaceuticals
are stringently regulated for efficacy and
patient safety, the negative effects they
may have in the natural environment
have not yet been sufficiently studied
and are not covered by an international
agreement or arrangement.

%

Design

4Policy instruments to control pharmaceuticals in the environment

Figure 3. The pharmaceutical life cycle

Design
Marketing

authorisation Production
Post-

authorisation
Collection

and disposal

Wastewater
treatment
and reuse

Prescription
and

consumption

OECD POLICY HIGHLIGHTS Pharmaceutical residues in freshwater: Hazards and policy responses . 9

Table 2. Selection of key mitigation policy options across the pharmaceutical life cycle

Step in pharmaceutical
life cycle

Relevant stakeholders Mitigation options

Cross-cutting
Government, Industry,
Research organisations

Targeted monitoring and prioritisation of high-risk pharmaceutical
ingredients.
Harness new innovations in water quality monitoring, modelling, scenario
development and risk assessment.
Environmental quality norms / water quality standards.

Design Industry
Innovation in green pharmacy, biological therapies, personalised or
precision medicines.

Authorisation Government, Industry

Legislation and standardised methodology for environmental risk
assessment and incorporation into pharmaceutical authorisation process.
More stringent conditions for putting a pharmaceutical on the market that is
of high-risk to the environment (e.g. increased risk intervention and mitigation
options, eco-labelling, prescription only, post-approval monitoring).

Production
Industry, Government,
Intergovernmental Organisations

Green public procurement with environmental criteria.
Environmental criteria for Good Manufacturing Practices, effluent
discharge limits and disclosure of pharmaceutical wastewater discharge
from supply chains.

Consumption (professional use)
Agriculture, Health sector,
Government

Emission prevention through disease prevention and sustainable use:
• improved human and animal health and well-being
• improved diagnostics, avoided prescriptions
• improved hygienic standards in health facilities, stable management

and livestock handling
• personalised medicines, vaccinations, targeted delivery mechanisms
• prescription of environmentally-friendly pharmaceutical alternatives1

• restrictions or bans of unnecessary high-risk pharmaceuticals
(e.g. veterinary use of antibiotics for preventative measures and
hormones as growth promoters in livestock)

Consumption (over-the-counter
purchases/ self-prescription)

Health sector, Industry, Consumers
Eco-labelling on pharmaceutical products to improve consumer choice
selection and awareness

Collection and disposal Solid waste utilities, Industry

Education campaigns to avoid disposal of pharmaceuticals via sink or toilet
Public pharmaceutical collection schemes for unused drugs
Extended producers responsibility schemes
Improved manure management by passive storage or anaerobic
fermentation in biogas plants

Wastewater treatment Wastewater utilities Upgrade of wastewater treatment plants

Drinking water treatment Drinking water utilities
Upgrade of drinking water treatment plants
Water safety planning

THE REMOVAL OF PHARMACEUTICALS
IS LIMITED BY WASTEWATER
TREATMENT PLANT UPGRADES

Upgrading wastewater treatment with
new technologies will not solely solve
the problem of pharmaceuticals in
water. They are limited by their removal
efficiencies, high capital investment and
operation costs and increased energy
consumption. They do not capture diffuse
sources of pharmaceutical pollution
(e.g. from agriculture and aquaculture).

Figure 3. The pharmaceutical life cycle
Design
Marketing
authorisation Production
Post-
authorisation
Collection
and disposal
Wastewater
treatment
and reuse
Prescription
and
consumption

Note: 1 Requires that a substitute pharmaceutical is available with lower
environmental risk. An alternative assessment would be required to confirm this, in
order to prevent pollution-swapping.

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Germany has developed an
environmental checklist for
veterinarians and farmers
with the aim of reducing the
use and release of veterinary
pharmaceuticals to the
environment.

The United States has
national regulations on
the disposal of hazardous
pharmaceutical waste in the
health sector.

In the United Kingdom,
the poultry industry has
successfully reduced
unnecessary antibiotic use
– whilst increasing meat
production – with a voluntary
antibiotic stewardship
programme.

A selection of policy instruments to control
pharmaceuticals in the environment in OECD countries

10 . OECD POLICY HIGHLIGHTS Pharmaceutical residues in freshwater: Hazards and policy responses

Sweden has a ‘Wise List’ of recommended pharmaceuticals
for the treatment of common diseases that takes into
account environmental impacts when comparing
medications that are equally safe and equally suitable for
the medical purpose.

Switzerland has a nationwide
tax to fund the upgrade of
100 wastewater treatment
plants with new technologies
to reduce pharmaceuticals in
water bodies.

Australia has a national
pharmaceutical collection and
disposal programme, with retail
pharmacies commonly acting as
collection sites.

Korea uses suspect and
non‑target screening to identify
and prioritise pharmaceuticals
for water quality monitoring.

OECD POLICY HIGHLIGHTS Pharmaceutical residues in freshwater: Hazards and policy responses . 11

The Swedish government has proposed a revised public
procurement system in which pollution control during
manufacturing is considered when pharmaceutical
companies complete to obtain product subsidies for state
healthcare.

12 . OECD POLICY HIGHLIGHTS Pharmaceutical residues in freshwater: Hazards and policy responses

5OECD Policy recommendations
The OECD recommends government’s take a collective,
life cycle approach to managing pharmaceuticals in the
environment. This means: i) designing and implementing
a policy mix of source-directed, use-orientated and
end-of-pipe measures; ii) targeting stakeholders
throughout the life cycle of pharmaceuticals; and iii) using
a combination of voluntary, economic and regulatory
instruments. A national pharmaceutical strategy and action

1. Improvement of knowledge, understanding and reporting on the occurrence, fate, toxicity,
and human health and ecological risks of pharmaceutical residues in water bodies in order to
lay the ground for future pollution reduction measures.

OECD recommendations on improving knowledge, understanding and reporting

• Identify potential environmental risks of existing and new active pharmaceutical ingredients
through intelligent and targeted assessment strategies. Reduce unknowns on relationships between
pharmaceuticals, and human and environmental health. The relative risk of active pharmaceuticals
ingredients should also be compared with other pollutants (e.g. heavy metals, persistent organic
pollutants and other contaminants of emerging concern) to achieve improvements in water quality
and ecosystems in the most cost effective way.

• Encourage the uptake of new monitoring methods, modelling and decision‑support tools to better
understand and predict the risks. Prioritise substances and water bodies of highest concern.

• Increase access to data and information, and institutional coordination, to reduce knowledge gaps.

• Adopt precautionary measures when scientific evidence is uncertain, and when the possible
consequences of not acting are high.

• Factor in financing needs and measures to recover policy transaction costs, as well as the capacity of
government officials and stakeholders to implement policies.

• Educate and engage with the public to manage perceived and actual risks, and improve awareness
and understanding.

plan to manage environmental risks should be developed
in collaboration with relevant government departments,
local authorities and other stakeholders, and be supported
by a strategic financing strategy to ensure effective
implementation.

Policies that cost-effectively manage pharmaceuticals for
the protection of water quality and freshwater ecosystems
rest on five strategies:

OECD POLICY HIGHLIGHTS Pharmaceutical residues in freshwater: Hazards and policy responses . 13

2. Source-directed approaches to impose, incentivise or encourage measures in order to
prevent the release of pharmaceuticals into water bodies. They are primarily targeted towards
pharmaceutical companies and manufacturing facilities.

OECD recommendations on source-directed approaches. Pharmaceutical life cycle stages:
design, marketing authorisation, manufacturing, post-authorisation

• Develop clear and shared environmental criteria (and performance indicators) for sustainable ‘green’
procurement of pharmaceuticals.

• Consider expansion of the regulatory framework for good manufacturing practice to include
mandatory environmental criteria.

• Develop drinking water safety plans, monitoring programmes of pharmaceuticals and incidence
reporting to identify and prevent contamination, and adapt policy to new science.

• Ensure Environmental Risk Assessment (ERA) robustness, consistency and transparency. Establish a
centralised database with independent regulatory oversight to share ERAs of pharmaceuticals and
prevent duplication efforts.

• Consider environmental risks in the risk‑benefit authorisation of human pharmaceuticals in order to
manage and mitigate risks.

• Provide incentive structures to advance green pharmacy, and personalised and precision medicines.
A return on public investments in new pharmaceuticals should be considered when assessing support
for the private sector in pharmaceutical development.

• Address any potential economic impacts to avoid loss of pharmaceuticals or supply chain
interruptions, and to limit increased costs to healthcare providers against static budgets.

• Establish new business models for pharmaceuticals that balance access needs, appropriate use and
adequate return. This is particularly important for new antibiotics and tackling AMR; current business
models link profit (sales) with volume (consumption).

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14 . OECD POLICY HIGHLIGHTS Pharmaceutical residues in freshwater: Hazards and policy responses

3. Use-orientated approaches to impose, incentivise or encourage reductions in the inappropriate
and excessive consumption of pharmaceuticals. They are designed to inform and change the
behaviours and practices of physicians, veterinarians, pharmacists, patients and farmers.

OECD recommendations on use-orientated approaches. Pharmaceutical life cycle stages:
prescription and use

• Reduce the incidence of infection and disease. Improved access to safe water supply, sanitation and
hygiene is particularly important. Other important measures include improved stable and livestock
handling, practitioner training, education campaigns and vaccinations.

• Reduce unnecessary use and release of pharmaceuticals. Improve diagnostics and delay prescription
of pharmaceuticals when they are not immediately required. If not already in place, consider bans or
restrictions on antibiotics for preventative use, and hormones as growth promoters, in the livestock
and aquaculture sectors.

• Optimise the use of pharmaceuticals with effective diagnosis, dosing, personalised medicines and
targeted delivery systems.

• Reduce self‑prescription of pharmaceuticals with high‑risk (e.g. antibiotics and pharmaceuticals that
target the endocrine system) and illegal sales of pharmaceuticals.

• Promote best practices on the storage and use of livestock manure and slurry from livestock treated
with pharmaceuticals.

OECD POLICY HIGHLIGHTS Pharmaceutical residues in freshwater: Hazards and policy responses . 15

4. End-of-pipe measures – as a compliment to strategies 1-3 – that impose, incentivise or
encourage improved waste and wastewater treatment to remove pharmaceutical residues after
their use or release into the aquatic environment.

OECD recommendations on end-of-pipe measures. Pharmaceutical life cycle stages:
collection and disposal, and wastewater treatment and reuse

• End‑of‑pipe measures should only be used in complementary to source‑directed and use‑orientated
measures. An over‑emphasis on upgrading wastewater treatment plant (WWTP) infrastructure is not a
sustainable, optimal use of limited resources.

• Ensure value‑for‑money in investments in WWTP upgrades through evaluation and prioritisation,
including achieving economies of scale. Consider potential trade‑offs (e.g. incomplete removal of
pharmaceutical residues to varying degrees; generation of potentially toxic transformation products
and sludge; increased energy, chemicals and carbon emissions).

• Factor in financing needs and cost‑recovery mechanisms for capital, and operation and maintenance
costs of WWTP upgrades, including potential affordability issues with sanitation tariffs.

• Ensure appropriate collection and disposal of waste pharmaceuticals. Educate and engage with health
professionals, veterinarians, consumers and farmers to raise awareness about inappropriate disposal of
unused medications. Consider extended producer responsibility schemes to recover costs.

• Promote best practices on the use and disposal of biosolids (which may include toxic transformation
products) following wastewater treatment.

5. Collaboration and a life cycle approach, combining the four strategies above and involving
several policy sectors. Action on pharmaceuticals in the environment is much more likely to be
extended and sustained if it is mainstreamed into broader health, agricultural and environmental
policies and projects.

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etc.3339.

Burns, E. et al. (2018), Application of prioritization approaches to
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Civity (2017), Pharmaceutical usage in the context of demographic
change: The significance of growing medication consumption in
Germany for raw water resources, Civity Management Consultants.

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the aquatic environment from wastewater treatment works: A
cause for concern?”, Science of The Total Environment, Vol. 613‑614,
pp. 538‑547, http://dx.doi.org/10.1016/J.SCITOTENV.2017.09.101.

IACG (2018), Antimicrobial resistance: Invest in innovation and
research, and boost research and development and access.
IACG discussion paper, UN Interagency Coordination Group on
Antimicrobial Resistance.

Küster, A. and N. Adler (2014), “Pharmaceuticals in the environment:
Scientific evidence of risks and its regulation”, Philosophical
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369/1656, http://dx.doi.org/10.1098/rstb.2013.0587.

Larsson, D. (2014), “Pollution from drug manufacturing: review and
perspectives”, Philosophical transactions of the Royal Society of
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org/10.1098/rstb.2013.0571.

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OECD Health Policy Studies, OECD Publishing, Paris, https://dx.doi.
org/10.1787/9789264307599‑en.

Product Stewardship Council (2018), Webinar | Global Best Practices
for Drug Take‑Back Programs ‑ Product Stewardship Institute (PSI),
https://www.productstewardship.us/page/20180607_GBPFDTBP.

Review on Antimicrobial Resistance (2015), Antimicrobials in
agriculture and the environment: Reducing unnecessary use and
waste.

UN Environment (2019), Global Chemicals Outlook II: From legacies
to innovative solutions, United Nations Environment Programme,
https://wedocs.unep.org/bitstream/handle/20.500.11822/27651/
GCOII_synth ?sequence=1&isAllowed=y.

Van Boeckel, T. et al. (2015), “Global trends in antimicrobial use in food
animals.”, Proceedings of the National Academy of Sciences of the
United States of America, Vol. 112/18, pp. 5649‑54, http://dx.doi.
org/10.1073/pnas.1503141112.

16 . OECD POLICY HIGHLIGHTS Pharmaceutical residues in freshwater: Hazards and policy responses

References

http://dx.doi.org/10.1002/etc.3339

http://dx.doi.org/10.1002/etc.3339

http://dx.doi.org/10.1080/10937404.2018.1465873

http://dx.doi.org/10.1080/10937404.2018.1465873

https://ec.europa.eu/health/sites/health/files/files/environment/study_environment

https://ec.europa.eu/health/sites/health/files/files/environment/study_environment

https://ec.europa.eu/health/sites/health/files/files/environment/study_environment

http://dx.doi.org/10.1038/s41579-019-0222-5

http://dx.doi.org/10.1016/J.SCITOTENV.2017.09.101

http://dx.doi.org/10.1098/rstb.2013.0587

http://dx.doi.org/10.1098/rstb.2013.0571

http://dx.doi.org/10.1098/rstb.2013.0571

https://dx.doi.org/10.1787/9789264307599-en

https://dx.doi.org/10.1787/9789264307599-en

https://www.productstewardship.us/page/20180607_GBPFDTBP (accessed on 23 July 2018)

https://wedocs.unep.org/bitstream/handle/20.500.11822/27651/GCOII_synth ?sequence=1&isAllowed=y (

https://wedocs.unep.org/bitstream/handle/20.500.11822/27651/GCOII_synth ?sequence=1&isAllowed=y (

http://dx.doi.org/10.1073/pnas.1503141112

http://dx.doi.org/10.1073/pnas.1503141112

OECD POLICY HIGHLIGHTS Pharmaceutical residues in freshwater: Hazards and policy responses . 17

Front & back: Green yellow pills © Marian Weyo
Water splash with bubbles of air © Yuri Samsonov
Inside: Hand in glove collects water in test tube © Irina Kozorog
& page 1 Water analysis © alejandro dans neergaard
Tractor plows a field © Svend77
Medicine research at science lab © Sisacorn
Page 3: Selection of pills © Bukhta Yurii
African boy holding colorful pills © Riccardo Mayer
Wastewater discharged into river © daizuoxin
Page 4: Blue and white capsules in blister pack © Fahroni
Medical factory © Boris Djuranovic
Mosquito sucking human blood © ArtLovePhoto
Page 5: Young piglet feeding © Thammachak Sotiya
Research medicine at science lab © Sisacorn
Page 7: Drip in a hospital corridor © sfam_photo

Photo credits (all images from shutterstock.com)

Page 8 & 9: Medical technology network concept © PopTika
Production of pills © Pavel Chagochkin
Medicine capsule pack at pharmacy © i viewfinder
Water treatment plant © People Image Studio
Page 12: Discussing charts on computer screen © NicoElNino
Page 13: Blue and white capsules © Fahroni
Page 14: Veterinarian holding syringe with cow © Budimir Jevtic
Medical factory © Boris Djuranovic
Pharmaceutics at drugstore © Syda Productions
Asian child washing hands © Casezy idea
Page 15: Industrial water recycling and purification © fotomor
Modern urban wastewater treatment plant © arhendrix
Disposal of hazardous waste in hospital © sfam_photo
Salmon fish farm, Norway © Marius Dobilas
Page 16 & 17: Water © Siegi

P
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© OECD 2017
OECD Environment Directorate

March 2017

This Policy Highlights is based on the OECD publication, Pharmaceutical
Residues in Freshwater: Hazards and Policy Responses.

The report calls for a better understanding of the effects of pharmaceutical
residues in the environment, greater international collaboration and
accountability distribution, and policy actions to prevent and remedy
emerging concerns. Laboratory and field tests show traces of oral
contraceptives causing the feminisation of fish and amphibians, and residues
of psychiatric drugs altering fish behaviour. Antimicrobial resistance, linked to
the overuse of antibiotics, has rapidly escalated into a global health crisis.

Unless adequate measures are taken to manage the risks, pharmaceutical
residues will increasingly be released into the environment as ageing
populations, advances in healthcare, and intensification of meat and fish
production spur the demand for pharmaceuticals worldwide. The report
outlines a collective, life-cycle approach to managing pharmaceuticals in the
environment. A policy mix of source-directed, use-orientated and end-of-
pipe measures, involving several policy sectors, can help to improve health
and protect the environment.

For more information:
OECD (2019), Pharmaceutical Residues in Freshwater: Hazards and
Policy Responses, OECD Studies on Water, OECD Publishing, Paris,
https://doi.org/10.1787/c936f42d‑en.

www.oecd.org/water

Hannah.Leckie@oecd.org

@OECD_ENV

© OECD Environment Directorate, November 2019

https://doi.org/10.1787/c936f42d-en

http://www.oecd.org/water

Tweets by OECD_ENV

Name

(First & Last):

CHEM 1002, Winter 2021, Lab #4: Pharmaceuticals in the Water

LAB ASSIGNMENT WORKSHEET

1) Provide a short summary of the Environmental Impacts of Pharmaceuticals policy report that you read, as part of your pre-lab.

Note:

The policy report is embedded in the Laboratory #4 Canvas Assignment.

Policy Article Summary

The policy article was put out by “OECD”. Use your research skills to learn about the organization that put out the policy report, by answering the questions in Data Table #1

Data Table #1 – Policy Article Author: OECD

Question	Answers
What Does “OECD” Stand For?
What is OECD’s Website (URL)?
What is OECD’s motto?
How is the OECD Funded?
What Percent of OECD’s Budget Comes from the United States?

2: Research Exercise

This part of the lab, on your own, after your laboratory section, as a “post-lab”.

Your TA will assign you a specific drug to research, from Data Table #4.

Data Table #4 – The drugs that were mentioned in the policy report

Drug #

Drug Name

Drug #

Drug Name

20

		Drug #			Drug Name
1	Diclofenac	9	Valproic Acid	17	Levonorgestrel
2	Cyclophosphamide	10	Ketoconazole	18	Fluoxetine
3	Mitomycin C	11	Clotrimazole	19	Sertraline
4	Fluorouracil	12	Hydroxyzine		20	Oxazepam
5	Metformin	13	Fexofenadine	Citalopram
6	Carbamazepine	14	Diphenhydramine	21	Chlorpromazine
7	Phenytoin	15	Ivermectin
8	Triclosan	16	Propranolol

Answer the following questions for your assigned drug. You will need to cite the sources that you use to help you to answer these questions.

1) What is the name of the drug that you were assigned?

Diclofenac

2) What is this drug used for?

3) What is known about the mechanism of action for your drug?

a. What is the delivery method?

b. How does the drug work?

c. What does the drug target?

d. What effects does the drug have on human physiology?

4) Summarize the potential sources of environmental pollution related to this drug.

5) Summarize the potential impacts of this drug in aquatic ecosystems. If possible, find specific research.

6) Based on all of your research, suggest specific mitigation efforts and policy recommendations that could be applied to reduce the impact this drug has on the water supply.

7) What sources did you use?

Note:
List

all

sources. For each source, include a brief description on how you used the source to answer a question (this is called an annotated bibliography).

CHEM 1002 – 2021, Laboratory #4 Worksheet 1

CHEM 1002 – 2021, Laboratory #4 Worksheet 1
CHEM 1002 – 2021, Laboratory #4 Worksheet 1