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Washing Away the Drugs in Our Global Waters: A Multi-Pronged Approach

People worldwide are living longer than ever before, according to the World Health Organization (WHO). Much of this increased longevity is due to improvements in the medical field, as advanced diagnostic techniques, surgical procedures, and pharmaceuticals have led to amazing improvements in overall health. But this progress is not without its own problems.

The copious supply of pharmaceuticals assist people with myriad health issues, but these products are also having an adverse impact on the environment.

Active Pharmaceutical Ingredients and How to Reduce Them:

The active pharmaceutical ingredients (APIs) of drugs are widely found in global water bodies. While some APIs degrade quickly, many are hard to remove from the environment. Thus, there is a growing concern that unintentional exposure to APIs can cause harm to living things, including people.

What’s in the Water?

APIs of pharmaceutical drugs, including antibiotics and birth control pills, end up in the environment through water bodies.   © J. Troha / Wikimedia Commons
APIs of pharmaceutical drugs, including antibiotics and birth control pills, end up in the environment through water bodies. © J. Troha / Wikimedia Commons

According to a study published this year in the Proceedings of the National Academy of Sciences (PNAS), titled, “Pharmaceutical pollution of the world’s rivers,” high concentrations of APIs were found in 104 countries. Samples of the 258 rivers studied showed large concentrations of the following

  • Caffeine. Found in coffee, tea, chocolate, and some sodas.

  • Nicotine. Found in tobacco products.

  • Acetaminophen. A common OTC pain reliever.

  • Metformin. Used for type 2 diabetes.

  • Carbamazepine. Prescribed for epilepsy and nerve pain.

Several other contaminants were found in the rivers of all continents except Antarctica: antihistamines, anesthetics, antidepressants, antihyperglycemics, anti-inflammatories, anticonvulsants, beta blockers, antimicrobials, and a drug used to treat insomnia.

How Do These Drugs Get into the Water?

Active pharmaceutical ingredients wind up in the environment in three ways: throughout the manufacturing phase, while they are being used, and during disposal. Evidence points to APIs being released in:

  • Sewage Wastewater treatment plants have a spotty record regarding APIs, with removal rates ranging from less than 10% up to nearly 100%, depending on the technology of the treatment plant and the chemical composition of the drugs. APIs enter sewer systems in wastewater during the manufacturing phase, as post-consumer waste, and from hospital discharge. From there, APIs can wind up impacting coastal fisheries and aquaculture. Studies have found that consumers of contaminated seafood may develop antibiotic resistance, such as through fishmeal.

  • Fisheries With the ever-increasing use of aquaculture, veterinary drugs are now used to keep cultured marine life healthy. The problem? Up to 75% of the medicine administered leaks into the environment.

  • Ranching and farming Antibiotics frequently are added to feed, drinking water, and fertilizers to keep crops and livestock healthy. These antibiotics can contaminate groundwater and ecosystems.

  • Waste disposal When APIs are discarded in coastal landfills, they can break down and invade groundwater or runoff, eventually entering waterways.

How Big Is the Problem?

APIs are found in waters across the globe. According to the PNAS study, contaminated rivers were found in Africa, Asia, Europe, the Americas, and Australia. Interestingly, no APIs were found in waters collected from Iceland or from a remote indigenous community in Venezuela where modern medicines are not used.

APIs are also found in drinking water, although at levels much lower than a therapeutic dose, according to USGS Research Ecologist Dr. Paul Bradley. It is thus fortunate that people’s harmful exposure to APIs is limited in this way.

Why Are APIs in Water Dangerous to Living Beings?

Repeated exposure to APIs in the world’s waters can have adverse health effects, according to the American Rivers website. There is a concern that APIs may affect the growth and reproductive capacities of animals that ingest them. Endocrine disruption may change reproductive responses, including the feminization of male fish.

Male fish in US rivers have been found to produce eggs. This may happen because endocrine disruptors in the rivers cause changes to the male’s reproductive system, producing oocytes, cells normally found in a female’s ovaries that grow into embryos when exposed to male hormones. These changes are thought to be the result of endocrine-disrupting chemicals. Such chemicals can come from natural estrogens, pharmaceuticals, or agricultural chemicals that run off into waterways, according to an article on EcoWatch. Birth control pills and natural sex hormones derived from livestock manure, as well as pesticides and herbicides, are also implicated in troubling changes.

Another problem comes from anti-microbial resistance building to the point where bacteria, viruses, fungi, and parasites change over time. If pathogens become resistant to antibiotics, they can cause more disease, extreme illnesses, and even death.

What Methods Are Being Used to Eliminate APIs?

Several techniques have been used to clean active pharmaceutical ingredients out of water bodies:

  • Nanofiltration. Filtration method used to soften and disinfect water.

  • Oxidation. A process that occurs when combining oxygen with another substance.

  • Reverse osmosis. Moving water through a membrane to remove contaminants.

  • Photolysis. Using light to decompose or separate molecules.

  • UV-degradation. Exposing a substance to sunlight to cause materials to disintegrate.

  • Adsorption. Used to remove dissolved impurities. Because it is inexpensive and easy to use, it is especially suitable for developing nations.

What Can Consumers Do?

People can make a considerable impact to address this important environmental issue. Here are some actions consumers can take to reduce the amount of APIs that end up in water bodies:

  • Consult medical professionals to see if there are alternative therapies to drugs currently being taken.

  • Dispose of drugs at a community or medical facility take-back program. Law enforcement agencies or pharmacies may also offer take-back programs.

  • If medications must be put in the trash—as some medicines advise on their labels—crush the pills and place them in a sealable plastic bag full of coffee grounds or kitty litter. The home additives help absorb the medication, and the sealed bag can prevent the pharmaceuticals from leaking into the environment.

  • Avoid flushing drugs down toilets or sinks.

MedSafe was introduced by the Andrew Rader U.S. Army Health Clinic in 2016 as a way of disposing of expired or unwanted medications for patrons.   © Nell King / Wikimedia Commons
MedSafe was introduced by the Andrew Rader U.S. Army Health Clinic in 2016 as a way of disposing of expired or unwanted medications for patrons. © Nell King / Wikimedia Commons

Ask if the Drug is Essential

Sometimes alternatives to certain medications exist, such as adopting healthier lifestyles. Regular exercise, a healthy diet, and getting plenty of sleep are proven ways of preventing and alleviating many illnesses. Meditation may help reduce pain without resorting to medications. Questions that can be asked of a doctor include: Is a drug being prescribed for a minor medical complaint? Are there alternative actions or therapies that can effectively and safely treat this condition?

With all the APIs found in water bodies, taking care of one’s body is the right thing to do, for the environment and for personal health.


*Cassie Journigan is a writer who lives in the north-central region of Florida in the United States. She focuses on issues related to sustainability. She is passionate about numerous topics including the Earth’s changing climate, pollution, social justice, and cross-cultural communications.


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