Chemicals are important in the health care sector, as they can be used as disinfectants, cleaners, laboratory reagents, sterilants, pesticides, pharmaceuticals and are used within medical devices and equipment, they also have major benefits for animal welfare. However, there is a growing recognition and rise of concern about the impacts of human health and the environment when pharmaceuticals and chemicals are not managed appropriately. Guidelines for Sustainable Procurement of Healthcare Commodities and Services, UNDP, March 2020
Given that pharmaceuticals are biologically active substances specifically designed to cause pharmacological effects in living organisms, they have an impact on wildlife and ecosystem health when are not treated in an environmentally sound manner.
Active pharmaceutical ingredients (APIs) are the biologically active ingredients in a pharmaceutical drug. These APIs are sold to pharmaceutical companies who make end products for patients globally. About 4,000 active pharmaceutical ingredients are administered worldwide in prescription medicines, over-the-counter therapeutic drugs and veterinary drugs. Global Chemicals Outlook II, UNEP, 2019
From a chemicals and waste management perspective, environmental and health concerns in this sector are primarily related to releases of pharmaceuticals to the environment.
Residues are released into rivers, lakes and groundwater aquifers. In addition, when applied in animal husbandry and where manure is used as a fertilizer, veterinary pharmaceuticals are released into the soil and wider environment. This results both in soil contamination, and biomagnification through uptake of pharmaceuticals into food crops.
Sources of releases of pharmaceuticals to the environment include direct emissions from drug manufacturing, patient and animal excretion, aquafarming, and disposal of unused or expired medicines.
Global Chemicals Outlook II, UNEP, 2019
This acts as a driver for the development of drug resistance, creating environmental ‘reservoirs’ of antibiotic-resistant microbes, particularly bacteria. Tackling drug-resistant infections globally: Final report and recommendations the review on antimicrobial resistance, chaired by Jim O’Neill. One of the most significant impacts of environmental residues of pharmaceuticals is the development of antimicrobial resistance (AMR).
What are Environmentally Persistent Pharmaceutical Pollutants?
Pharmaceuticals designed to be slowly degradable or even nondegradable to resist chemical degradation during passage through a human or animal body present a special risk when they enter, persist or disseminate in the environment. Such substances are referred to as environmentally persistent pharmaceutical pollutants (EPPPs).
When released into the environment, the biological activity of environmentally persistent pharmaceutical pollutants may directly adversely affect non-target organisms, such as wildlife, and cause long -term impacts on ecosystem health and resilience. The latter occurs through population-level effects on reproductive ability, which persist into future generations of non-target organisms.
Environmentally persistent pharmaceutical pollutants are widely and increasingly being used in consumer products. However, significant knowledge gaps on the environmental and health impacts of these pollutants remain.
In 2016, a global literature review of studies that measured environmental concentrations of environmentally persistent pharmaceutical pollutants (including antibiotics, analgesics, lipid-lowering drugs, estrogens, and others) detected a total of 631 different pharmaceuticals or their transformation products in the environment of 71 countries; 16 of these were detected in all five UN regions. Pharmaceuticals in the environment: Global occurrence and potential cooperative action under the Strategic Approach to International Chemicals Management (SAICM)
What is being done to address the issue of Environmentally Persistent Pharmaceutical Pollutants?
As a result of the studies and with a raise of concern, ‘environmentally persistent pharmaceutical products’ (EPPP) were nominated an emerging policy issue at the fourth session of the International Conference on Chemicals Management (ICCM 4) in 2015. Stakeholders resolved to implement cooperative action to increase awareness and understanding among policymakers and stakeholders and to generate and share information to fill identified knowledge gaps (ICCM 4 Resolution IV/2 part III). The resolution calls for coordinated approaches, including among Inter-Organization Programme for the Sound Management of Chemicals (IOMC) agencies, to provide consistent and evidence-based assistance to governments.
UNEP, as one of the relevant IOMC participating organizations, is working on the topic. A scoping and mapping exercise is being developed to collect and compile information of environmentally persistent pharmaceutical pollutants in different stages of their life cycle, including presence in wastewater, studies and practices in place, applicable legislation, stakeholders involved and work being undertaken. This can serve as the basis to add understanding on environmentally persistent pharmaceutical pollutants situation. The initial results identified ‘hotspots’ where attention is required. Based on these findings UNEP is focusing on research and work on take-back programmes and environmentally sound disposal for unwanted medicines, sustainable procurement issues and antimicrobial resistance and environment.
With the support of the European Commission, UNEP is developing a gap analysis and papers on sustainable procurement and take-back provisions, key issues related to EPPPs, and is raising awareness and promoting discussions among different stakeholders.
A multi-stakeholder wastewater initiative exists under the Global Programme of Action for the Protection of the Marine-Environment from Land-based Activities to exchange knowledge and best practices.
The pharmaceutical industry is highly innovative and competitive, and the production and sales of pharmaceuticals are growing rapidly. Initiatives such as the Pharmaceutical Supply Chain Initiative (PSCI) or the AMR Industry Alliance show its commitment to tackle these issues.
Further Resources
- Environmentally persistent pharmaceutical pollutants UNEP Factsheet, December 2022
