Drug residues present and persisting in natural water is an effective marker for a potentially serious adverse environmental effect.
A series of recent studies suggests that pharmaceutical factories are not as careful with their waste as they should be, Nature reports. First, a 2009 study found high levels of bioactive ingredients in treated waste being released from a wastewater-treatment plant in India. Last year, investigations of two water-processing plants in New York revealed similar events. And now, new evidence published in Environment International suggests bioactive drugs are also making it into the waterways in France, and that they are affecting the fish populations in the local rivers.
Pollutant escapes from manufacturing processes, identified by local pollution ‘hotspots’, are simply unforgivable. And the New York observations are particularly noteworthy also, pointing to deficiencies in wastewatre treatment as much as disposal errors.
Every effort must be taken to encourage communities to stop disposing unwanted pharmaceuticals down the toilet, despite what Granny told them to do! This requires, of course, a satisfactory and convenient alternate disposal route, though in the UK we are still sitting on our hands and studiously ignoring this requirement. Lean prescribing – to reduce prescriptions to the minimum required amount – is a natural compliment to this and is beginning to happen, if only to reduce NHS prescription costs. Nonetheless, the advantages are obvious to all.
The considerable fuss about the possibility of pollutant drug residues from fully discharged syringes – regulators conveniently ignore empty drug containers, vials and bottles and tubes etc – and the odd tablet or capsule in a sack of soft waste leading to unacceptable concentrations surviving in wastewater effluent from ATT processing is nothing more that a cynical ploy to exploit one market sector at the expense of another – we need not here go into detail of the individuals and reasons behind that ploy, but it is widely known.
As noted so many times before on the Clinical Waste Discussion Forum, the biggest issue is still ignored. Lack of investment in what is basically still a Victorian wastewater treatment infrastructure fails to remove these drug residues from sewage inflows. Downstream pollutant concentrations must be a consequence primarily of the excretion of the administered dose in the urine of patient. Administration of drugs to the national herd necessary for routine veterinary care and as part of the standard and unquestionably commercial approach to animal husbandry defeats even our wastewater treatment systems and goes straight to land!
In contrast, the contribution of ATT-associated discharges must be infinitesimally small. Likewise, the discharges from bin washing, from ATT and incineration sites, though bin washing in specialist drug waste processing sites receiving substantial quantities of manufacturing wastes might be somewhat different.
Regulation does not always follow science, and sometimes avoids even simple common sense, to create an intractable fog that impedes meaningful research and sensible regulatory focus.