Skip to main content

Advertisement

Log in

Expert Stakeholders’ Views on the Management of Human Pharmaceuticals in the Environment

  • Published:
Environmental Management Aims and scope Submit manuscript

Abstract

Human pharmaceuticals are ubiquitous water contaminants that may have subtle detrimental effects on aquatic organisms, and possibly also on human health. The risks of pharmaceuticals, or pharmaceutically active compounds, remain poorly understood. Awareness of the presence of pharmaceuticals in the environment, coupled with evidence of effects such as fish feminization, however, suggest that precautionary management action to reduce the release of pharmaceuticals to the environment should be considered. The purpose of our study was to evaluate the scope of the issue and possible management strategies from the perspectives of expert stakeholders, drawn from government, academia, and the pharmaceutical and consulting industries, involved in scientific research or policy and management activity, from Canada, the United States, and Europe. Twenty-seven interviewees were asked about their views on management strategies such as pharmaceutical-return programs and incentives for the development of “green” pharmaceuticals. Interviewees generally believed that pharmaceuticals in the environment represented a concern for both human and ecosystem health, although they were more concerned about impacts on aquatic ecosystems. They believed that advanced wastewater treatment technology, education of medical professionals to reduce overprescription, pharmaceutical-return programs coupled with public education, and requirements for all municipalities to have a minimum of secondary wastewater treatment were the most effective management strategies to reduce the environmental impacts of pharmaceuticals. These strategies should be considered by governments interested in managing the risks of human pharmaceuticals in the environment. Combinations of management strategies will likely be most effective in mitigating the risks presented by pharmaceuticals.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2

Similar content being viewed by others

References

  • Balcýoðu I. A., M. Ötker. 2003. Treatment of pharmaceutical wastewater containing antibiotics by O3 and O3/H2O2 processes. Chemosphere 50:85–95

    Article  Google Scholar 

  • Barnes K. K., S. C. Christenson, D. W. Kolpin, M. J. Focazio, E. T. Furlong, S. D. Zaugg, M. T. Meyer, L. B. Barber. 2004. Pharmaceuticals and other organic waste water contaminants within a leachate plume downgradient of a municipal landfill. Ground Water Monitoring Remed 24:119–126

    CAS  Google Scholar 

  • Boxall A. B. A., P. Blackwell, R. Cavallo, P. Kay, J. Tolls. 2002. The sorption and transport of a sulphonamide antibiotic in soil systems. Toxicol Lett 131:19–28

    Article  CAS  Google Scholar 

  • Boyd G. R., H. Reemtsma, G. A. Grimm, S. Mitra. 2003. Pharmaceuticals and personal care products (PPCPs) in surface and treated waters of Louisiana, USA and Ontario, Canada. Science Total Envir 311:135–149

    Article  CAS  Google Scholar 

  • Brain R. A., D. J. Johnson, S. M. Richards, M. L. Hanson, H. Sanderson, M. W. Lam, C. Young, S. A. Mabury, P. K. Sibley, K. R. Solomon. 2004. Microcosm evaluation of the effects of an eight pharmaceutical mixture to the aquatic macrophytes Lemna gibba and Myriophyllum sibiricum. Aquat Toxicol 70:23–40

    Article  CAS  Google Scholar 

  • Canadian Standards Association. 1997. CAN/CSA-Q850-97: Risk management: a guideline for decision-makers, Etobicoke, Ontario, 45 pp

  • Carballa M., F. Omil, J. M. Lema, M. Llompart, C. García-Jares, I. Rodríguez, M. Gómez, T. Ternes. 2004. Behavior of pharmaceuticals, cosmetics and hormones in a sewage treatment plant. Water Res 38:2918–2926

    Article  CAS  Google Scholar 

  • CEPA. 1999. Canadian Environmental Protection Act. The House of Commons of Canada, Bill C-32, as passed by the House of Commons, June 1, 1999

  • Christensen F. M. 1998. Pharmaceuticals in the environment—a human risk? Regul Toxicol Pharmacol 28:212–221

    Article  CAS  Google Scholar 

  • Cleuvers M. 2003. Aquatic ecotoxicity of pharmaceuticals including the assessment of combination effects. Toxicol Lett 142:185–194

    Article  CAS  Google Scholar 

  • Cordy G. E., N. L. Duran, H. Bower, R. C. Rice, E. T. Furlong, S. D. Zaugg, M. T. Meyer, L. B. Barber, D. W. Kolpin. 2004. Do pharmaceuticals, pathogens, and other organic waste water compounds persist when waste water is used for recharge? Ground Water Monitoring Remed 24:58–69

    CAS  Google Scholar 

  • Covello V. T. 1989. Informing people about risks from chemicals, radiation, and other toxic substances: a review of obstacles to public understanding and effective risk communication. In Leiss W. (ed.), Prospects and problems in risk communication. University of Waterloo Press, Waterloo, Pages 1–49

    Google Scholar 

  • CPMP. 2001. Discussion paper on environmental risk assessment of non-genetically modified organisms (non-GMO) containing medicinal products for human use. CPMP/SWP/4447/00, Committee for Proprietary Medicinal Products, London, UK, 9 pp

  • Datta L-e. 1997. A pragmatic basis for mixed-method designs. In Greene J. C., Caracelli V. J. (eds.), Advances in mixed-method evaluation: the challenges and benefits of integrating diverse paradigms. New directions for evaluation. Jossey-Bass, San Francisco, Pages 33–46

    Google Scholar 

  • Daughton C. G., T. A. Ternes. 1999. Pharmaceuticals and personal care products in the environment: Agents of subtle change? Envir Health Perspect 107: 907–938

    CAS  Google Scholar 

  • Daughton C. G. 2003a. Cradle-to-cradle stewardship of drugs for minimizing their environmental disposition while promoting human health—Part 1: Rationale and avenues toward a green pharmacy. Envir Health Perspect 111:757–774

    Article  CAS  Google Scholar 

  • Daughton C. G. 2003b. Cradle-to-cradle stewardship of drugs for minimizing their environmental disposition while promoting human health. II. Drug disposal, waste reduction, and future directions. Envir Health Perspect 111:775–785

    Article  CAS  Google Scholar 

  • Daughton C. G. 2004. PPCPs in the environment: Future research—beginning with the end always in mind. In K. Kümmerer (ed.), Pharmaceuticals in the environment. Springer-Verlag, Berlin, Pages 463–495

    Google Scholar 

  • Dizer H., B. Fischer, I. Sepulveda, E. Loffredo, N. Senesi, F. Santana, P. D. Hansen. 2002. Estrogenic effect of leachates and soil extracts from lysimeters spiked with sewage sludge and reference endocrine disrupters. Envir Toxicol 17:105–112

    Article  CAS  Google Scholar 

  • Doerr-MacEwen N. A., M. E. Haight. 2005. Tailoring the precautionary principle to pharmaceuticals in the environment: accounting for experts’ concerns. In A. G. Kungolos, C. A. Brebbia, E. Beriatos (eds.), Sustainable development and planning II (vol. 1). WIT Press, Southampton, Pages 281–291

    Google Scholar 

  • Eckel W. P., B. Ross, R. K. Isensee. 1993. Pentobarbital found in ground water. Ground Water 31:801–804

    Article  CAS  Google Scholar 

  • FDA. 1998. Guidance for industry: Environmental Assessment of human drug and biologics applications. Government of the United States of America, 33 pp

  • Fisher P. M. J., R. Borland. 2003. Gauging the pharmaceutical burden on Sydney’s environment: a preventative response. J Cleaner Production 11:315–320

    Article  Google Scholar 

  • Fong P. P. 1998. Zebra mussel spawning is induced in low concentrations of putative serotonin reuptake inhibitors. Biol Bull 194:143–149

    CAS  Google Scholar 

  • Fong P. P. 2001. Antidepressants in aquatic organisms: a wide range of effects. In C. G. Daughton, T. L. Jones-Lepp (eds.), Pharmaceuticals and personal care products in the environment: scientific and regulatory issues. American Chemical Society, Washington, DC, PP 264–281

    Google Scholar 

  • Golet E. M., I. Xifra, H. Siegrist, A. C. Alder, W. Giger. 2003. Environmental exposure assessment of fluoroquinolone antibacterial agents from sewage to soil. Envir Sci Technol 37:32–43

    Article  CAS  Google Scholar 

  • Government of British Columbia. 1997. Waste management act: Post-consumer residual stewardship program regulation. B.C. Reg. 111/97, O.C. 333/97

  • Greene J. C., V. J. Caracelli. 1997. Defining and describing the paradigm issue in mixed-method evaluation. In J. C. Greene, V. J. Caracelli (eds.), Advances in mixed-method evaluation: the challenges and benefits of integrating diverse paradigms. New directions for evaluation. Jossey-Bass Publishers, San Francisco, Pages 5–18

    Google Scholar 

  • Greene J. C., V. J. Caracelli, W. F. Graham. 1989. Toward a conceptual framework for mixed-method evaluation designs. Educ Eval Policy Analysis 11:255–274

    Article  Google Scholar 

  • Greiner P., I. Rönnefahrt. 2003. Management of environmental risks in the life cycle of pharmaceuticals. Envirapharma, Lyon

  • Guardabassi L., A. Petersen, J. E. Olsen, A. Dalsgaard. 1998. Antibiotic resistance in Acinetobacter spp. isolated from sewers receiving waste effluent from a hospital and a pharmaceutical plant. Appl Envir Microbiol 64:3499–3502

    CAS  Google Scholar 

  • Health Canada. 2002. Health Canada to require environmental assessments of products regulated under the Food and Drug Act. http://www.hc-sc.gc.ca/english/media/releases/2001.2001_98e.htm

  • Health Canada. 2003. Environmental assessment regulations: final issue identification paper. http://www.hc-sc.gc.ca/ear-ree/final_issue_id_2_e.html

  • Heberer T. 2002. Occurrence, fate, and removal of pharmaceutical residues in the aquatic environment: a review of recent research data. Toxicol Lett 131:5–17

    Article  CAS  Google Scholar 

  • Heberer T., D. Feldmann, K. Reddersen, H. Altmann, T. Zimmerman. 2002. Production of drinking water from highly contaminated surface waters: Removal of organic, inorganic, and microbial contaminants applying mobile membrane filtration units. Acta Hydrochim Hydrobiol 30:24–33

    Article  CAS  Google Scholar 

  • Heberer T., K. Schmidt-Bäumier, H. J. Stan. 1998. Occurrence and distribution of organic contaminants in the aquatic system in Berlin. Part 1: Drug residues and other polar contaminants in Berlin surface and groundwater. Acta Hydrochim Hydrobiol 26:272–278

    Article  CAS  Google Scholar 

  • Holm J. V., K. Rugger, P. L. Bjerg, T. H. Christensen. 1995. Occurrence and distribution of pharmaceutical organic compounds in the groundwater downgradient of a landfill (Grinsted, Denmark). Envir Sci Technol 29:1415–1420

    Article  CAS  Google Scholar 

  • Holtz S. 2006. There is no “away”. Pharmaceuticals, personal care products, and endocrine-disrupting substances: emerging contaminants detected in water. Canadian Institute for Environmental Law and Policy, Toronto, 94 pp

  • Jobling S., M. Nolan, C. R. Tyler, G. Brightly, J. P. Sumpter. 1998 Widespread sexual disruption in wild fish. Envir Sci Technol 32:2498–2506

    Article  CAS  Google Scholar 

  • Kinney C. A., E. T. Furlong, S. L. Werner, J. D. Cahill. 2006. Presence and distribution of wastewater-derived pharmaceuticals in soil irrigated with reclaimed water. Envir Toxicol Chem 25:317–326

    Article  CAS  Google Scholar 

  • Kolpin D. W., E. T. Furlong, M. T. Meyer, M. E. Thurman, S. D. Zaugg, L. B. Barber, H. T. Buxton. 2002. Pharmaceuticals, hormones, and other organic wastewater contaminants in U.S. streams, 1999–2000: A national reconnaissance. Envir Sci Technol 36:1202–1211

    Article  CAS  Google Scholar 

  • Krosnick J. A., L. R. Fabrigar. 1997. Designing rating scales for effective measurement in surveys. In L. Lyberg, P. Biemer, M. Collins, E. de Leeuw, C. Dippo, N. Schwarz, D. Trewin (eds.), Survey measurement and process quality. John Wiley & Sons, New York, Pages 141–164

    Google Scholar 

  • Larsen T. A., J. Lienert, A. Joss, H. Siegrist. 2004. How to avoid pharmaceuticals in the aquatic environment. J Biotechnol 113:295–304

    Article  CAS  Google Scholar 

  • Larsson D. G. J., M. Adolfsson-Erici, J. Parkkonen, M. Pettersson, A. H. Berg, P. E., Olsson, L. Förlin. 1999. Ethinyloestradiol—an undesired fish contraceptive? Aquat Toxicol 45:91–97

    Article  CAS  Google Scholar 

  • McGarvin M. 2001. Science, precaution, facts and values. In T. O’ Riordan, J. Cameron, A. Jordan (eds.), Reinterpreting the precautionary principle. Cameron May, London, Pages 35–60

    Google Scholar 

  • Metcalfe C. D., X. S. Miao, B. Koenig, J. Struger. 2003. Distribution of acidic and neutral drugs in surface waters near sewage treatment plants in the lower Great Lakes, Canada. Envir Toxicol Chem 22:2881–2889

    Article  CAS  Google Scholar 

  • Mittelstaedt M. 2003. Drug traces found in cities’ water. Page 1 in The Globe and Mail, February 10

  • Morgan M. G., L. F. Pitelka, E. Shevliakova. 2001. Elicitation of expert judgments of climate change impacts on forest ecosystems. Climatic Change 49:279–307

    Article  CAS  Google Scholar 

  • Oaks J. L., M. Gilbert, M. Virani, R. T. Watson, C. U. Meteyer, B. A. Rideout, H. L. Shaviprasad, S. Ahmed, M. J. I. Chaudhry, M. Arshad, S. Mahmood, A. Ali, A. A. Khan. 2004. Diclofenac residues as the cause of vulture population decline in Pakistan. Nature 427:630–633

    Article  CAS  Google Scholar 

  • O’Brien E., D. R. Dietrich. 2004.Hindsight rather than foresight: reality versus the EU draft guideline on pharmaceuticals in the environment. TRENDS Biotechnol 22:326–330

    Article  CAS  Google Scholar 

  • O’Connor D. R. 2002. Report of the Walkerton inquiry: the events of May 2000 and related issues, Part I. Government of Ontario, Toronto, 188 pp

    Google Scholar 

  • Purdom C. E., P. A. Hardiman, V. J. Bye, N. C. Eno, C. R. Tyler, J. R. Sumpter. 1994. Estrogenic effects of effluents from sewage treatment works. Chem Ecol 8:275–285

    CAS  Google Scholar 

  • Product Stewardship Institute. 2004a. PSI Pharmaceuticals Project. http://www.productstewardship.us/prod_pharm_project.html

  • Product Stewardship Institute. 2004b. Household pharmaceutical waste: regulatory and management issues. San Francisco Department of the Environment. http://www.productstewardship.us/supportingdocs/Pharm_CAWasteMgmt.pdf

  • Quijano R. F. 2003. Elements of the precautionary principle. In J. A. Tickner (ed.), Precaution, environmental science, and preventive public policy. Island Press, Washington, Pages 21–27

    Google Scholar 

  • Rönnefahrt I., J. Koschorreck, M. Kolossa-Gehring. 2003. Practical examples for risk management of pharmaceuticals in the framework of authorization, EnvirPharma, Lyon, France

  • Sacher F., F. T. Lange, H. J. Brauch, I. Blankenhorn. 2001. Pharmaceuticals in groundwaters. Analytical methods and results of a monitoring program in Baden-Wurtemburg, Germany. J Chromatogr A 938:199–210

    Article  CAS  Google Scholar 

  • Sanderson H., D. J. Johnson, C. J. Wilson, R. A. Brain, K. R. Solomon. 2003. Probabilistic hazards assessment of environmentally occurring pharmaceuticals: toxicity to fish, daphnids and algae by ECOSARS screening. Toxicol Lett 144:383–395

    Article  CAS  Google Scholar 

  • Sanderson H., D. J. Johnson, T. Reitsma, R. A. Brain, C. J. Wilson, K. R. Solomon. 2004. Ranking and prioritization of environmental risks of pharmaceuticals in surface waters. Regul Toxicol Pharmacol 39:158–183

    Article  CAS  Google Scholar 

  • Schulman L. J., E. V. Sargent, B. D. Naumann, E. C. Faria, D. G. Dolan, J. P. Wargo. 2002. A human health risk assessment of pharmaceuticals in the aquatic environment. Hum Ecol Risk Assess 8:657–680

    CAS  Google Scholar 

  • Sedlak D. L., K. E. Pinkston. 2001. Factors affecting the concentrations of pharmaceuticals released to the aquatic environment. Water Resources Update 120:56–64

    Google Scholar 

  • SIGRE. 2002. Por la salud de la naturaleza: Memoria de actividades, 31 pp

  • Slovic P. 1993. Perceived risk, trust, and democracy. Risk Analysis 13:675–682

    Article  Google Scholar 

  • Stan H. J., T. Heberer, M. Linkerhagner. 1994. Vorkommen von Clofibrinsaure im aquatischen System—Fuhrt die therapeutische Anwendung zu einer Belastung von Oberflachen-, Grund- und Trinkwasser? Vom Vasser 79:57–68

    Google Scholar 

  • Stockholm läns landsting. 2005. Environmentally classified pharmaceuticals, Stockholm, 16 pp

  • Stumpf M., T. A. Ternes, R. D. Wilken, S. V. Rodrigues, W. Baumann. 1999. Polar drug residues in sewage and natural waters in the state of Rio de Janeiro, Brazil. Sci Total Envir 225:135–141

    Article  Google Scholar 

  • Ternes T. A. 1998 Occurrence of drugs in German sewage treatment plants and rivers. Water Res 32:3245–3260

    Article  CAS  Google Scholar 

  • Ternes T. A., J. Stüber, N. Herrmann, D. McDowell, A. Ried, M. Kampmann, B. Teiser. 2003. Ozonation: a tool for removal of pharmaceuticals, contrast media and musk fragrances from wastewater? Water Res 37:1976–1982

    Article  CAS  Google Scholar 

  • The Presidential/Congressional Commission on Risk Assessment and Risk Management. 1997 Framework for environmental health risk management: final report, volume 1. US EPA, 70 pp

  • United Nations General Assembly. 1992. Report of the United Nations conference on environment and development. A/CONF.151/26 Vol. I, Rio de Janeiro, 5 pp

  • von Krauss M. P. K., E. A. Casman, M. J. Small. 2004. Elicitation of expert judgments of uncertainty in the risk assessment of herbicide-tolerant oilseed crops. Risk Analysis 24:1515–1527

    Article  Google Scholar 

  • Webb S., T. A. Ternes, M. Gibert, K. Olejniczak. 2003. Indirect human exposure to pharmaceuticals via drinking water. Toxicol Lett 142:157–167

    Article  CAS  Google Scholar 

  • Wennmalm Å. 2003. Management of pharmaceutical drug residues from public health care in Stockholm County Council, Envirpharma Conference, Lyon

  • Westerhoff P., Y. Yoon, S. A. Snyder, E. Wert. 2005. Fate of endocrine-disruptors, pharmaceutical, and personal care product chemicals during simulated drinking water treatment processes. Envir Sci Technol 39:6649–6663

    Article  CAS  Google Scholar 

  • Weterings R. A. P. M., J. C. M. Van Eijndhoven. 1989. Informing the public about uncertain risks. Risk Analysis 9:473–482

    Article  Google Scholar 

  • Wiegel S., A. Aulinger, R. Brockmeyer, H. Harms, J. Löffler, H. Reincke, R. Schmidt, B. Stachel, W. von Tümpling, A. Wanke. 2004. Pharmaceuticals in the river Elbe and its tributaries. Chemosphere 57:107–126

    Article  CAS  Google Scholar 

  • Wiener J. B., M. D. Rogers. 2002. Comparing precaution in the United States and Europe. J Risk Res 5:317–349

    Article  Google Scholar 

  • Wilson B. A., V. H. Smith, F. J. Denoyelles, C. K. Larive. 2003. Effects of three pharmaceutical and personal care products on natural freshwater algal assemblages. Envir Sci Technol 37:1713–1719

    Article  CAS  Google Scholar 

  • Wolf L., I. Held, M. Eiswirth, H. Hötzl. 2004. Impact of leaky sewers on groundwater quality. Acta Hydrochim Hydrobiol 32:361–373

    Article  CAS  Google Scholar 

  • Zwiener C., F. H. Frimmel. 2000. Oxidative treatment of pharmaceuticals in water. Water Research 34:1881–1885

    Article  CAS  Google Scholar 

Download references

Acknowledgments

Many thanks to the interviewees who generously gave their time to participate in this study. We also extend our appreciation to the Pierre Elliott Trudeau Foundation, which provided a travel grant for this study, in addition to a doctoral scholarship, and to the Social Sciences and Humanities Research Council of Canada (SSHRC), for also providing funding in the form of a doctoral scholarship.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Nora A. Doerr-MacEwen.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Doerr-MacEwen, N.A., Haight, M.E. Expert Stakeholders’ Views on the Management of Human Pharmaceuticals in the Environment. Environmental Management 38, 853–866 (2006). https://doi.org/10.1007/s00267-005-0306-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00267-005-0306-z

Keywords

Navigation