Consideration of the environmental impact of human pharmaceuticals in prescribing decisions

It’s #TechnicalTuesday and NCET Toxicologist Adeolu Aderemi is discussing how the environmental impact of human pharmaceuticals can be improved by prescribing decisions.

The continuous discharge of pharmaceuticals for human use into water bodies remains an ongoing global concern due to the threat they pose to aquatic organisms as well as humans. Some of these contaminants include endocrine disruptors and antibiotics. Apart from waste streams that contain pharmaceuticals from veterinary and industrial sources entering our environment, humans are considered the greatest source of these pseudo-persistent contaminants in the environment (via excretion wastewater treatment works (WWTW)).

Unfortunately, following consumption by patients, pharmaceuticals and their metabolites are excreted into the sewer and reach WWTWs, which are unable to fully eliminate them, leading to their frequent detection in surface water as well as drinking water. Since the advanced treatment technologies available to tackle this problem are cost- and energy-intensive, source control - such as taking environmental information into account in prescribing decisions - has been recommended as a vital means of reducing the risk from pharmaceutical substances in the United Kingdom.

This is based on the selection criteria approach currently used by Stockholm County Council in which formulary choice of recommended medicines for the Stockholm healthcare region (known as the 'Wise List') includes environmental considerations. Provided that the cost and clinical effectiveness of medicines can be balanced then their selection and prescription for human use should start to take their environmental or ecotoxicological impacts into consideration. What do you think?'