Journal of Pollution Effects & Control
Open Access

How can Medications be Reduced in the Environment? A Critique

Megha Gandhi^1*, Kajal A. Pradhan² and Dhara A. Chavda^{1 *}Correspondence: Megha Gandhi, Shree H.N Shukla Institute of Pharmaceutical Education & Research, India, Tel: 9587453198, Email:

Author info »

Introduction

In 1977–1978, the first reports on drugs in wastewater and natural water were published [1]. Since After that, understanding the sources, destiny, and ecotoxicology. The field of drugs has begun to progress. Pharmaceuticals have been found in groundwater, surface water, wastewater, soils, and biota all over the world [2,3]. Many pharmacological sources and mechanisms have been identified in general [4,5]. Pharmaceuticals can be utilised as indicators of surface and groundwater pollution caused by domestic wastewater because it is frequently cited as the principal source [6]. Non-wastewater emission pathways, such as aquacultures and wastewaters, are also relevant [7] derived from livestock In addition, in the case of particular groups of people, pharmaceuticals, and non-municipal wastewater routes may have the upper hand. The problem of pharmaceutical pollution in the environment is complicated, not only because of the multiple origins and complex fates [7] but also because of the numerous pharmacological substances in use. 713 pharmaceutically active compounds were examined in wastewater and environmental samples, out of a total of 11,926 (https://www. drugbank.ca/stats) [2]. There are no environmental toxicity issues with 88 percent of drugs information [8,9]. The assessment begins with an overview of upstream options, including design, synthesis, production, prescription, sales, and waste management. Then there's source control (aquaculture, hospital wastewaters, animal wastewater, residential and industrial wastewaters, runoff, landfills leaching, unintentional and intentional introduction of untreated wastewaters) and sophisticated treatment technology.

Pharmaceutical Development and Manufacture

Pharmaceutical consumption will increase for various reasons [9] the worldwide trend of population ageing and life span extension, economic expansion, intensified livestock husbandry, and climate change that exacerbates existing diseases. Malaria and dengue fever (Cavicchioli) are two examples of diseases (2019). The synthesis of environmentally friendly medications is based on the assumption that pharmaceuticals will easily disintegrate and be less hazardous to aquatic organisms after excretion, and that this can be accomplished by manipulating the chemical structure. This enhancement should not alter the active components or the mechanism of action during shelf storage. Alternatives to antibiotics include enzymes, peptides, vaccines, antibodies, phage treatments, immunological stimulation, prebiotics, probiotics, essential oils, and herbal medications, among others [10-12]. In this era of antibiotic resistance, finding alternatives to antibiotics is more crucial than ever [13,14]. Synthesis of bacteria-specific antibiotics is one option. In addition, expiration dates must be re- evaluated. Most producers purposefully lower these or utilize a one-year standard value. Another challenge is the long-term environmental sustainability of medicinal ingredients [15]. As a result of such activities, pharmaceutical waste, as well as the costs associated with it patient.

Prescription and Sales of Pharmaceuticals

Prescriptions and sales of medications are increasing year after year, and will continue to do so in the next years [16] Despite the fact that the population of the Country expanded by 21% in the last decade, the number of prescriptions increased by 85 percent [17] a lot more 50 percent of People take prescription drugs on a regular basis, typically from multiple doctors. When the pathogen is diagnosed at a low level, medications are frequently administered or chosen incorrectly. When a patient takes medications “just in case,” it is referred to as a “just in case” condition is well-known, and it is the result of both specialist and patient pressure. An excellent example is when antibiotics are in short supply. Despite the fact that influenza is a viral condition, it is prescribed for it. Antibiotics are ineffective in treating this Infection. Prescription monitoring is especially significant in the case of elderly people who frequently take the same active ingredient from different specialists. Improvements in pharmaceutical prescription are a critical goal for the existing health-care system (Costa-Font and Gemmill) 2011 (Toyama). More importantly, disease prevention is the most effective way to reduce pharmaceutical use in the environment. An examination of population trends and the Prediction of trends in this area would be beneficial for effective decision-making. Developing a long-term strategy [18].

The following activities can help increase pharmaceutical sales:

Trial and installment dispensing in small quantities is a viable choice. This is particularly critical for medications with a short shelf life, such as aspirin.

The suitable packaging—the visibility of the expiration dates, as well as the dosing—should be improved. Furthermore, on the information leaflet attached to the packaging, information on the importance of returning outdated drugs to certain locations (most commonly pharmacies) should be provided and highlighted.

To avoid the circumstance where multiple specialists prescribed the same active ingredient, but with different names or modalities of application, an electronic and accessible online system of patient treatment history is needed (for example pills and syrup).

Returning leftover medications to the pharmacy through a system. Furthermore, this prevents the usage of this medicine in the future without first consulting an expert.

The standardization of pharmaceutical names for goods containing the same active ingredient, as well as for patients who buy them without knowing what they contain.

Eco-labeling enhances consumer choice and awareness, which in turn improves societal welfare (Li 2020).

Restriction on pharmaceutical advertising, particularly for painkillers and "lifestyle drugs." Medications used to treat non–life threatening and non–painful illnesses such as acne, balding, wrinkles, and erectile dysfunction are known as lifestyle pharmaceuticals. Pharmaceuticals used to "satisfy a non-medical or non-health-related objective" are another definition [19,20]. The majority of these are self-medicated.

Control of pharmaceutical sales on the internet. Large packages are frequently available for a low price and of unknown purity.

Control of the pharmaceutical illegal market. According to press reports, roughly 25% of medications are sold on the black market (according to World Anti-Doping Agency estimations), with a substantial percentage of them being counterfeit [21] anabolic androgenic steroids [22].

Advanced Treatment Technology and Source Control Consumers

Waste management: The incorrect dumping of medications down sinks or toilets is one of the reasons for their prevalence in municipal wastewater. Of course, the best approach is to return to the programmer. The literature has an analysis of medications returned to pharmacies [23,24]. Because they are regarded as hazardous waste, medicines returned to pharmacies are typically disposed of by burning, including the packaging [25].

Storm water Runoff and Surface Runoff

Only by understanding the dynamics of storm water movement can storm water pollution be controlled [26]. Traditional stormwater treatment systems are mechanical (screens, sieves, separators, filters), physicochemical (fotation, focculation, sedimentation) and biological (fotation, focculation, sedimentation) biotic (ponds, marshes, sand flters), and through reducing emissions filtration, storage, and application. Stormwater treatment from hydrophobic contaminants has already been proposed [27,28] but pharmaceuticals would almost certainly require more expensive materials and procedures more sophisticated technology.

Advanced Technology for Water Treatment

The benefits and drawbacks of various procedures (wastewater treatment plants (WWTPs) with activated sludge treatment, WWTPs with biological sludge treatment, etc.) membrane, coagulation, artificial wetlands, chlorination. Bioreactors, micro-, ultra-, and Nano filtration, reverse osmosis, ozonation, photo catalysis, and advanced oxidation processes are all examples of advanced oxidation processes. (Photocatalysis, Fenton, and photo- Fenton are examples of AOPs.) Medications are being phased out (in terms of efficiency, toxicity of products, cost, technical operation, among others).

Sewage from Industry

Because there are no regulatory limitations for pharmaceuticals, monitoring of industrial wastewater is currently focused on fundamental indicators such as COD, BOD, and heavy metal concentrations. For the reduction of such point sources of pharmaceuticals in the environment, the general rule of prevention and “Best Available Technique” must be implemented [29]. Regular monitoring will provide evidence for decision-makers to demand that the quality of treated wastewater be improved in the pharmaceutical manufacturing industry.

Sewage from Hospitals

Hospitals produce a variety of liquid and solid wastes, which have different criteria around the world [30]. There is no specific management directive in Europe of sewage from hospitals Nonetheless, member nations have expressed their dissatisfaction with the current system their own set of rules. In general, hospital wastewater should not be discharged directly into surface water. It is advised that treatment and disposal into surface water or pretreatment and disposal into WWTPs be done. The WHO advice can be found in the book "Safety in the Workplace."

Waste Management from Health-Care Activities” (2nd Edition, Geneva, 2014) [31]. The simultaneous reduction in antibiotics together with antibiotic resistance genes by advanced technology (membrane bioreactor treatment (MBR), ozonation, granulated activated carbon (GAC) and UV treatment) was presented in a real case study.

Agricultural Waste Water

Although a direct harmful effect from this concentration is improbable, with a continuous flow of animal effluent, a change in the bacteria community was seen [32]. Currently, more countries are banning the use of antibiotics which are important for human treatment and for livestock use. Some procedures must be used promptly to reduce the possibility of pharmaceuticals posing a health risk to wildlife and humans due to the presence of antibiotic resistance.

Fisheries

Because of direct contact with aquatic organisms and bacterium resistance to the antibiotics already described, the use of antibiotics in fish production is a hazard for the environment (reviewed in (Santos and Ramos 2018)). Vaccines are available, although they have limits, particularly in the case of crustacea. Other options include bacteriophages, microbiota, phytobiotics, postbiotics, prebiotics, probiotics, and synbiotics (all of which are discussed in [33], with details on the benefits and drawbacks of each technique).

Dumpsites

It has been reported that landflls have polluted groundwater [34,35]. Some medications have been found in such high amounts that they pose a serious threat to groundwater quality [36]. There are treatment options for such wastewater [37,38] and they are effective in terms of standard regulated parameters. Mixing with municipal wastewater, recycling, anaerobic and aerobic systems, coagulation/focculation, and sorption on carbon materials are all part of this excellent treatment [39]. On the one hand, leachates from wastewater will be decreased as a result of stricter rules and a greater number of new landfills with appropriate groundwater protection equipment. As a result, the most effective action is to avoid dumping medications in landfills.

Plants that Cleanse Waste Water

Several variables may contribute to the presence of medicines in municipal wastewater. To begin with, medications are applied orally, inhaled, or applied topically, and their incomplete metabolism in the human body results in a discharge into household wastewater. Despite the significant expense of implementing and operating new technologies, numerous EU countries have begun this process, Switzerland, for example, began executing a plan in 2016 to invest in upgrades to limit the discharge of micropollutants into the aquatic environment from its sewage treatment facilities using an ozonation method in 100 of the 700 WWTPs that exist in the country [40,41]. Given that, even if advanced treatment techniques were used, some pharmaceutical material would eventually find up in surface, ground, and drinking water, a preferable answer is to focus on the "pipe's beginning."

Untreated Wastewater is introduced by Accident or on Purpose

The last source, which is unquantifiable and has, yet to be calculated, is the deliberate or unintentional entry of untreated wastewater. Investing in the modernization of the sewage system, as well as linking all houses to sewage systems, are all ways to avoid this source of pollution and the storm water sewage system, as well as monitoring and linking it to the sewage system of the municipality. Furthermore, there is a need to search for unlawful wastewater dumps, implement external controls in pharmaceutical factories, and improve sanitation. Permitting systems.

Prioritization of Actions

It is difficult to manage, but it is also difficult to perform. Some 2006 insights provide an expert appraisal of important aspects in the pharmaceutical problem management (Doerr-2006 MacEwen and Haight). In interviews (open-ended and closed-ended questions), a group of 27 experts from university, government, and industry were questioned for their opinions. Respective perspectives on the effectiveness and viability a set of actions: Rules governing the production of green medications, as well as risk assessment regulations Advanced therapy was the most successful choice in terms of effectiveness (the highest ranking score), Experts, on the other hand, believe that this is not the case. It would be difficult to put into practice. It was observed that the only low score was for “green medication manufacturing incentives.” The most important thing to do is to improve human and animal health. Experts in several sectors have emphasized the need of working upstream of the pharmaceutical life cycle and the benign-by- design concept. In both veterinary and human medicine, the concept is desirable. Several activities taken at this stage have been linked to human benefits, as they improve pharmaceutical safety. Advanced therapeutic technologies, as well as a short-term solution. When alternative options aren't available, this method should be used impossible [42-45].

Conclusion

Within the notion, the logical consequence of action effect equality for humans and the environment is linked to mutually inseparable dependencies. Working upstream in the pharmaceutical life cycle reduces the influence of not just native chemicals, but also metabolites and transformation products produced during advanced treatment. This broad spectrum of efforts for pharmaceutical minimization should be undertaken in parallel by numerous participants, worldwide and at various organizational levels: scientific establishments, manufacturers, governments, non-governmental organizations, Households and industry. Optimistically, following a review of the literature from 1990 to 2018, it is clear that there are growing worries about pharmaceutical contamination. Environmental issues, as well as remediation activities.

References

1. Cardoso O, Porcher JM, Sanchez W. Factory-discharged pharmaceuticals could be a relevant source of aquatic environment contamination: review of evidence and need for knowledge. Chemosphere. 2014;115:20-30.
2. aus der Beek T, Weber FA, Bergmann A, Hickmann S, Ebert I, Hein A, et al. Pharmaceuticals in the environment—Global occurrences and perspectives. Environ Toxicol and Chem. 2016;35(4):823-35.
3. Le TH, Ng C, Tran NH, Chen H, Gin KY. Removal of antibiotic residues, antibiotic resistant bacteria and antibiotic resistance genes in municipal wastewater by membrane bioreactor systems. Water Res. 2015;145:498-508.
4. Patel M, Kumar R, Kishor K, Mlsna T, Pittman Jr CU, Mohan D. Pharmaceuticals of emerging concern in aquatic systems: chemistry, occurrence, effects, and removal methods. Chemical Rev. 2019;119(6):3510-673.
5. Puckowski A, Mioduszewska K, Łukaszewicz P, Borecka M, Caban M, Maszkowska J, et al. Bioaccumulation and analytics of pharmaceutical residues in the environment: A review. J Pharmaceut and Biomed Analysis. 2016;127:232-55.
6. Tran NH, Gin KY, Ngo HH. Fecal pollution source tracking toolbox for identification, evaluation and characterization of fecal contamination in receiving urban surface waters and groundwater. Sci Total Environ. 2015;538:38-57.
7. Caldwell DJ, Mertens B, Kappler K, Senac T, Journel R, Wilson P, et al. A risk‐based approach to managing active pharmaceutical ingredients in manufacturing effluent. Environ Toxicol and Chemistry. 2016;35(4):813-22.
8. Bagnis S, Fitzsimons MF, Snape J, Tappin A, Comber S. Processes of distribution of pharmaceuticals in surface freshwaters: implications for risk assessment. Environ Chemistry Letters. 2018;16(4):1193-216.
9. OECD. Pharmaceutical residues in freshwater: hazards and policy responses. 2019.
10. Cavicchioli R, Ripple WJ, Timmis KN, Azam F, Bakken LR, Baylis M, et al. Scientists’ warning to humanity: microorganisms and climate change. Nature Reviews Microbiol. 2019;17(9):569-86.
11. Czaplewski L, Bax R, Clokie M, Dawson M, Fairhead H, Fischetti VA, et al. Alternatives to antibiotics—a pipeline portfolio review. The Lancet infectious Dis. 2016;16(2):239-51.
12. Omonijo FA, Ni L, Gong J, Wang Q, Lahaye L, Yang C. Essential oils as alternatives to antibiotics in swine production. Animal Nutrition. 2018;4(2):126-36.
13. World Health Organization. Antimicrobial Resistance, Global Report on Surveillance. 2014.
14. Uppu DS, Ghosh C, Haldar J. Surviving sepsis in the era of antibiotic resistance: are there any alternative approaches to antibiotic therapy?. Microbial Pathogenesis. 2015;80:7-13.
15. Raju G, Sarkar P, Singla E, Singh H, Sharma RK. Comparison of environmental sustainability of pharmaceutical packaging. Perspectives in Sci. 2016;8:683-5.
16. Evaluate Pharma. World Preview. Outlook to 2022. Eval Pharma.2017;1–41.
17. Carr T. Too many meds? America’s love affair with prescription medication. Consumer Reports. 2017;3.
18. Font JC, Toyama MG. Does cost sharing really reduce inappropriate prescriptions among the elderly?. Health Policy. 2011;101(2):195-208.
19. Li Y. Competing eco-labels and product market competition. Resource and Energy Economics. 2020;60:101149.
20. Flower R. Lifestyle drugs: pharmacology and the social agenda. Trends in Pharmacological Sciences. 2004;25(4):182-5.
21. Coopman V, Cordonnier J. Counterfeit drugs and pharmaceutical preparations seized from the black market among bodybuilders. InAnnales de Toxicologie Analytique 2012;24(2):73-80.
22. da Justa Neves DB, Caldas ED. GC–MS quantitative analysis of black market pharmaceutical products containing anabolic androgenic steroids seized by the Brazilian Federal Police. Forensic Sci Int. 2017;275:272-81.
23. Abahussain E, Waheedi M, Koshy S (2012). Practice, awareness and opinion of pharmacists toward disposal of unwanted medications in Kuwait. Saudi Pharm J 20:195–201.
24. Ibrahim SZ, Mamdouh HM, El-Haddad IZ. Analysis of medications returned to community pharmacies in Alexandria, Egypt. Life Sci J. 2012;9(2):746-51.
25. Kadam A, Patil S, Patil S, Tumkur A. Pharmaceutical waste management an overview. Ind J Pharm Practice. 2016 Jan;9(1):3.
26. Vezzaro L, Benedetti L, Gevaert V, De Keyser W, Verdonck F, De Baets B, et al. A model library for dynamic transport and fate of micropollutants in integrated urban wastewater and stormwater systems. Environ Modelling & Software. 2014;53:98-111.
27. Björklund K, Li L. Evaluation of low-cost materials for sorption of hydrophobic organic pollutants in stormwater. J Environ Management. 2015;159:106-14.
28. Soleimanifar H, Deng Y, Wu L, Sarkar D. Water treatment residual (WTR)-coated wood mulch for alleviation of toxic metals and phosphorus from polluted urban stormwater runoff. Chemosphere. 2016;154:289-92.
29. Cardoso O, Porcher JM, Sanchez W. Factory-discharged pharmaceuticals could be a relevant source of aquatic environment contamination: review of evidence and need for knowledge. Chemosphere. 2014;115:20-30.
30. Carraro E, Bonetta S, Bertino C, Lorenzi E, Bonetta S, Gilli G. Hospital effluents management: chemical, physical, microbiological risks and legislation in different countries. J Environ Manage. 2016;168:185-99.
31. Chartier Y, editor. Safe management of wastes from health-care activities. World Health Organization; 2014.
32. Jia S, Zhang XX, Miao Y, Zhao Y, Ye L, Li B, et al. Fate of antibiotic resistance genes and their associations with bacterial community in livestock breeding wastewater and its receiving river water. Water Res. 2017;124:259-68.
33. Pérez-Sánchez T, Mora-Sánchez B, Balcázar JL. Biological approaches for disease control in aquaculture: advantages, limitations and challenges. Trends in Microbio. 2018;26(11):896-903.
34. Samadder SR, Prabhakar R, Khan D, Kishan D, Chauhan MS. Analysis of the contaminants released from municipal solid waste landfill site: a case study. Sci Total Environ. 2017;580:593-601.
35. Branchet P, Castro NA, Fenet H, Gomez E, Courant F, Sebag D, Gardon J, Jourdan C, Ngatcha BN, Kengne I, Cadot E. Anthropic impacts on Sub-Saharan urban water resources through their pharmaceutical contamination (Yaoundé, Center Region, Cameroon). Sci of the Total Environ. 2019;660:886-98.
36. Peng X, Ou W, Wang C, Wang Z, Huang Q, Jin J, et al. Occurrence and ecological potential of pharmaceuticals and personal care products in groundwater and reservoirs in the vicinity of municipal landfills in China. Sci of the Total Environ. 2014;490:889-98.
37. Bolyard SC, Reinhart DR. Application of landfill treatment approaches for stabilization of municipal solid waste. Waste Management. 2016;55:22-30.          
38. Bakraouy H, Souabi S, Digua K, Dkhissi O, Sabar M, Fadil M. Optimization of the treatment of an anaerobic pretreated landfill leachate by a coagulation–flocculation process using experimental design methodology. Process Safety and Environ Protection. 2017;109:621-30.
39. Costa AM, Alfaia RG, Campos JC. Landfill leachate treatment in Brazil–An overview. J Environ Manage. 2019;232:110-6.
40. Carolin CF, Kumar PS, Joshiba GJ, Kumar VV. Analysis and removal of pharmaceutical residues from wastewater using membrane bioreactors: a review. Environ Chemistry Letters. 2021;19(1):329-43.
41. Bourgin M, Beck B, Boehler M, Borowska E, Fleiner J, Salhi Eet al. Evaluation of a full-scale wastewater treatment plant upgraded with ozonation and biological post-treatments: Abatement of micro pollutants, formation of transformation products and oxidation by-products. Water Res. 2018;129:486-98.
42. Doerr-MacEwen NA, Haight ME. Expert stakeholders’ views on the management of human pharmaceuticals in the environment. Environ Manage. 2006;38(5):853-66.
43. Daughton CG. Cradle-to-cradle stewardship of drugs for minimizing their environmental disposition while promoting human health. I. Rationale for and avenues toward a green pharmacy. Environ Health Perspectives. 2003;111(5):757-74.
44. Daughton CG, Ruhoy IS. Green pharmacy and pharmEcovigilance: prescribing and the planet. Expert Review of Clinical Pharma. 2011;4(2):211-32.
45. Patel M, Kumar R, Kishor K, Mlsna T, Pittman Jr CU, Mohan D. Pharmaceuticals of emerging concern in aquatic systems: Chemistry, occurrence, effects, and removal methods. Chem Rev. 2019;119(6):3510-673.