Investigating dynamic sources of pharmaceuticals: Demographic and seasonal use are more important than down-the-drain disposal in wastewater effluent in a University City setting

Ecopharmacology: Knowledge, Attitude, and Medication Disposal Practice Among Pharmacy Students

Background

Ecopharmacology, as a form of drug management for the environment, focuses on the impact of drugs on the environment. Pharmacists, and by extension pharmacy students, are expected to play an important role in ecopharmacology. Therefore, this study was conducted to determine the knowledge and attitude towards ecopharmacology and the practice of disposal of leftover or expired medicines among pharmacy students.

Methods

This was a descriptive cross-sectional study among pharmacy students in Northwestern Ethiopia. The study took place from May 1 to June 15, 2023. A self-administered questionnaire was used for data collection.

Results

Four hundred and forty-five students were included in the study. Only 91 (20%) of the students were aware of the term ecopharmacology, 27% knew that excretion from the human or animal body is the major route by which pharmaceutical agents enter the environment, and 42% were aware of the risk of increased antimicrobial resistance due to antibiotic residues in the environment. In addition, only 27% of respondents reported receiving information about the disposal of pharmaceuticals. The most common method of disposing of medications was throwing them away in household trash (61.8%).

Conclusion

Our results suggest that while most pharmacy students in Ethiopia have a positive attitude toward ecopharmacology, they do not know enough about ecopharmacology and dispose of their medicines poorly. More uniform education in ecopharmacology and pharmaceutical pollution might be warranted in the pharmacy curriculum.

More movement with manure: increased mobility of erythromycin through agricultural soil in the presence of manure

Antibiotic residues in the environment threaten soil and aquatic organisms and human and livestock health through the building of antimicrobial resistance. Manure spreading associated with animal agriculture is one source of environmental antibiotic residues. To better understand the risk of contamination, we studied the adsorption of erythromycin, a model macrolide antibiotic used across human and animal medicine. We conducted a series of equilibrium batch experiments to determine the kinetics and extent of adsorption and a continuous-flow column adsorption experiment to observe non-equilibrium adsorption patterns. We determined that the adsorption equilibration time to soil was approximately 72 h in our batch experiments. Erythromycin adsorbed to soil relatively strongly (K = 8.01 × 10-2 L/mg; qmax = 1.53 × 10-3 mg/mg), adsorbed to the soil in the presence of manure with less affinity (K = 1.99 × 10-4 L/mg) at a soil: manure ratio of 10:1 by mass, and did not adsorb to manure across the solid ratios tested. We observed multi-phased adsorption of erythromycin to the soil during the non-equilibrium column experiment, which was largely absent from the treatments with both soil and manure present. These results suggest that erythromycin is more mobile in the environment when introduced with manure, which is likely the largest source of agriculturally sourced environmental antibiotics.

From market to environment - consumption-normalised pharmaceutical emissions in the Rhine catchment

Direct and indirect threats by organic micropollutants can only be reliably assessed and prevented if the exposure to these chemicals is known, which in turn requires a confident estimate of their emitted amounts into the environment. APIs (Active Pharmaceutical Ingredients) enter surface waters mostly through the sewer system and wastewater treatment plants (WWTPs). However, their effluent fluxes are highly variable and influenced by several different factors that challenge robust emission estimates. Here, we defined a dimensionless, theoretically consumption-independent 'escape factor' (k_esc) for estimating the amount of APIs (expected to be) present in WWTP effluents. The factor is determined as the proportion of marketed and actually emitted amounts of APIs. A large collection of German and Swiss monitoring datasets were analyzed to calculate stochastic k_esc values for 31 APIs, reflecting both the magnitude and uncertainty of consumption-normalised emissions. Escape factors provide an easy-to-use tool for the estimation of average API emissions and expected variability from numerous WWTPs given that consumption data are provided, thereby supporting simulation modeling of the fate of APIs in stream networks or exposure assessments.

Gamma irradiation-induced degradation and mineralization of methocarbamol in aqueous solution

Gamma irradiation degradation of the extensively used muscle relaxant in the world methocarbamol (MET) was studied. MET aqueous solutions were irradiated by gamma rays emitted by a Cobalt 60 source at doses of 1-4 kGy. Our findings demonstrated that gamma irradiation degraded more than 98.5% of MET. Absorption spectra analysis revealed that when increased irradiation dose, the absorption bands declined with complete disappearance at 4 kGy dose. Additionally, the most radiolytic degradation rate was recorded at neutral pH, marked by Total Organic Carbon (TOC) removal rate of 98% reflecting the total mineralization of MET at 4 kGy. In-depth spectrophotometric analyses advocated a pseudo-first-order type of MET degradation kinetics. The obtained apparent rate constant value was k_{app, MET} = (0.02167 ± 0.0006) min^-1. Gas chromatography-mass spectrometry (GC-MS) allowed the detection of 3-(o-methoxyphenoxy)-1,2 propanediol,2-methoxyphenol, 1,2,3 propanetriol, 1,2-dihydroxybenzene and 1,2,4 benzentriol identified as by-products generated during radiolytic degradation. Finally, an outline of the degradation mechanism was suggested according to the obtained by-products.

Impact of the COVID-19 pandemic on household disinfectant consumption behaviors and related environmental concerns: A questionnaire-based survey in China

Considering the potential hazardous effects of disinfectant residues on environment, organisms and biodiversity, the sharp rise in use of disinfectants during COVID-19 pandemic has been considered highly likely to cause worldwide secondary disasters in ecosystems and human health. This questionnaire-based survey investigated the impact of COVID-19 outbreak on household disinfectant product consumption levels and behavior of 3667 Chinese residents. In particular, in the context that no strategy is currently available to minimize the disinfectant pollution, based on the similarities between disinfectants and pharmaceuticals, we proposed a perspective of ecopharmacovigilance (EPV), which is an effective measure to minimize the environmental risks posed by pharmaceuticals using drug administration protocols, for disinfectant environmental risk management. The public's environmental perceptions, attitudes and the related practices regarding household disinfectant consumption from an EPV perspective were also included in the study. The results showed that the COVID-19 outbreak caused a tremendous rise in the public's household disinfectant consumption and usage levels in China. After the COVID-19 outbreak, the chlorine-based and alcohol-based disinfectants were considered as the most preferred products for household disinfection and hand sanitization, respectively. Importantly, the Chinese public's environmental perceptions and practice on disinfectants were poor. Less than half respondents had positive attitudes toward the source control of disinfectant pollution. The population groups including females, the middle aged adults, those having healthcare professional background, as well as the higher-educated could be focused on to develop targeted efforts for the future control of disinfectant pollution in environment.

Carbamazepine Levels Related to the Demographic Indicators in Groundwater of Densely Populated Area

Consumption of pharmaceuticals by people is growing. Carbamazepine (CBZ) is an extensively used anti-epileptic drug that is recalcitrant to degradation. As a result, CBZ has been widely detected in the aquatic ecosystem due to its daily consumption and drainage in sewage systems. Leakages from sewage networks and septic tanks may represent one of the main sources of CBZ in groundwater. In this study, CBZ concentrations in groundwater and their correlations with the demographic structure of the population were investigated in the densely populated Milan urban area. Seventy-six demographic variables were retrieved from the Italian Population and Housing census. Twenty-one groundwater samples were collected from unconfined and semi-confined aquifers of the Milan area and the concentration of CBZ was measured. Groundwater CBZ levels in both aquifers were associated with the demographic data within a circular buffer with a radius of 1.5 km. All data were analyzed using a multivariate statistical approach. The results showed a significant association (p < 0.05) between CBZ concentrations and specific demographic segments of the population. Higher CBZ concentrations were found to be associated with the population aged 70 years and over (aging index), and with families having children aged under 5 years (family index). In addition, the divorce index was correlated with the high concentration of CBZ, whereas the educated and sexagenarian population showed a negative correlation. Our results indicated that the contamination of CBZ follows the same pattern in unconfined and semi-confined aquifers, which are used for drinking water purposes in Milan area. Therefore, changing the CBZ consumption pattern or replacing CBZ with other drugs may strongly influence groundwater contamination of the investigated area.

Diagnosing Down-the-Drain Disposal of Unused Pharmaceuticals at a River Catchment Level: Unrecognized Sources of Environmental Contamination That Require Nontechnological Solutions

Down-the-drain disposal of pharmaceuticals remains an overlooked and unrecognized source of environmental contamination that requires nontechnological "at-source" solutions. Monitoring of 31 pharmaceuticals over 7 days in five wastewater treatment plants (WWTPs) serving five cities in South-West UK revealed down-the-drain codisposal of six pharmaceuticals to three WWTPs (carbamazepine and propranolol in city A, sildenafil in city B, and diltiazem, capecitabine, and sertraline in city D), with a one-off record codisposal of estimated 253 pills = 40 g of carbamazepine and estimated 96 pills = 4 g of propranolol in city A accounting for their 10- and 3-fold respective increases in wastewater daily loads. Direct disposal of pharmaceuticals was found to affect the efficiency of wastewater treatment with much higher pharmaceutical removal (decrease in daily load) during "down-the-drain disposal" days. This is due to lack of conjugated glucuronide metabolites that are cleaved during "consumption-only" days, with the release of a parent pharmaceutical counterbalancing its removal. Higher removal of pharmaceuticals during down-the-drain disposal days reduced pharmaceutical loads reaching receiving environment, albeit with significant levels remaining. The estimated daily loads in receiving water downstream from a discharge point accounted for 13.8 ± 3.4 and 2.1 ± 0.2 g day^-1 of carbamazepine and propranolol, respectively, during consumption-only days and peaked at 20.9 g day^-1 (carbamazepine) and 4.6 g day^-1 (propranolol) during down-the-drain disposal days. Actions are needed to reduce down-the-drain disposal of pharmaceuticals. Our recent work indicated that down-the-drain disposal of pharmaceuticals doubled since the last study in 2005, which may be due to the lack of information and messaging that informs people to dispose of unused medicines at pharmacies. Media campaigns that inform the public of how to safely dispose of medicines are key to improving rates of return and reducing pharmaceutical waste in the environment. The environment is a key motivator for returning unused medicines to a pharmacy and so messaging should highlight environmental risks associated with improper disposal.

Spatio-Temporal Distribution and Influencing Factors of Human and Veterinary Pharmaceuticals in the Tributary Surface Waters of the Han River Watershed, South Korea

Human and veterinary pharmaceuticals are being increasingly used for disease treatment; hence, their distribution and factors influencing them in the aquatic environment need to be investigated. This study observed the effect of human and animal populations, usage, purchasing criteria (prescription vs. non-prescription), and land use to identify the spatio-temporal distribution of eight pharmaceuticals at twenty-four sites of the tributaries of the Han River watershed. In rural areas, the mean concentration (detection frequency) of non-prescription pharmaceuticals (NPPs) was higher (lower) compared to that of prescription pharmaceuticals (PPs); in urban areas, a reverse trend was observed. Pharmaceutical concentrations in urban and rural areas were mainly affected by wastewater treatment plants (WWTPs) and non-point sources, respectively; concentrations were higher downstream (4.9 times) than upstream of the WWTPs. The concentration distribution (according to the target) was as follows: human–veterinary > human > veterinary. Correlation between total concentration and total usage of the pharmaceuticals was high, except for NPPs. Most livestock and land use (except cropland) were significantly positively correlated with pharmaceutical concentrations. Concentrations were mainly higher (1.5 times) during cold seasons than during warm seasons. The results of this study can assist policymakers in managing pharmaceutical pollutants while prioritizing emerging pollutants.

Modeling estrogenic activity in streams throughout the Potomac and Chesapeake Bay watersheds

Endocrine-disrupting compounds (EDCs), specifically estrogenic endocrine-disrupting compounds, vary in concentration and composition in surface waters under the influence of different landscape sources and landcover gradients. Estrogenic activity in surface waters may lead to adverse effects in aquatic species at both individual and population levels, often observed through the presence of intersex and vitellogenin induction in male fish. In the Chesapeake Bay Watershed, located on the mid-Atlantic coast of the USA, intersex has been observed in several sub-watersheds where previous studies have identified specific landscape sources of EDCs in tandem with observed fish health effects. Previous work in the Potomac River Watershed (PRW), the largest basin within the Chesapeake Bay Watershed, was leveraged to build random forest regression models to predict estrogenic activity at unsampled reaches in both the Potomac River and larger Chesapeake Bay Watersheds (CBW). Model outputs including important variables, partial dependence plots, and predicted values of estrogenic activity at unsampled reaches provide insight into drivers of estrogenic activity at different seasons and scales. Using the US Environmental Protection Agency effects-based threshold of 1.0 ng/L 17 β-estradiol equivalents, catchments predicted to exceed this value were categorized as at risk for adverse effects from exposure to estrogenic compounds and evaluated relative to healthy watersheds and recreation access locations throughout the PRW. Results show immediate catchment scale models are more reliable than upstream models, and the best predictive variables differ by season and scale. A small percentage of healthy watersheds (< 13%) and public access sites were classified as at risk using the "Total" (annual) model in the CBW. This study is the first Potomac River Watershed assessment of estrogenic activity, providing a new foundation for future risk assessment and management design efforts, with additional context provided for the entire Chesapeake Bay Watershed.

Targeted eco-pharmacovigilance as an optimized management strategy for adverse effects of pharmaceuticals in the environment

From a perspective of drug administration, eco-pharmacovigilance (EPV) has been proposed as a new approach to prevent the environmental risks posed by pharmaceutical emerging contaminants. However, it is impracticable to practice unitary and rigor EPV process for all the pharmaceutical substances with complex and diversified chemical, biological or toxicological properties. We proposed the "targeted EPV" that is the science and activities associated with the targeted detection, evaluation, understanding, and prevention of adverse effects of high-priority hazardous pharmaceuticals in the environment, especially focusing on the control of main anthropogenic sources of pharmaceutical emission among key stakeholders in high-risk areas could be used as an optimized management strategy for pharmaceutical pollution. "Targeted EPV" implementation should focus on the targeted monitoring of the occurrence of high-priority pharmaceuticals in environmental samples, the targeted reporting of over-standard discharge, the targeted management for main emission sources, the targeted legislation and researches on high-priority pharmaceutical pollutants, as well as the targeted educational strategies for specific key populations.

Environmental knowledge, behaviors, and attitudes regarding caffeine consumption among Chinese university students from the perspective of ecopharmacovigilance

Caffeine is considered the most representative pharmaceutical emerging contaminant (PEC) because of its ubiquity, high environmental abundance, uncovered ecological risks, and its indicator property for anthropogenic environmental inputs of PECs. Ecopharmacovigilance (EPV) targeting caffeine has been proposed as an optimized measure for the control of caffeine pollution sources and the related anthropogenic behaviors from the perspective of pharmacy administration. This cross-sectional study was conducted to evaluate the environmental knowledge, behaviors, and attitudes regarding caffeine consumption among university students, one of the groups with high caffeine consumption, from an EPV perspective. Three hundred and seven usable survey instruments were acquired. The mean score for environmental knowledge about caffeine consumption was 3.66 out of a total of 7. The consumption frequency of caffeinated drinks, food, or drugs among student respondents was low. Throwing away in "household garbage" was an important disposal mechanism for unconsumed caffeinated products. Most students showed positive attitudes and strong intentions toward caffeine pollution control from the perspective of targeted EPV. These data suggested high acceptance of EPV program targeting caffeine among university students. However, more should be done to enhance their related knowledge, and some strengthening interventions for the effective removal of residual caffeine in garbage are needed.

Occurrence and risks of antibiotics in an urban river in northeastern Tibetan Plateau

There is a dearth of information on the occurrence and risks of antibiotics in the urban rivers from plateau areas. This study investigated 83 antibiotics in water and sediments of an urban river and effluents of sewage treatment plants (E-STPs) in Xining, Qinghai (northeastern Tibetan Plateau). Fifty-three antibiotics were detected, and the concentrations of individual antibiotics varied in the range of undetected (ND)-552 ng/L in water, ND-164 ng/g in sediments, and ND-3821 ng/L in E-STPs. Seasonal differences of antibiotic concentrations were significant for water samples (p < 0.05) but insignificant for sediments (p > 0.05). In urban area, E-STP is the main source of antibiotics in the river, while runoff from manured cropland contributes partially to antibiotics in the river in the suburban area. The antibiotic compositions in water were different from those in sediments, but were similar to those in E-STPs. Notably, because of strong solar radiation and long sunshine hours in the plateau area, low levels of quinolones, which are sensitive to photolysis, were observed in river water. Moreover, norfloxacin and enrofloxacin, observed in urban river from other regions of China, were not detected in the Huangshui River water. The occurrence of ofloxacin, erythromycin, roxithromycin, clarithromycin, and trimethoprim in E-STPs may induce a possible risk to antibiotic resistance evolution. Trimethoprim, anhydroerythromycin, sulfamethoxazole, sulfapyridine, and clindamycin in river water could pose low to medium risks to aquatic organisms. Further investigation on the occurrence and distribution of antibiotic resistance genes in the Huangshui River is urgently needed.

Temporal-spatial variation and environmental risk assessment of pharmaceuticals in tributaries of the Han River watershed, South Korea

Eight compounds from three categories of pharmaceuticals [5 antibiotics, 2 non-steroidal anti-inflammatory drugs, and 1 anti-epileptics] were monitored at 24 sites in the tributaries of the Han River watershed in South Korea, 2016. The seasonal occurrence, temporal-spatial variation, potential compound source(s), and a risk assessment of this watershed, which is the largest drinking water source in the country, were investigated. Clarithromycin was detected most frequently (72.2%) with the greatest median concentration (0.151 ± 0.072 μg L^-1), followed by carbamazepine and sulfamethoxazole. The seasonality of the pharmaceuticals was observed, with higher concentrations and detection frequencies in spring than in summer and autumn; this was possibly caused by lower levels of microbial activities associated with lower water temperatures than other seasons. In terms of geographical variation, urban areas had higher pharmaceutical concentrations than rural areas, which was attributed to the former's high population density and largest wastewater treatment plants (WWTPs) regardless of season. The total concentration and detection frequency of WWTPs were 12.4 and 2.5 times higher in downstream sites than upstream sites, thereby conveying that WWTPs were the main source for the presence of pharmaceuticals in tributaries. According to the results produced from calculations of the risk quotient (RQ) of aquatic organisms, clarithromycin and sulfamethazine were identified as posing relatively high ecological risk (RQ > 1) during the spring that was identified for this study. This study can provide policymakers with scientific support for prioritizing pollutant management and collections of global data on emerging pollutants.

What's in Your Body of Water? A Pilot Study Using Metaphoric Framing to Reduce the Psychological Distance in Pharmaceutical Pollution Risk Communication

Aquatic pharmaceutical pollution poses ecotoxicological risks to the environment and human health. Consumer pharmaceutical use and disposal behaviors represent a significant source of pharmaceutical compounds in surface waters, and communication strategies are needed to promote pro-environmental behaviors to reduce pharmaceutical pollution. Designing effective risk communication campaigns requires an understanding of public perceptions of aquatic pharmaceutical pollution. The purpose of this mixed-methods pilot study was to test the efficacy of using theories from cognitive linguistics and psychology (conceptual metaphor theory and construal level theory of psychological distance, respectively) in using metaphors in pharmaceutical pollution risk communication. Our methods included a randomized cross-over design in which a convenience sample of university students (n = 20) viewed visual representations of pharmaceutical pollution risks (metaphor based and non-metaphor). We used cognitive interviewing methods to assess metaphor use on participants understanding of pharmaceutical pollution risk, concern about this risk, and willingness to act. Results indicate that participants preferred the metaphorically-framed visual, and that the use of metaphor significantly reduced participants' perceived social and geographic distance of pharmaceutical pollution risk, suggesting a relationship between metaphoric framing and psychological distance warranting additional research. Theoretical and practical implications of metaphor use in risk communications are discussed.

Sulfamethoxazole/Trimethoprim ratio as a new marker in raw wastewaters: A critical review

Global Trimethoprim (TMP) and Sulfamethoxazole (SMX) occurrences in raw wastewaters were systematically collected from the literature (n = 140 articles) in order to assess the relevance of using the SMX/TMP ratio as a marker of the main origin of wastewaters. These two antibiotics were selected due to their frequent use in association (i.e. co-trimoxazole) in a 5:1 ratio (SMX:TMP) for medication purposes, generating a unique opportunity to globally evaluate the validity of this ratio based on concentration values. Several parameters (e.g. sorption, biodegradation) may affect the theoretical SMX/TMP ratio. However, the collected data highlighted the good agreement between the theoretical ratio and the experimental one, especially in wastewater treatment plant influents and hospital effluents. Only livestock effluents displayed a very high SMX/TMP ratio, indicative of the very significant use of sulfonamide alone in this industry. Conversely, several countries displayed low SMX/TMP ratio values, highlighting local features in the human pharmacopoeia. This review provides new insights in order to develop an easy to handle and sound marker of wastewater origins (i.e. human/livestock), beyond atypical local customs.

Occurrence, source estimation and risk assessment of pharmaceuticals in the Chaobai River characterized by adjacent land use

This study investigated the occurrence of 27 pharmaceuticals with diverse physicochemical properties in a year-long monitoring campaign in the Chaobai River, China. The correlation between the distribution of pharmaceuticals in the river and the adjacent sources was elucidated. The results indicate that the agriculture area was the most polluted area with a median summed pharmaceutical concentration of 225.3 ng L^-1, followed by the urban area and the mountain area with the corresponding values of 136.9 and 29.9 ng L^-1, respectively. In terms of individual compounds, 22 out of 27 compounds were detected with concentrations ranging from <1 to 1972 ng L^-1. Caffeine, carbamazepine, azithromycin, bezafibrate, metoprolol, sulfadiazine, sulfamethoxazole, clarithromycin, erythromycin, roxithromycin, and trimethoprim were pharmaceuticals with relatively high levels, with median concentrations ranging from 3.3 to 25.6 ng L^-1 and detection frequencies ranging from 40% to 97%. Higher concentrations were mainly observed during cold seasons, with mean concentrations 1 to 52 times as high as those during warm seasons. Spatial analysis reveals that the pharmaceutical concentrations in different areas were impacted by different sources. A wastewater treatment plant was an important source in the urban area, while the agriculture area was impacted by various treated and untreated wastewater sources. The species sensitivity distribution model and risk quotient (RQ) method were combined in the ecological risk assessment. The results indicate that the multi-substance potentially affected fraction (msPAF) values of the sampling sites were below 0.04%, whereas nearly half of RQ values were higher than 1. Caffeine was proposed as a priority compound due to its high contribution rate (i.e., 79%) to the cumulative msPAF value, which implies that increased control and management of untreated wastewater sources along the Chaobai River is necessary.

Influence of hydrologic and anthropogenic drivers on emerging organic contaminants in drinking water sources in the Susquehanna River Basin

Occurrence of emerging organic contaminants (EOCs) in surface water bodies can cause adverse effects on non-target organisms. When surface waters are used as drinking water sources, temporal variability in EOC concentrations can potentially impact drinking water quality and human health. To better understand spatiotemporal variability of EOCs in drinking water sources in Central Pennsylvania, EOCs were evaluated in six drinking water sources during a two-year study period (April 2016-June 2018) in the Susquehanna River Basin (SRB). The study was conducted in two phases: Phase I was a spatially distributed sampling approach within the SRB focusing on seven human pharmaceuticals and Phase II was a temporally intensive sampling regime at a single site focusing on a broader range of EOCs. Concentration-discharge relationships were utilized to classify EOC transport dynamics and understand the extent to which hydrologic and anthropogenic factors, such as surface runoff and wastewater effluent, may contribute to EOC occurrence. Overall, EOCs were present at higher concentrations in colder seasons than warmer seasons. Thiamethoxam, a neonicotinoid insecticide, and caffeine exhibited accretion dynamics during high-flow periods, suggesting higher transport during surface runoff events. Human pharmaceuticals known to persist in wastewater effluent were inversely correlated with discharge, indicating dilution characteristics consistent with diminished wastewater signals during high-flow periods. Acetaminophen exhibited near-chemostatic transport dynamics, indicating nonpoint source inputs during high-flow periods. Risk calculations revealed that although EOCs posed medium-to-high risk to aquatic organisms, human health risk through fish consumption was low.

Impact of meteorological and social events on human-excreted contaminant loads in raw wastewater: From daily to weekly dynamics

The temporal dynamics of the wastewater influent loads of 25 drug target residues (DTR, both pharmaceuticals and illicit drugs) was assessed during 84 consecutive days. This monitoring scale enables longer temporal patterns than weekday/weekend patterns to be explored. In this study, we focus on day to day variations and the potential statistical correlation of each DTR analyzed in order to better understand the potential forcings that lead to the load variation of DTRs (alone or in clusters). The weekly patterns based on the weekly loads of DTRs were also analyzed and the impact of social and meteorological events on their variations was investigated. Two cold events occurred during the monitoring period and were associated with the highest loads of analgesics and non-steroidal anti-inflammatory drugs, as well as the lowest loads of stimulants. During the Easter holidays, a significant decrease in some year-long medication as well as analgesics was found, consistent with the demographic decrease within the catchment during this period. Lastly, a good correlation between the academic calendar and the loads of stimulants was found, emphasizing the overrepresentation of students in the consumption of recreational drugs. This study furnishes new insights in order to better understand the variations in DTR loads in wastewater influents, beyond the weekday/weekend pattern and the seasonal effect. Further investigations remain necessary, especially a real-time monitoring of the population figures within the catchment in order to improve our understanding of these results.

Assessment of 83 pharmaceuticals in WWTP influent and effluent samples by UHPLC-MS/MS: Hourly variation

The removal efficiency of pharmaceuticals in wastewater treatment plants (WWTPs) is variable and some of these compounds pass these plants almost intact and others presenting a removal efficiency close to 100%. Their incomplete removal results in a continuous discharge of pharmaceuticals into the environment. To assess the profile of contamination of influents and effluents over a day, a set of 83 pharmaceuticals were evaluated hourly in a WWTP in Leiria, Portugal. The composite samples of the influent and effluent were also collected. Concentrations varied from <MDL for ketoprofen, clarithromycin, ofloxacin, and diltiazem to 63.97 μg/L for caffeine in the WWTP influent composite sample and <MDL for clarithromycin, bupropion, and diltiazem to 2.01 μg/L for O-desmethylvenlafaxine for effluent composite sample. Concentrations in the range of μg/L were found for hydroxyibuprofen, salicylic acid, d,l-norephedrine, and caffeine in the WWTP influent, and diclofenac, carbamazepine, O-desmethylvenlafaxine in the WWTP effluents. For the samples collected hourly, thirty-eight and twenty-nine pharmaceuticals were detected in at least one WWTP sample. In the WWTP influent the total concentration of detected pharmaceuticals was higher between 15 and 22 h and lower in the period from 23 to 10 h in the morning. In the WWTP effluent, a slight variation was noticed throughout the sampling hours. Carbamazepine, fluoxetine, sertraline, atorvastatin, caffeine, simvastatin, and trazodone were the pharmaceuticals with risk quotient (RQ) >1 in WWTP influents, and carbamazepine, fluoxetine, sertraline the pharmaceuticals with an RQ > 1 in WWTP effluents.

Concentrations of pharmaceuticals and other micropollutants in groundwater downgradient from large on-site wastewater discharges

Large subsurface treatment systems (LSTS) and rapid infiltration basins (RIB) are preferred onsite wastewater treatments compared to direct discharge of treated wastewater to streams and adjacent facilities. Discharge of these wastewater treatments may result in contaminant loading to aquifers that also serve as drinking water sources downgradient from the discharge site. Until recently, few studies have characterized the contribution of micropollutants (e.g. pharmaceuticals, fragrances, flame retardants, etc.) to receiving aquifers. We conducted a pilot project to characterize the occurrence of micropollutants in groundwater downgradient from 7 on-site treatment systems in Minnesota, USA: 5 community LSTS and 2 municipal RIB. One downgradient monitoring well was sampled three times at each facility over one year. Of 223 micropollutants analyzed, 35 were detected. Total sample concentrations ranged from 90 to 4,039 ng/L. Sulfamethoxazole (antibiotic) was detected in all samples at concentrations from 7 to 965 ng/L. Other pharmaceuticals (0.12–1,000 ng/L), organophosphorus flame retardants (10–500 ng/L), and other anthropogenic chemicals (4–775 ng/L) were also detected. The numbers and concentrations of micropollutants detected were inversely related to dissolved oxygen and depth to water. Ratios of pharmaceutical concentrations to human-health screening values were <0.10 for most samples. However, concentrations of carbamazepine and sulfamethoxazole exceeded screening values at two sites. Study results illustrate that large on-site wastewater systems designed to discharge to permeable soil or shallow groundwater effectively deliver pharmaceuticals and other micropollutants to groundwater aquifers and could contribute micropollutants to drinking water via water supply wells.

Pharmaceutical manufacturing facility discharges can substantially increase the pharmaceutical load to U.S. wastewaters

Discharges from pharmaceutical manufacturing facilities (PMFs) previously have been identified as important sources of pharmaceuticals to the environment. Yet few studies are available to establish the influence of PMFs on the pharmaceutical source contribution to wastewater treatment plants (WWTPs) and waterways at the national scale. Consequently, a national network of 13 WWTPs receiving PMF discharges, six WWTPs with no PMF input, and one WWTP that transitioned through a PMF closure were selected from across the United States to assess the influence of PMF inputs on pharmaceutical loading to WWTPs. Effluent samples were analyzed for 120 pharmaceuticals and pharmaceutical degradates. Of these, 33 pharmaceuticals had concentrations substantially higher in PMF-influenced effluent (maximum 555,000 ng/L) compared to effluent from control sites (maximum 175 ng/L). Concentrations in WWTP receiving PMF input are variable, as discharges from PMFs are episodic, indicating that production activities can vary substantially over relatively short (several months) periods and have the potential to rapidly transition to other pharmaceutical products. Results show that PMFs are an important, national-scale source of pharmaceuticals to the environment.

Temporal and spatial variation in pharmaceutical concentrations in an urban river system

Many studies have quantified pharmaceuticals in the environment, few however, have incorporated detailed temporal and spatial variability due to associated costs in terms of time and materials. Here, we target 33 physico-chemically diverse pharmaceuticals in a spatiotemporal exposure study into the occurrence of pharmaceuticals in the wastewater system and the Rivers Ouse and Foss (two diverse river systems) in the city of York, UK. Removal rates in two of the WWTPs sampled (a conventional activated sludge (CAS) and trickling filter plant) ranged from not eliminated (carbamazepine) to >99% (paracetamol). Data comparisons indicate that pharmaceutical exposures in river systems are highly variable regionally, in part due to variability in prescribing practices, hydrology, wastewater management, and urbanisation and that select annual median pharmaceutical concentrations observed in this study were higher than those previously observed in the European Union and Asia thus far. Significant spatial variability was found between all sites in both river systems, while seasonal variability was significant for 86% and 50% of compounds in the River Foss and Ouse, respectively. Seasonal variations in flow, in-stream attenuation, usage and septic effluent releases are suspected drivers behind some of the observed temporal exposure variability. When the data were used to evaluate a simple environmental exposure model for pharmaceuticals, mean ratios of predicted environmental concentrations (PECs), obtained using the model, to measured environmental concentrations (MECs) were 0.51 and 0.04 for the River Foss and River Ouse, respectively. Such PEC/MEC ratios indicate that the model underestimates actual concentrations in both river systems, but to a much greater extent in the larger River Ouse.

Risks associated with the environmental release of pharmaceuticals on the U.S. Food and Drug Administration "flush list"

A select few prescription drugs can be especially harmful and, in some cases, fatal with just one dose when not used as prescribed. Therefore, the U. S. Food and Drug Administration (FDA) recommends that expired, unwanted, or otherwise unused portions of most of these drugs be disposed of quickly through a take-back program. If such an option is not readily available, FDA recommends that they be flushed down the sink or toilet. The goal of the current investigation was to evaluate the ecological and human-health risks associated with the environmental release of the 15 active pharmaceutical ingredients (APIs) currently on the FDA "flush list". The evaluation suggests that even when highly conservative assumptions are used-including that the entire API mass supplied for clinical use is flushed, all relevant sources in addition to clinical use of the API are considered, and no metabolic loss, environmental degradation, or dilution of wastewater effluents are used in estimating environmental concentrations-most of these APIs present a negligible eco-toxicological risk, both as individual compounds and as a mixture. For a few of these APIs, additional eco-toxicological data will need to be developed. Using similar conservative assumptions for human-health risks, all 15 APIs present negligible risk through ingestion of water and fish.

Are exposure predictions, used for the prioritization of pharmaceuticals in the environment, fit for purpose?

Prioritization methodologies are often used for identifying those pharmaceuticals that pose the greatest risk to the natural environment and to focus laboratory testing or environmental monitoring toward pharmaceuticals of greatest concern. Risk-based prioritization approaches, employing models to derive exposure concentrations, are commonly used, but the reliability of these models is unclear. The present study evaluated the accuracy of exposure models commonly used for pharmaceutical prioritization. Targeted monitoring was conducted for 95 pharmaceuticals in the Rivers Foss and Ouse in the City of York (UK). Predicted environmental concentration (PEC) ranges were estimated based on localized prescription, hydrological data, reported metabolism, and wastewater treatment plant (WWTP) removal rates, and were compared with measured environmental concentrations (MECs). For the River Foss, PECs, obtained using highest metabolism and lowest WWTP removal, were similar to MECs. In contrast, this trend was not observed for the River Ouse, possibly because of pharmaceutical inputs unaccounted for by our modeling. Pharmaceuticals were ranked by risk based on either MECs or PECs. With 2 exceptions (dextromethorphan and diphenhydramine), risk ranking based on both MECs and PECs produced similar results in the River Foss. Overall, these findings indicate that PECs may well be appropriate for prioritization of pharmaceuticals in the environment when robust and local data on the system of interest are available and reflective of most source inputs. Environ Toxicol Chem 2017;36:2823-2832. © 2017 SETAC.

Investigating sources of pharmaceutical pollution: Survey of over-the-counter and prescription medication purchasing, use, and disposal practices among university students

Pharmaceutical pollution in surface waters poses a range of risks to public health and aquatic ecosystems. Consumers contribute to pharmaceutical pollution via use and disposal of medications, though data on such behaviors is limited. This paper investigates the purchasing, use, and disposal practices among a population that has been researched only minimally to date, yet will determine pharmaceutical pollution for decades to come: young adults represented by a university student population. We employed an online, 21-question survey to examine behaviors related to pharmaceuticals among students at the University of Vermont (n = 358). Results indicate that the majority of respondents had purchased medications in the previous 12 months (94%), and had leftover drugs (61%). Contrary to previous studies of older populations, only a small proportion of students had disposed of drugs (18%); municipal trash was the primary route of drug disposal (25%), and very few students disposed drugs via flushing (1%). Less than a quarter of students were aware of drug take-back programs (24%), and only 4% had ever used take-back services. These findings indicate that the university student population may be storing a large volume of unused drugs that will require future disposal. Increasing awareness of, access to, and participation in pro-environment pharmaceutical behaviors, such as purchasing over-the-counter medication in smaller quantities and utilizing drug take-back programs, could minimize future pharmaceutical pollution from this population.

Uptake and Disposition of Select Pharmaceuticals by Bluegill Exposed at Constant Concentrations in a Flow-Through Aquatic Exposure System

The increasing use of pharmaceuticals has led to their subsequent input into and release from wastewater treatment plants, with corresponding discharge into surface waters that may subsequently exert adverse effects upon aquatic organisms. Although the distribution of pharmaceuticals in surface water has been extensively studied, the details of uptake, internal distribution, and kinetic processing of pharmaceuticals in exposed fish have received less attention. For this research, we investigated the uptake, disposition, and toxicokinetics of five pharmaceuticals (diclofenac, methocarbamol, rosuvastatin, sulfamethoxazole, and temazepam) in bluegill sunfish (Lepomis macrochirus) exposed to environmentally relevant concentrations (1000-4000 ng L^-1) in a flow-through exposure system. Temazepam and methocarbamol were consistently detected in bluegill biological samples with the highest concentrations in bile of 4, 940, and 180 ng g^-1, respectively, while sulfamethoxazole, diclofenac, and rosuvastatin were only infrequently detected. Over 30-day exposures, the relative magnitude of mean concentrations of temazepam and methocarbamol in biological samples generally followed the order: bile ≫ gut > liver and brain > muscle, plasma, and gill. Ranges of bioconcentration factors (BCFs) in different biological samples were 0.71-3960 and 0.13-48.6 for temazepam and methocarbamol, respectively. Log BCFs were statistically positively correlated to pH adjusted log K_ow (that is, log D_ow), with the strongest relations for liver and brain (r² = 0.92 and 0.99, respectively), implying that bioconcentration patterns of ionizable pharmaceuticals depend on molecular status, that is, whether a pharmaceutical is un-ionized or ionized at ambient tissue pH. Methocarbamol and temazepam underwent rapid uptake and elimination in bluegill biological compartments with uptake rate constants (K_u) and elimination rate constants (K_e) at 0.0066-0.0330 h^-1 and 0.0075-0.0384 h^-1, respectively, and half-lives at 18.1-92.4 h. Exposure to mixtures of diclofenac, methocarbamol, sulfamethoxazole, and temazepam had little or no influence on the uptake and elimination rates, suggesting independent multiple uptake and disposition behaviors of pharmaceuticals by fish would occur when exposed to effluent-influenced surface waters.