Huin Weng Kit, Pharmacist from Hospital Selama, Perak
There could be traces of
pharmaceutical wastes in your
drinking water and
you wouldn’t know it!
Drug pollution is a growing problem that people seldom address which will leave devastating effects on the environment as well as to all living organisms including humans. Without proper disposal, medicines find their way into lakes, rivers, seas and even drinking water and will eventually cause adverse effects.
To have a clear understanding on this matter, we speak to Pharmacist from Hospital Selama, Perak, Huin Weng Kit.
Could you share with us your thoughts on drug pollution?
As the world population increases, new medicines are found and developed to help cure diseases as well as meet people’s expectations to live a long and healthy life while reducing all risk factors of diseases such as cardiovascular disease or cancer.
With existing and new developing medicines, along with it comes certain issues and concerns about drug pollution and how it begins. Some of which are:
- How does your body process the medicines you take?
- Are they completely absorbed by the body?
- Will medicines decompose just like other pollutants?
- Will it produce any unfavourable effect during the degrading process?
Drug pollution may not have an immediate effect on humans as the concentration is generally lower due to water dilution. However, in the near future, if we don’t have a comprehensive risk assessment method and solution to mitigate the risk, the widely spread contaminated water will eventually lead to major problems that will affect our daily activities. This condition will worsen if no actions are taken to solve or overcome drug pollution.
How do pharmaceutical waste enter the water cycle?
There are a few different ways. First, it is through the excretion from the human body in the form of urine and feaces. Active ingredients in medicines will metabolise in the human body to different extents and some can be excreted unchanged, which means the excreted waste products can still exert its pharmacological effects to the environment.
Secondly, is that leftover medicines are discarded in inappropriate manners such as:
- Flushing down the toilet.
- Liquid medications poured down the sink.
- Throwing away pills and liquid medication along with kitchen wastes or household items without proper disposal method.
All of this contributes to the pool of drug pollution in the water cycle.
Lastly, is when manufacturing companies dispose unwanted medicinal drugs into the waterway inappropriately.
"With existing and new developing medicines, along with it comes certain issues and concerns about drug pollution and how it begins."
Which type of pharmaceutical products are most commonly found polluting waters?
According to a German review paper, it has shown that most common pharmaceutical products that are polluting waters in Asian countries are antibiotics.
Antibiotics are prescribed for bacterial infection and patients are required to finish the entire antibiotic course. However, many people aren’t following the instructions given by their healthcare professionals, therefore resulting in antibiotics polluting our water cycle.
How are drug pollutants different from other types of pollutant?
Pharmaceuticals could interact with each other through different mechanisms and produce unpredictable and potentially long-term harmful effects on humans. For example, antibiotics pollution could worsen the current antibiotics resistance issue when resistance genes in environmental bacteria could easily spread to pathogens. Antibiotics, which have saved millions of lives could be rendered ineffective by antibiotics resistant germs.
For example, drug factories built in rural areas dispose residue to the nearby river, which would cause bacteria to build up around the area. So, when antibiotics are disposed incorrectly, the bacteria from the river will develop resistance through various ways and if humans or other living organisms consumed the downstream water with the newly developed resistance gene bacteria, it could cause infections. That is how the resistance genes from the environment spread to humans.
It might take a long process for these changes to occur. However, if it does happen, then the antibiotic resistance genes will be too strong for any antibiotic to kill.
What are the effects of pharmaceutical waste to marine life?
Pharmaceutical waste can give rise to ecotoxicological effects which are when there are changes in the structure, function or biological level of an organism that are from adverse effects of chemical exposure.
Experiments and reports have shown that a group of hormone medicines – estrogen – could feminise male fish and affect its fertility. Estrogen detected on water surfaces in many countries has exceeded the limit, which then leads to harmful effects to the water ecosystem. Apart from that, a commonly found concentration of antidepressant also affects marine invertebrates, disrupts snails’ locomotion, aggressive crayfish behaviour and altered freshwater amphipods are seen.
"According to a German review paper, it has shown that most common pharmaceutical products that are pollution waters in Asian countries are antibiotics."
Are there any pollution prevention measures taken by the Ministry of Health (MOH)?
The MOH has assigned a few clinical waste companies to dispose unwanted pharmaceutical products properly. Hospital and clinic staffs will dispose unwanted or used pharmaceutical items such as:
- Used cotton wool
- Bandages
- Syringes
- Ampoules of medicines
- Blood
- Urine
- Lab glasses
- Waste containers
These items are disposed into different coloured bags and containers based on particular categories. The waste products will then be sent to the clinical waste store by designated staff according to their working shifts. The staff will have to weigh the waste products and document it before it is discarded.
How can pharmacists play roles in preventing drug pollution?
Pharmacists involved in the drug discovery process to weigh in the difference
between the efficacy of medicine and the possible lead of pollution. If medicines are designed to be less harmful at the initial state, the environmental pollution could be reduced eventually. Production and manufacturing pharmacists should ensure that clinical wastes are properly disposed in their factories.For liquid medications, a proper, efficient and validated treatment plant should be set up in the factory to facilitate the removal of clinical waste before channeling it into the waterway. Solid waste is normally sent to clinical waste companies for proper disposal.
How can pharmacists bring awareness to the public on drug pollution?
Community and hospital pharmacists are continuously educating the public on proper methods and techniques required to discard medications through various programmes, such as “Kenali Ubat Anda” (Know Your Medicines) as well as through the World Pharmacists Day. Patients are encouraged to return unused, excessive, expired medications to their pharmacists to be discarded properly.
Aside from that, when patients are prescribed medicines with appliances such as insulin cartridges, needles and inhales, pharmacists will provide a clear explanation to the patients on the right way to dispose of these items when it is no longer in use.
Disposing all pharmaceutical products and appliances correctly will not only benefit us but also the environment. If you do not know how to throw an unused medicine the right way, then visit the nearest pharmacy and ask the pharmacist about it. They will be able to clear all your doubts.
References: aus der Beek, T., Weber, F. A., Bergmann, A., Hickmann, S., Ebert, I., Hein, A., & Küster, A. (2016). Pharmaceuticals in the environment—Global occurrences and perspectives. Environmental Toxicology and Chemistry, 35(4), 823-835. Lyons, G (2014) Pharmaceuticals in the environment: A growing threat to our tap water and wildlife. A CHEM Trust report.
