Environmental impact of medicines

The environmental impact of medicines is a problem of great magnitude, which affects both human health and ecosystems. Because the consumption of drugs, both for human and veterinary use, is increasing worldwide, it is feared that the volume of drug residues will also increase. Recent research has evaluated this problem and proposed possible solutions.

Pharmacocontamination is a complex problem that must be addressed in an interdisciplinary manner, including all the agents that participate in the life cycle of the drug. There are many pending challenges in the management of drug contamination and, therefore, it is necessary to address some of these challenges experimentally, taking into account the point of view of health professionals.

This is supported by a thesis defended by Saioa Domingo Echaburu and directed by Dr. Gorka Orive, with the help of Unax Lertxundi, at the Faculty of Pharmacy of the University of the Basque Country/Euskal Herriko Unibertsitatea.

In this research, the hospital consumption of the drugs used in Vitoria-Gasteiz during the first wave of the SARS-CoV-2 pandemic (April-July 2020) for the treatment of COVID-19 has been studied. . In addition, the environmental presence (in wastewater) of these drugs has been studied, also evaluating their potential ecotoxicological risk. On the other hand, the presence in the environment of dangerous drugs in healthcare settings (according to the NIOSH list, group 1: carcinogenic) has been reviewed and their potential ecotoxicological risk has been evaluated, based on the data available in the scientific literature. Finally, the impact of drug pollution on the Sustainable Development Goals (SDG) has been studied.

From left to right: Unax Lertxundi, Saioa Domingo and Gorka Orive. (Photo: Nuria González, UPV/EHU)

During the first wave of the pandemic caused by the SARS-CoV-2 virus, the intensive care units of Vitoria-Gasteiz hospitals increased their capacity by 216%. The hospital consumption of antiviral drugs and drugs with sedoanalgesic activity increased dramatically, highlighting the consumption of cisatracurium (it multiplied by 25) and that of lopinavir-ritonavir (it multiplied by 20).

In that period, the concentrations of some drugs used in patients with COVID-19 were measured at the Crispijana Wastewater Treatment Plant, which collects, among others, wastewater from the municipality of Vitoria-Gasteiz (including hospital wastewater ). It should be noted that hydroxychloroquine in the environment was measured for the first time worldwide. In addition, lopinavir was measured in the environment for the second time worldwide.

“For most of the most relevant drugs used in the first SARS-CoV-2 pandemic wave in Vitoria-Gasteiz, information on their possible harmful effects on the environment is scarce (except in the case of azithromycin). Taking into account the environmental concentrations measured in the study, a moderate ecotoxicological risk was estimated for azithromycin and low for hydroxychloroquine and lopinavir-ritonavir”, confirms Saioa Domingo Echaburu, author of the thesis.

The list of ‘dangerous drugs’ in health environments published periodically by the United States National Institute for Occupational Safety and Health (NIOSH) is a reference in the health field, and group 1 classifies drugs that are carcinogenic. For the investigation, the presence in the environment of these drugs was reviewed, but for most of these compounds an evaluation of the ecotoxicological risk could not be established.

“It has been observed that the environmental impact of dangerous drugs in group 1 of the NIOSH list has not been sufficiently studied. For this reason, the dangerous drug criterion could be considered when prioritizing the study of the environmental impact (presence and effects) of drugs”, highlights the researcher.

Despite the fact that the study of the environmental impact of medicines is considered a priority line of research for certain institutions related to health and the environment, the relationship between drug pollution and the Sustainable Development Goals (SDG) has not been sufficiently studied. . Drug pollution could affect at least 12 of the 17 SDGs. Therefore, the fight against drug pollution could be essential to achieve the SDGs.

The thesis ‘Pharmacontamination: environmental impact of medicines from the point of view of health professionals’ is part of the ‘Basque Sustainable Pharmacy’ initiative, which presents an innovation program in the field of pharmacocontamination-environmental impact of medicines, being the first thesis developed in that program.

It has been prepared by Saioa Domingo Echaburu and directed by Professor Gorka Orive Arroyo within the doctoral program ‘Medicine Research and Evaluation. Application of pharmaceutical technology to the development of advanced therapies’.

The field of drug contamination has traditionally been approached by professionals outside the world of health. One of the central ideas of this thesis is the need to incorporate health professionals both in research and in the search for solutions to face the challenge posed by the environmental impact of medicines. (Source: UPV/EHU)