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Pharmaceuticals are an important element of medical and veterinary practice, and their beneficial effects on human and animal health, food production and economic welfare are widely acknowledged. However, an area where we lack a common understanding is what happens when these pharmaceuticals are constantly discharged into the environment, through pharmaceutical manufacturing, consumption and excretion, and improper disposal of unused or expired products.

Residues of pharmaceuticals, such as hormones, antidepressants and antibiotics, have been detected in surface water and groundwater across the globe. High levels of pharmaceutical residues have been found downstream of pharmaceutical manufacturing plants, and conventional wastewater treatment plants are not designed to remove pharmaceuticals in wastewater. Furthermore, veterinary pharmaceutical residues from agriculture and aquaculture can enter water bodies without any treatment.

Evidence is growing of the negative environmental impacts, with laboratory and field tests showing traces of oral contraceptives causing the feminisation of fish and amphibians, and residues of psychiatric drugs altering fish behaviour. The mis- and over-use of antibiotics is an important contributing factor of the emergence and spread of antimicrobial resistance - a global health crisis with the potential for enormous health, food security and economic consequences.

Unless adequate measures are taken to manage the risks, pharmaceutical residues will increasingly be released into the environment. Ageing populations, advances in healthcare, and intensification of meat and fish production is spurring the demand for pharmaceuticals worldwide. At the same time, the need for clean water will also increase, including treated wastewater for agriculture and high-purity water for manufacturing pharmaceuticals. Climate change is further reducing water availability in sufficient quantity and quality, as well as increasing the risk and spread of disease.

As the challenge of meeting the 2030 sustainable development goals on water and health progresses, emerging issues such as pharmaceuticals in the environment should be prevented from becoming future traditional environmental and human health threats. Health ministers of the G20 have declared to fight antimicrobial resistance. The OECD Council Recommendation on Water calls for Adherents to prevent, reduce and manage all sources of water pollution, in surface and ground waters and related coastal ecosystems, while paying attention to pollutants of emerging concern such pharmaceutical residues. Stakeholders of the Strategic Approach to International Chemicals Management adopted environmentally persistent pharmaceutical pollutants as an emerging policy issue, and agreed international cooperation is crucial to build awareness and promote action on the issue.

Pharmaceutical residues in freshwater is a challenge that must continue to be addressed in ways that take into account advances in our knowledge. This report contributes to this growing imperative. It stresses the need for a better understanding of the effects of pharmaceuticals in the environment, calls for greater international collaboration and accountability distribution, and suggests policy actions to prevent and remedy the problem across the pharmaceutical life cycle. A cross-sectoral response, with economic and regulatory drivers from central government is recommended to incentivise action by pharmaceutical companies, healthcare providers, veterinarians, farmers and food producers, wastewater utilities and the general public. A focus on preventive options, such as disease prevention and improved diagnostics, the sustainable design, manufacture and procurement of pharmaceuticals, and restrictions on the use of pharmaceuticals with high environmental risk, will deliver the most long-term and large-scale environmental benefits.

This timely report brings together the expertise and experience of the health and environment communities. I am confident that policymakers can find both inspiration and pragmatic support in this report, to translate ambition into action on improving health and protecting the environment.


Rodolfo Lacy

OECD Environment Director

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