Review
Drug pollution & Sustainable Development Goals

https://doi.org/10.1016/j.scitotenv.2021.149412Get rights and content

Highlights

  • Drugs are only mentioned in one of the 17 Sustainable Development Goals (SDGs).

  • Drug pollution may threaten SDG consecution.

  • There is less awareness about environmental impact of drugs in lower-middle income countries.

  • The “One Health” approach should be applied to all drugs, not only antimicrobials.

Abstract

The United Nations set “The 2030 Agenda for Sustainable Development,” which includes the Sustainable Development Goals (SDGs), a collection of 17 global goals designed to be a “blueprint to achieve a better and more sustainable future for all”. Although only mentioned in one of the seventeen goals (goal 3), we argue that drugs in general, and growing drug pollution in particular, affects the SDGs in deeper, not readily apparent ways. So far, the emerging problem of drug pollution has not been sufficiently addressed. Here, we outline and discuss how drug pollution can affect SDGs and even threaten their achievement.

Section snippets

Goal 2: zero hunger

Agriculture, including aquaculture, supplies most of the food required by the increasing world's population to survive. Hence, bacterial diseases affecting crops can create food shortages, resulting in malnutrition, and even famine. But years of antibiotic use in the prevention and treatment of these infections in humans and farm animals have contributed to the emergence of multidrug-resistant bacteria (Sieiro et al., 2020), with even treated wastewater becoming a source of both antibiotic

Goal 3: good health and wellbeing

Drugs have been indispensable to improve human health and wellbeing. In fact, in the last few decades, the WHO has promoted strategies like mass drug administration to control or eliminate many neglected tropical diseases that cause devastating consequences worldwide. This strategic approach, in which thousands or even millions of doses are administered simultaneously, has produced unquestionable benefits. However, the ecotoxicological aspects (in which drugs with proven ecological damage like

Goal 4: quality education

Organizations such as the Higher Education Sustainability Initiative (HESI) (Higher Education Sustainability Initiative (HESI), 2020), the recently created Global University Network for Innovations group of experts on SDGs and Higher Education (GUNI) (Global University Network for Innovation, 2020), and the Association for the Advancement of Sustainability in Higher Education (AASHE) (Association for the Advancement of Sustainability in Higher Education (AASHE), 2020) are initiatives that try

Goal 6: clean water and sanitation

Water is essential for life. As water is always present in the flux of pharmaceuticals in nature, it is also the environmental compartment where more drugs and residues are found. As a result, along with water scarcity and floods, water pollution is one of the main water-related challenges.

Wastewater treatment plants (WWTP) do not eliminate all drugs, but the situation is even worse in many countries. SDGs have a special relevance in LMIC, where water is more polluted with drugs (Fekadu et al.,

Goal 7: affordable and clean energy

As part of the circular economy, correct management of unused medicines could avoid pharmaceuticals from being released to the environment, while energy can be created in the process. There are interesting initiatives already, in which low-risk drugs are destroyed through energy recovery, that is, they are used as fuel in industrial facilities or to produce electrical energy (Sistema Integrado de Gestión y Recogida de Envases del sector farmacéutico (SIGRE), 2019).

From a life cycle perspective,

Goal 8: decent work and economic growth

Sustainable tourism or “green tourism” should be encouraged as it helps create jobs and promotes local culture and products, allowing economic growth. In certain areas, the landscape, wildlife and environment are the main tourist attractions. Indeed, this kind of tourism may be the principal economic activity of the region, i.e. coral reefs in many tropical countries like the Maldives. But drug pollution in these areas could threaten their main economic inputs (Rizzi et al., 2020). Thus, drug

Goal 9: industry, innovation and infrastructure

Direct emission of pharmaceuticals from drug manufacturing can produce very high concentrations in the environment (up to several mg/l) and should be a matter of concern (Larsson, 2014). Much of the scarce available data comes from India and China, which have become the “pharmacy of the developing world” (Rewari et al., 2020). But there are also studies coming from several countries in Europe, United States among others (Larsson, 2014). Investing efficient industrial wastewater technology is

Goal 11: sustainable cities and communities

The United Nations estimates that 68% of the world population will live in urban areas by 2050 (United Nations (UN) Department of Economy and Social Affairs, 2018). But over 80% of the world's wastewater is released to the environment without adequate treatment (United Nations (UN), 2017). The combination of these two facts makes modern cities an important source of drug pollution. Although the presence of pharmaceuticals in the environment has been less studied in the Global South,

Goal 12: responsible production and consumption

The European Parliament has recently urged the European Union to take measures towards more sensible use and disposal of pharmaceuticals to prevent risks to the environment and public health (European Parliament, 2019). They acknowledge measures to reduce the pollution should not only include end-of-pipe controls (e.g., improved wastewater treatment), but encompass the entire life cycle of drugs, from design and production to disposal. Source–directed approaches are probably the ones that

Goal 14: life below water

Pharmaceuticals are reaching every environmental matrix, including seawater. However, so far, the potential impact of drugs in sea life and coastal environments has received scant attention, even as 41% of world global population live within coastal limits (Gaw et al., 2014).

There is increasing evidence that drugs are affecting marine and coastal environments. So far, the majority of data reported for pharmaceutical concentrations in marine organisms are for antibiotics used in aquaculture (Gaw

Goal 15: life on land

Ordinarily, healthcare professionals, generally suffering from an anthropic bias, do not pay much attention to the phylogenetic origins of dopamine or serotonin, or if plants may be somehow affected by the benzodiazepines they accumulate. But, of course, as many environmentalists know well, therapeutic targets wherein human and veterinary drugs act are not human-specific. For example, biogenic monoamines and their respective receptors are found in amphibians, fish, insects and echinoderms (

Goal 17: partnership for the goals

One of the objectives of this goal is to enhance international support for implementing effective and targeted capacity-building in LMIC to support national plans to implement all the SDGs. In this sense, we highlight the need for global cooperation between countries to better understand the impact of pharmaceuticals in the environment (Lees et al., 2016).

More than ever, both biomedical and environmental scientific disciplines should work together to better understand the problem of drug

Discussion

Drugs have brought unquestionable benefits to human and animal health, and we envision that their use will continue to be essential to ensure healthy lives and promote well-being. By enabling longer, healthier lives, reproductive control, and reducing risks of infection, drugs can be the Holy Grail for the achieving health-related SDGs. But the growth of drug consumption in the last decades has also led to increased presence of pharmaceuticals in the environment around the world. With still not

Funding information

None.

Declaration of competing interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

References (111)

  • G. Lan et al.

    Effects of dopamine on growth, carbon metabolism, and nitrogen metabolism in cucumber under nitrate stress

    Sci. Hortic.

    (2020)
  • J.C.E. Lane et al.

    (OHDSI-COVID-19 consortium), risk of hydroxychloroquine alone and in combination with azithromycin in the treatment of rheumatoid arthritis: a multinational, retrospective study

    Lancet Rheumatol.

    (2020)
  • C. Leder

    Putting benign by design into practice-novel concepts for green and sustainable pharmacy: designing green drug derivatives by non-targeted synthesis and screening for biodegradability

    Sustain. Chem. Pharm.

    (2015)
  • K. Lees et al.

    Pharmaceuticals in soils of lower income countries: physico-chemical fate and risks from wastewater irrigation

    Environ. Int.

    (2016)
  • U. Lertxundi et al.

    It’s about time healthcare professionals and academics start thinking about drug pollution

    Sustain. Chem. Pharm.

    (2020)
  • Y. Li et al.

    Sertraline inhibits top-down forces (predation) in microbial food web and promotes nitrification in sediment

    Environ. Pollut.

    (2020)
  • S. Martínez-Morcillo et al.

    Presence of pharmaceutical compounds, levels of biochemical biomarkers in seafood tissues and risk assessment for human health: results from a case study in North-Western Spain

    Int. J. Hyg. Environ. Health

    (2020)
  • M. Mezzelani et al.

    Human pharmaceuticals in marine mussels: evidence of sneaky environmental hazard along italian coasts

    Mar. Environ. Res.

    (2020)
  • T.H. Miller et al.

    A review of the pharmaceutical exposome in aquatic fauna

    Environ. Pollut.

    (2018)
  • S. Mukherjee

    Novel perspectives on the molecular crosstalk mechanisms of serotonin and melatonin in plants

    Plant Physiol. Biochem.

    (2018)
  • C. Nannou et al.

    Antiviral drugs in aquatic environment and wastewater treatment plants: a review on occurrence, fate, removal and ecotoxicity

    Sci. Total Environ.

    (2020)
  • J. Nieminen et al.

    Green solvents in recovery of aluminium and plastic from waste pharmaceutical blister packaging

    Waste Manag.

    (2020)
  • G. Orive et al.

    Mass drug administration: is it time for considering drug pollution?

    Lancet

    (2020)
  • G. Orive et al.

    Redefining the “rational use of medicines”

    Sustain. Chem. Pharm.

    (2021)
  • M. Pazda et al.

    Antibiotic resistance genes identified in wastewater treatment plant systems - a review

    Sci. Total Environ.

    (2019)
  • A. Poustie et al.

    Reclaimed wastewater as a viable water source for agricultural irrigation: a review of food crop growth inhibition and promotion in the context of environmental change

    Sci. Total Environ.

    (2020)
  • M. Race et al.

    Current emerging SARS-CoV-2 pandemic: potential direct/indirect negative impacts of virus persistence and related therapeutic drugs on the aquatic compartments

    Environ. Res.

    (2020)
  • C. Rizzi et al.

    First record of emerging contaminants in sponges of an inhabited island in the Maldives

    Mar. Pollut. Bull.

    (2020)
  • M.M. Santos et al.

    Statins: an undesirable class of aquatic contaminants?

    Aquat. Toxicol.

    (2016)
  • J.V. Tarazona et al.

    Environmental impact assessment of COVID-19 therapeutic solutions. A prospective analysis

    Sci. Total Environ.

    (2021 Mar)
  • R.N. Abey-Lee et al.

    Experimental manipulation of monoamine levels alters personality in crickets

    Sci. Rep.

    (2018)
  • H. Alhamad et al.

    Beliefs and intentions towards reusing medicines in the future: a large-scale, cross-sectional study of patients in the UK

    Int. J. Pharm. Pract.

    (2018)
  • K.A.F. de Alvarenga et al.

    Effects of antipsychotics on intestinal motility in zebrafish larvae

    Neurogastroenterol. Motil.

    (2017)
  • Internet

  • A. Banerjee et al.

    Bats and coronaviruses

    Viruses

    (2019)
  • B.K. Banik

    Green approaches in medicinal chemistry for sustainable drug design

  • P. Bauknecht et al.

    Ancient coexistence of norepinephrine, tyramine, and octopamine signaling in bilaterians

    BMC Biol.

    (2017)
  • E. Bernhardt et al.

    Synthetic chemicals as agents of global change

    Front. Ecol. Environ.

    (2017)
  • T.P.Van Boeckel et al.

    Global trends in antimicrobial use in food animals

    Proc. Natl. Acad. Sci. U. S. A.

    (2015)
  • T. Brodin et al.

    Dilute concentrations of a psychiatric drug Alter behavior of fish from natural populations

    Science

    (2013)
  • M. Chiarello et al.

    Popular pharmaceutical residues in hospital wastewater: quantification and qualification of degradation products by mass spectroscopy after treatment with membrane bioreactor

    Environ. Sci. Pollut. Res. Int.

    (2016)
  • J.P. Choisy

    The vultures at the crossroads of biodiversity, politics, tourism, the environment, and agriculture

    Vulture News

    (2013)
  • R.M. Clarke et al.

    Evaluation of “classic” and emerging contaminants resulting from the application of biosolids to agricultural lands: a review

    Hum. Ecol. Risk. Assess.

    (2014)
  • S.D.W. Comber et al.

    COVID-19, antibiotics and one health: a UK environmental risk assessment

    J. Antimicrob. Chemother.

    (2018)
  • D. Connely

    Reuse of medicines returned by other patients

    Pharm. J.

    (2018)
  • Consolidated Text: Regulation (EC) No 1907/2006 of the European Parliament and of the Council of 18 December 2006 Concerning the Registration, Evaluation, Authorisation and Restriction of Chemicals (REACH), Establishing a European Chemicals Agency, Amending Directive 1999/45/EC and Repealing Council Regulation (EEC) No 793/93 and Commission Regulation (EC) No 1488/94 as well as Council Directive 76/769/EEC and Commission Directives 91/155/EEC, 93/67/EEC, 93/105/EC and 2000/21/EC (Text with EEA relevance)Text with EEA Relevance

    (2006)
  • L. Dai et al.

    Ginsenoside nanoparticle: a new green drug delivery system

    J. Mater. Chem. B

    (2016)
  • P. Donyai et al.

    Stakeholder views on the idea of medicines reuse in the UK

    Pharmacy (Basel)

    (2021)
  • European Union Strategic Approach to Pharmaceuticals in the Environment

    (2019)
  • R. Loos et al.

    Review of the 1st Watch List Under the Water Framework Directive and Recommendations for the 2nd Watch List

    (2018)
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