Potential ecological footprints of active pharmaceutical ingredients: an examination of risk factors in low-, middle- and high-income countries

Abstract

Active pharmaceutical ingredients (APIs) can enter the natural environment during manufacture, use and/or disposal, and consequently public concern about their potential adverse impacts in the environment is growing. Despite the bulk of the human population living in Asia and Africa (mostly in low- or middle-income countries), limited work relating to research, development and regulations on APIs in the environment have so far been conducted in these regions. Also, the API manufacturing sector is gradually shifting to countries with lower production costs. This paper focuses mainly on APIs for human consumption and highlights key differences between the low-, middle- and high-income countries, covering factors such as population and demographics, manufacture, prescriptions, treatment, disposal and reuse of waste and wastewater. The striking differences in populations (both human and animal), urbanization, sewer connectivity and other factors have revealed that the environmental compartments receiving the bulk of API residues differ markedly between low- and high-income countries. High sewer connectivity in developed countries allows capture and treatment of the waste stream (point-source). However, in many low- or middle-income countries, sewerage connectivity is generally low and in some areas waste is collected predominantly in septic systems. Consequently, the diffuse-source impact, such as on groundwater from leaking septic systems or on land due to disposal of raw sewage or septage, may be of greater concern. A screening level assessment of potential burdens of APIs in urban and rural environments of countries representing low- and middle-income as well as high-income has been made. Implications for ecological risks of APIs used by humans in lower income countries are discussed.

Sources, impacts and trends of pharmaceuticals in the marine and coastal environment

“…Typhoon shelters for small boats were a point source of antibiotics in Victoria Harbour, Hong Kong [23]. As discussed by Kookana et al [24] in this issue, many large cities in Asia still rely on septic tanks with poorly managed septage which can contaminate surface and groundwaters with pharmaceuticals and ultimately be discharged into coastal areas. Sewage impacted groundwater can also be a source of pharmaceuticals entering coastal waters.…”

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

“…There is currently a lack of public usage data for the amount and type of APIs used in many LLMIC due to poor record keeping, extensive selfmedication and the use of non-prescribed APIs over large population numbers (Kookana et al, 2014;Kotwani et al, 2012;Rehman et al, 2015). This knowledge gap is further confounded by inconsistent adherence to therapeutic treatments, particularly for longer-term prescribing (Kookana et al, 2014).…”

“…Each may be treated, partially treated or untreated (Corcoran et al, 2010;Jiménez et al, 2010). Difficulties in quantifying the magnitude of wastewater loads, in tandem with a paucity of environmental monitoring data of APIs in LLMIC, makes accurate and precise predictions of temporal trends in API loadings uncertain Kookana et al, 2014).…”

Medicating the environment: assessing risks of pharmaceuticals to wildlife and ecosystems

“…However, Kookana et al [3] suggest that a number of factors, such as climate, culture, ecology and also existing regulatory frameworks, mean that the risks in Asia and other developing economies may require different research approaches and management solutions [3]. Transnational collaborations will be immensely profitable in terms of knowledge exchange and development.…”

“…With this comes an increase in the quantity and diversity of pharmaceuticals consumed and subsequently excreted. Significant quantities of pharmaceuticals can be emitted to the environment from manufacturing sites (particularly, but not exclusively, in lower income countries, reviewed by Larsson [2]), in addition to those released via inadequately treated sewage [3]. Different types of pharmaceuticals also are commonly used to enhance livestock production in both high-and low-income countries, sometimes without strong regulatory controls for use or discharge.…”