Hailey Romano

Annotated Bibliography

From your coffee every morning, to the Advil you frequently take and the antibiotics you get for
your seasonal colds. Do you ever wonder where it all goes? Pharmaceutical pollution is when
analgesics, antibiotics, and hormones are present in soil and water resources. Due to the
manufacturing process, use, disposal, wastewater treatment effluent discharge, domestic and
animal wastes, hospital wastes, landfill leachate, and industrial wastes, pharmaceuticals have
found their way into the environment (Wilkinson, J., & Boxall, A., 2022, p. 1), causing many
negative outcomes (Küster, A., & Adler, N., 2014, p.6 ). This includes antimicrobial resistance,
damage to food chains and food webs to mostly aquatic populations, and altered drinking water
(Wilkinson, J., & Boxall, A., 2022, p. 6 ). There are some solutions that are practiced today such
as the use of incinerators, drug take-back programs, and legislative guidelines (Desai, M., Njoku,
A., & Nimo Sefah, L., 2022, p.5 ). For example, Guidance #213 a policy finalized by the FDA
that limits antibiotics for veterinary use and the One Action Health Plan implemented in the EU
that promotes health pollution rather than treating disease to fight antimicrobial resistance. But
these solutions are not effective enough, as pharmaceuticals are still discharged globally on a
large scale. So how does pharmaceutical pollution affect wastewater management and what are
some reasonable solutions to maintain this? Using a variety of sources I was able to find some
changes that can be made both with the filtration process of pharmaceuticals and to the policy
aspect of pharmaceutical pollution.

Many of these articles came to a similar conclusion in terms of what difficulties are associated
with pharmaceutical pollution. Many articles mentioned that targeting the original waste
producer or waste holders is a complicated task making it difficult to hold polluters accountable.
The article “Pharmaceutical Pollution from Human Use and the Polluters Pay Principle” refers to
the Extended Producer Responsibility Principle (EPR) that argues “ in accordance with the
polluter-pay principle, the costs of waste management, including for the necessary infrastructure
and its operation, shall be borne by the original waste producer or by the current or previous
waste holders”(Malmqvist et al., 2023, p. 155) and further states that “locating responsibility (for
paying the costs and organizing necessary actions and facilities) for waste management as
closely as possible to the source of the waste producing chain” (Malmqvist et al., 2023, p. 155).
This article argues that there is need for more pressure to be put on polluters and there is not a
great enough change to address it. The article continues to argue that it is difficult to determine
who's actually responsible.

Similarly “Pharmaceuticals in the Environment: Scientific Evidence of Risks and its

Regulations” explains that it is difficult to detect a single product's effect on the environment.
And continues to state that “Often, it is difficult to relate a visible effect to the release of a certain
pharmaceutical substance contained in a product” (Küster, A., & Adler, N., 2014, p. 2). This goes
hand in hand with the idea that it is difficult to target a specific polluter. Another trend that I
found in several articles was the relationship between untreated sewage discharge and higher
levels of APIs (active pharmaceutical ingredients). The scientific article “Pharmaceutical
Pollution of the World’s Rivers” used a variety of experiments and datasets to find that
“On-the-ground observations made by sampling teams during sample collection revealed that the
highest API concentrations were observed at 1) sampling sites receiving inputs from
pharmaceutical manufacturing, 2) sites receiving discharge of untreated sewage, 3) locations in
particularly arid climates and 4) sites receiving sewage exhauster truck emissions and waste
dumping” (4). Another article “A review on Constructed Wetlands-based Removal of
Pharmaceutical Contaminants Derived From Non-point Source Pollution” argues that “The
primary route of PCs (pharmaceutical contaminants) flowing into water systems is through
wastewater treatment effluent discharge” (2). And that “Studies reveal that most PCs cannot be
quickly and ultimately eliminated” (2). This is because wastewater treatment plants are not
designed to remove pharmaceuticals thus leaving behind drug residues. This leads me to
question, what are reasonable preventative measures or solutions to this problem?

Most of these articles didn’t run into disagreements or have conflicting ideas but they all had
different ideas for solutions. Most of the articles stated that using green chemistry to substitute
active pharmaceutical ingredients, upgrading wastewater management systems, new legislative
guidelines, making ERA databases public, and addressing pollution from the manufacturing
process as solutions to fight pharmaceutical pollution. However, the solutions from “A review on
Constructed Wetlands-based Removal of Pharmaceutical Contaminants Derived From Non-point
Source Pollution” stood out to me the most as new solutions were mentioned in an
environmentally friendly way. This article explained the use of constructed wetlands to filter out
pollutants rather than the use of new wastewater management systems. This author argued that
the use of phytoremediation, plant roots/ tissues and the use of different soils or substrates within
constructed wetlands were effective at removing pharmaceutical pollutants. To be more specific
“it has been reported that plants present in CWs (constructed-wetlands), played a significant role
in the removal of certain PCs (pharmaceutical contaminants) such as ibuprofen, salicylic acid,
naproxen, amoxicillin, etc” (8). The author also compared different substrates finding that gravel
and more looser substrates were more effective at removing pharmaceuticals rather than more
sand or clay based substrates. This was very unique to me as most of the other articles mentioned
more of the policy aspects of the situation rather than finding environmentally friendly solutions.
Of course unless changes are made to legislation, there will still be a large amount of
pharmaceuticals that will bring residues into the environment but finding solutions on removing
them at the same time further addresses this issue.
Citations;

Ravikumar, Y., Yun, J., Zhang, G., Zabed, H., & Qi, X. (2022, March 28). A review on constructed
wetlands-based removal of pharmaceutical contaminants derived from non-point source pollution.
Environmental Technology & Innovation.
https://www.sciencedirect.com/science/article/pii/S2352186422001201

Küster, A., & Adler, N. (2014). Pharmaceuticals in the environment: scientific evidence of risks and its
regulation. Philosophical Transactions: Biological Sciences, 369(1656), 1–8.
http://www.jstor.org/stable/24501918

Wilkinson, J., & Boxall, A. (2022). Pharmaceutical pollution of the world’s rivers. Web of science.
https://www.webofscience.com/wos/woscc/full-record/WOS:000766924200012

Desai, M., Njoku, A., & Nimo-Sefah, L. (2022). Comparing Environmental Policies to Reduce
Pharmaceutical Pollution and Address Disparities. International journal of environmental research and
public health, 19(14), 8292. https://doi.org/10.3390/ijerph19148292

Malmqvist, E., Fumagalli, D., Munthe, C., & Larsson, D. G. J. (2023). Pharmaceutical Pollution from Human
Use and the Polluter Pays Principle. Public health ethics, 16(2), 152–164.
https://doi.org/10.1093/phe/phad012

Raloff, J. (2019, August 8). Antidepressants make for sad fish. Science News.
https://www.sciencenews.org/article/antidepressants-make-sad-fish