Recently, the Proceedings of the National Academy of Sciences published a study that was conducted by a group of researchers last year under the auspices of the University of York, UK on the pharmaceutical pollution of the world’s rivers. The 127 academics representing 86 institutions worldwide reported that more than 1,000 test sites along 258 rivers in over 100 countries, spanning all of the continents, were sampled. With the exception of two rivers in Iceland and one near a village in Venezuela, whose inhabitants use no modern medicine, all revealed evidence of unsafe levels of “active pharmaceutical ingredients” (APIs) that could have deleterious effects on aquatic life.
Though the impact of these effects is yet unknown, there is a clear and definite threat to global health. The researchers believe that their findings have dire implications for the attainment of the UN’s Sustainable Development Goal 6, which is ‘Ensure availability and sustainable management of water for all’. Target 6.3 reads “By 2030, improve water quality by reducing pollution, eliminating dumping and minimising release of hazardous chemicals and materials, halving the proportion of untreated wastewater and substantially increasing recycling and safe reuse globally.”
In fact, they were able to detect in the water samples, through testing, the presence of caffeine and nicotine, along with the active ingredients in drugs used to treat pain, fevers, malaria, diabetes, epilepsy, depression and insomnia. In addition, beta blockers (for the heart), antihistamines, anti-inflammatory, hormonal, antibiotic and anaesthetic drugs were detected.
Some of the samples were taken close to areas where sewage dumping was evident, or there was a pharmaceutical manufacturing entity close by coupled with poor wastewater management, but that was not always the case.
While this research is among the most extensive undertaken on a global scale to date, it does not stand in isolation. Evidence of pharmaceuticals in aquatic systems was reported as early as the 1970s, including well-publicised instances, starting in 2007, of the discovery of male fish that had become feminised after being exposed to the active ingredients in contraceptive pills believed to have entered the aquatic environment through wastewater.
Previous studies had also discovered pharmaceuticals in surface and groundwater including drinking water supplies, though in infinitesimal quantities. It is believed that drugs enter the waterways via several routes: the dumping of unused/unneeded medications in the garbage; flushing unwanted meds down the toilet or dissolving them in the sink; whatever is unabsorbed by the body and passed out in bodily waste into the sewage system.
This is by no means an essay intent on depicting pharmaceuticals as the culprit. On the contrary, medicines can be miraculous; they have cured people stricken with deadly diseases, and lengthened the lifespans of some afflicted with chronic illnesses, including mental illness, often improving their quality of life. Penicillin and other antibiotics, insulin and antiretrovirals are among the better known drugs that fit those categories.
Part of the problem is the way in which we use, misuse and dispose of medicines. Drug adherence and compliance are problematic the world over. However, they tend to be worse in developing countries where trust in the medical profession overall can be an issue. The proclivity to stop using medication before the prescribed dosage is completed is endemic among humans. The reasons are usually varied, sometimes complicated: people feel better and believe they no longer need their medicines; they forget to take them; they believe them to be harmful; they want to hide their illness from others; they become frustrated or lose hope; or they find themselves unable to cope with the medicine’s side effects. None of these are good reasons and all can ultimately prove injurious to health in the short term.
When unused pharmaceuticals are dumped in the garbage and end up in landfills, they break down and leach into groundwater. When they are flushed down the sink or the toilet, they end up in rivers and other surface water, even in places where wastewater is treated.
Ideally, unused prescription drugs should be returned to pharmacies, which would then ensure that they are safely disposed of. In some parts of the world there are dropboxes at or near police stations where they can be placed for disposal. However, in most places, Guyana being one of them, this is not a subject that is addressed with patients by doctors or pharmacists. Except in very rare cases, adherence and compliance are not stressed, nor are relatives advised about what to do with leftover meds in the event a patient dies.
Furthermore, this country has at least two pharmaceutical companies which the EPA should be monitoring with regard to the proper disposal of chemical waste from their manufacturing processes. It is doubtful whether the local water authority has the capacity to test for APIs, or if the necessity for this has even occurred to those in authority there.
The Amazon was mentioned in the study referred to above, but it is not known whether any rivers in Guyana were sampled. Nevertheless, given this country’s poor history with waste management, coupled with the dearth of knowledge surrounding medications, the right time to tackle this issue here would be now, before it becomes a huge problem. It would require having an EPA that has teeth, autonomy and is well funded. The means exist for this; what is needed is political will. Our leaders would do well to take literally the West African proverb which says, “Filthy water cannot be washed”.
