The first open access interactive tool in the UK to combine national environmental and prescribing data, which aims to help researchers better understand the effects medicines have on Scotland’s environment, was launched on 13 June 2022 by the Scottish Environment Protection Agency (SEPA), on behalf of the One Health Breakthrough Partnership (OHBP).
The OHBP is a collaboration between SEPA, NHS Highland, Scottish Water and the University of the Highlands and Islands (UHI) and brings together key regional and national stakeholders across the water, environment, and healthcare sectors, who are committed to addressing the issue of pharmaceutical pollution and is designed to stimulate innovation towards helping achieve optimal health for people, animals and the environment.
The data tool leads on from a Centre of Expertise for Waters (CREW) project for the OHBP, which published its findings earlier this year. The project combined and assessed published and unpublished academic data, with monitoring data from Scottish Water and SEPA. These environmental data have been used to develop the data visualisation tool, alongside primary care prescribing data from Public Health Scotland (PHS).
The main route for human medicines to enter the water environment is via toilets. Some of this is due to the way our bodies metabolise medicines, with between 30% and 100% of the active ingredient in an oral dose ending up flushed away after people go to the toilet. Some is more easily avoidable, as a 2021 survey showed around one-in-10 people throw old and unused medicines down the sink or toilet, instead of returning them to a pharmacy for safe disposal. In both situations, medicines can end up in sewage at wastewater treatment works, where treatment has not been designed to remove such pollutants and are then discharged to the water environment.
Pollution of the water environment by medicines can negatively affect aquatic life by impacting their growth, behaviour, reproduction and survival. In most cases, the concentrations of medicines in the water environment are much lower than the therapeutic dose, which makes it difficult to determine what impact they may be having. Medicines in the environment may also be contributing to an increase in bacteria, viruses, fungi and parasites that no longer respond to medicines, known as antimicrobial resistance (AMR) and to the spread of antibiotic resistance in people. Making the data contained within the visualisation tool easily accessible means they can be used to inform research and improve wider understanding of these issues.
The tool will be used by the OHBP, research partners and others to explore and develop appropriate and sustainable solutions in reducing the discharge of pharmaceuticals to the environment and will also guide monitoring efforts, as the group continues to improve understanding of the environmental occurrence and impact of these pollutants.
Future interventions will target medicines which pose the highest environmental risk, giving prescribers and patients more information on the environmental effects of medicines. A key part of reducing the quantity of pharmaceuticals that enter sewerage systems is through educating people about the possible environmental effects of what they stock in their medicine cabinet and encouraging them to return unused medicines to pharmacies for proper disposal.
Changes to pharmaceutical prescribing practices, infection control strategies and future regulatory standards are other potential avenues for reducing the unintended release of medicines to the environment.
Source: SEPA, 13 June 2022