A new data visualisation tool aims to help researchers better understand the effects medicines have on Scotland’s environment. It has been launched by the Scottish Environment Protection Agency (SEPA) on behalf of the One Health Breakthrough Partnership (OHBP)*.
‘Pharmaceuticals in the Water Environment’ is the first open access interactive tool in the UK to combine national environmental and prescribing data. With data for 60 medicines detected in river water, raw wastewater and treated wastewater, it is designed to help researchers, academics, health professionals and environmental scientists develop a better understanding of the link between medicine use and the presence of pharmaceuticals in 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 in the report ‘Pharmaceuticals in the water environment: baseline assessment and recommendations’. The project combined and assessed published and unpublished academic data with monitoring data from Scottish Water and SEPA.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 (community) prescribing data from Public Health Scotland.
Medicines in the environment
The main route for human medicines to enter the water environment is via toilets. Some of this is due to the way human bodies metabolise medicines – between 30% and 100% of the active ingredient in an oral dose ends up being flushed away after people go to the toilet. Some is more easily avoidable – 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 in 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 or 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.
John Redshaw, SEPA Principal Specialist Scientist and an OHBP lead, said:
“SEPA, as a founding member of the OHBP is pleased to have played a key role in the production of this data visualisation tool, which provides a very important step forward in addressing the discharge of medicines to Scotland’s water environment.
“SEPA is working with the OHBP and other UK partners to identify and prioritise the medicines that are presenting the greatest risks to our water environments and to explore ways in which such information might be used to inform prescribing of medicines and future regulatory standards.”
NHS Highland OHBP lead, Sharon Pfleger, Consultant in Pharmaceutical Public Health, said:
“NHS Highland is delighted to see the launch of ‘Pharmaceuticals in the Water Environment’. Over the last year we have been working with our partners in the OHBP to develop the first tool which combines prescribing data with data about water quality and the presence of pharmaceuticals. We are committed to helping keep our environment as well as our public healthy and to making the use of medicines as sustainable as possible. We are excited to now have this tool to help us take forward further work to help educate our prescribers and the public and make medicines taking as environmentally friendly as possible.”
The tool will be used by the OHBP, research partners and others to explore and develop appropriate and sustainable solutions to reduce the discharge of pharmaceuticals to the environment. It will also guide monitoring efforts as the group continues to improve understanding of the environmental occurrence and impact of these pollutants.
Professor Stuart Gibb, Director of the Environmental Research Institute at UHI, said the tool “will allow a better understanding of the relationships between the prescription of pharmaceuticals and their presence in natural waters. It should also therefore aid our ability to focus where and how interventions should be made to reduce pollution, and protect the integrity of our water resources.”
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.
SEPA says it is working with Scottish Water on Scotland’s Chemicals Investigation Programme (CIP). “Through environmental investigation this project identifies chemicals of concern including pharmaceuticals, their sources and concentrations leaving the sewerage system and plans how they should be addressed in the most sustainable way, and whether treatment at existing wastewater treatment plants can be enhanced to increase their removal. In June 2021, CIP3 Scotland (the current phase) started sampling for substances of emerging concern, including some medicines, and these results will be uploaded to the visualisation tool in due course.”
Scottish Water OHBP lead, Elise Cartmell, Chief Scientist, said:
“Scottish Water has been working to develop this tool over the last year and is delighted to see its launch as we are now able to link information from the water environment with prescribing data. This tool will help in developing the most sustainable methods to address the emerging issue of pharmaceuticals with our partners to protect our precious environment.”
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.
* The One Health Breakthrough Partnership is described as “a unique collaboration between SEPA, NHS Highland, Scottish Water and the University of the Highlands and Islands (UHI). Bringing together key regional and national stakeholders across the water, environment, and healthcare sectors who are committed to addressing the issue of pharmaceutical pollution, the partnership is designed to stimulate innovation to help achieve optimal health for people, animals and our environment.”