“Medical wastes from syringes, bottles, and tablet strips are found strewn across the river”, reported a newspaper recently. It continued that these wastes accumulate at the estuary and causing harm or injury not only to the local fisher men but also to the fishes. This is not an isolated incident. In another incidence, the unused or expired medicines are thrown into the riverside. Similar things have been happening throughout the country. The inappropriate disposal of pharmaceuticals are causing significant damage to the environment which in turn affecting the public health.  Is it the ignorance or our chalta hai attitude? Perhaps both. While we are concerned with environmental impact of pesticides, heavy metals, persistent organic pollutants, and industrial chemicals but are little concerned when it comes to pharmaceutical wastes disposal. Worldwide there has been consistence efforts advocating better environment.

The recent Paris Agreement on climate change has an obligation ‘to protect people’ and specifically ‘right to health’.  Health is closely associated with the climate. The Lancet, the prestigious medical journal, quotes “Tackling climate change could be the greatest global health opportunity of the 21st Century”. The studies have shown that there are more than one lakh incidents where measurable concentrations of pharmaceuticals are reported mostly in sewage, waste water treatment effluent, and surface water. Traces are reported in drinking water too. But, much is not known about the impact of these substances on environment or public health.

The biologically active substance, often called active pharmaceutical ingredient, in a pharmaceutical product (also called medicine) may cause negative effects on exposed living organisms. The use of diclofenac in animals has caused the collapse of vulture population as the vultures take the corpse of animals. The residual diclofenac has caused the vulture deaths. Following this observation the use of diclofenac in animals is banned in our country. The adverse effects of medicines can be appreciated from Oliver Wendell Holmes’ quote “If the whole of the material medica, as now used, could be sunk to the bottom of the sea, it would be all better for mankind and the all the worse for the fishes”. Two serious health impacts of environmental exposure of active pharmaceutical ingredients are mentioned here. Exposure to hormone in the environment may cause disturbance in reproduction. This could lead to even population collapse, a report warns. Another serious issues is the release of residual antibiotics to the environment contributing the cause of antibiotic resistance. The effect of antibiotics is much beyond the contribution of antibiotic resistance. As the antibiotics (more appropriately antimicrobials) kill, destroy or control bacterial (microbial) population, their presence can lead to disturbance of microorganisms in ecosystem. Algae, the producer of ecosystem, are highly sensitive to antibiotics. The entry of active antibiotics or their active metabolites disturb the bacterial flora of sewage plants leading to ineffective decomposition of sludge and consequent release to the public water supply system.

In addition to the biological (or, pharmacological) impact in the environment, the physicochemical properties of the pharmaceuticals too cause damage.  The most of the pharmaceuticals are either weak acids or weak bases. They undergo ionization across the pH ranges found in surface water modifying the pH of surface water. The pharmaceuticals can have strong influence on their partitioning within environmental compartments such as water, sediment, soil and biological tissues affecting or exposing the non-target organisms.

The pharmaceuticals and their active metabolites enter the environment through release from production facilities, excretion from humans and animals using medicines and inappropriate disposal medicine wastes (including unused medicines). Swachh Bharat initiative is an indirect way to prevent the entry of the excreta into the environment. With increasingly concerned at the contamination of water bodies by antibiotic sources, 15 universities from 8 countries have joined hands together to test water samples as a part of Halting Environmental Antibiotic Resistance Dissemination (HEARD) project. As a part of this project, the researchers from Indian Institute of Technology, Madras, in association with number of relevant government agencies, will samples from water bodies: Coom, Adyar River and Pallikarnal marshland.

The life cycle of medicines begins with processing of active pharmaceutical ingredients, continues with the process of distribution and sale, and ends with use either at patient or facility level.  This means there are many stake holders: raw material suppliers, manufacturing units, marketing organization, pharmacies, patients, health facilities and regulators of medicines. All of them are required to be sensitised on environmental impacts of the pharmaceuticals. While there are few regulations which regulates appropriate waste disposal at manufacturing levels and at health facility level, largely there are no awareness among the publics and pharmacy levels on safe disposal of the medicines.

The International Pharmaceutical Federation (FIP), world body of pharmacists, in association with World Health Organization (WHO), identified disposal of medicinal products is an important issue in pharmacy practice and included in Good Pharmacy Practice (GPP) guidelines. The GPP guidelines call for development and practice of minimum standards for disposal of medicinal preparations and medical products. Pharmacists should not only provide necessary information on appropriate disposal of medicinal products but also need to ensure their safe disposal at their practicing sites both in community and hospital setting.  

The environment is a major determinant of health. Environmental hazards are responsible for an estimated 25 per cent of the total burden of diseases worldwide. Massive public awareness programmes, adoption of eco-friendly approach in pharmaceutical processing to waste disposal, sensitization of practicing pharmacists and educating the future pharmacists on the issue of environmental impact of pharmaceuticals would go in a long way reducing the ill effects caused by pharmaceuticals. Let us do our bit of contribution to make a better environment for us and future generations!