Informing preventative approaches to reducing pharmaceutical pollution

The One Health Breakthrough Partnership is a multi-agency partnership – involving the National Health Service, Scottish Water and the Scottish Environmental Protection Agency, as well as Higher Education and Research Institutes - working to reduce pharmaceutical pollution and environmental antimicrobial resistance in Scotland. One regional Scottish health board is planning a pilot project on making changes to prescribing practice to achieve these aims. We present the method and results of a baseline study conducted in advance of this pilot.
Prioritising pharmaceuticals for risk assessment and monitoring is challenging, due to the large number of different compounds on the market [1]. To predict and understand environmental concentrations with confidence, it is necessary to explore not only local or regional pharmaceutical consumption but also the environmental context and wastewater treatment infrastructure [2]. This study used a multi-pronged approach, enabled by the uniquely collaborative nature of the partnership. A wide range of datasets were collated, including hospital and community prescribing patterns; infrastructural data on healthcare facilities, sewer network and wastewater treatment plants; septic tank locations; river flow data, as well as previous monitoring data from a range of environmental research projects by various universities, research institutes, the regulator and the water board. These were analysed to determine the spatial extent and severity of pharmaceutical pollution in Scotland. Utilisation of such heterogeneous data sources required careful consideration of data quality [3] and of the research questions of the underlying studies.
The resulting picture of the presence of compounds was subsequently evaluated against data on persistence, bioaccumulation and ecotoxicity, using the Swedish WISE list as a point of reference, as well as minimal selective concentrations, in order to inform priority compounds in this pilot. In addition, we conducted a gap analysis of areas or compound for which their is a paucity of data and make recommendations for further research.

References

[1] Helwig K, Hunter C, MacLachlan J, McNaughtan M, Roberts J, Cornelissen A, Dagot C, Evenblij H, Klepiszewski K, Lyko S, Nafo I, McArdell CS, Venditti S and Pahl O J Environ Anal Toxicol 2013, 3:4

[2] Helwig K, Hunter C, McNaughtan M, Roberts J, Pahl O Environmental Toxicology and Chemistry 35:4 Special Issue: Pharmaceuticals in the Environment pp 1043-1050

[3] Tim aus der Beek, Frank‐Andreas Weber, Axel Bergmann, Silke Hickmann, Ina Ebert, Arne Hein, Anette Küster Environmental Toxicology and Chemistry 35:4 Special Issue: Pharmaceuticals in the Environment pp 823-835

Acknowledgements

The authors acknowledge the financial support of CREW, Scotland, and the expertise and collaboration of all partners involved in the One Health Breakthrough Partnership.