A newly available dataset on pharmaceuticals used in Scottish hospitals enabled an Environmental Risk Assessment that includes hospital consumption of pharmaceuticals, as previous UK rankings have been based on community prescription only. As health and the environment are devolved issues for the Scottish government, it is in any case merited to consider a Scottish ranking separately; regional differentiation is particularly relevant in the spatial context of the Water Framework Directive. Nine pharmaceuticals are identified as having a risk quotient (RQ) greater than 1. Four of these, the antibacterials piperacillin, tazobactam, flucloxacillin and ciprofloxacin, had high hospital contributions and had not been highlighted before in rankings based on community prescriptions. Some drugs with RQ < 0.1 are almost exclusively used in hospitals and could be more concentrated near effluents carrying hospital wastewater, where they may be of local concern. As separate treatment of hospital effluents is a policy option, specific inclusion of hospital consumption is important. Continually increasing availability of ecotoxicological data and trends in consumption further contribute to a substantially different prioritisation than in previous rankings. This leads us to conclude that regular review of risk is necessary.
- environmental risk