Pharmaceuticals in sewage systems and surface waters – status quo

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noPILLS in waters

Pharmaceuticals in the Environment (PiE) are an increasingly recognised risk to the quality of surface water and groundwater. The noPILLS project contributed towards a better understanding of the complex system of processes and – probably more importantly – actors that influence the presence of pharmaceutical micropollutants in waste water and, ultimately, receiving waters.Clearly, a problem as complex and wide-ranging as that of pharmaceuticals in the aquatic environment cannot be comprehensively explored by a single project. However, noPILLS aimed to provide a unique insight into the problem by first defining the range of factors affecting pharmaceuticals in the environment, together with related points for intervention, and then investigating these interventions in a multi- and inter-disciplinary fashion. In developing the concept of a “medicinal product chain” (of processes and actors), noPILLS identified potential “levers for intervention” towards the reduction of pharmaceutical ingress into the aquatic environment. This report describes a series of case studies of applied investigative nature along the medicinal product chain, which explored and evaluated a range of levers for intervention for their underlying efficacy, efficiency, barriers and challenges.In summary, the noPILLS project has shown that:• Pharmaceutical micropollutants are ubiquitous in the aquatic environment in the project areas, and contribute to environmental effects;• Regional differences exist in environmental conditions, as can be expected due to macro-geographical influences (landscape, climate etc), but conditions can also vary within regions and in time, with the biggest factors being influx of effluents and dilution in the environment;• A risk highlighted by noPILLS is that of antibiotic resistance developing in - or being introduced into - the aquatic environment via the sewerage network;• People, acting both as consumers/patients and as professionals, play an important role in the medicinal product chain and need to be involved more in intervention activities;• Strong regional differences exist in factors that are influenced by human behaviour, attitudes, and awareness; most likely this is primarily a result of regional differences in systems (e.g. health system, funding, waste management);• There appears to be a relatively high level of underlying willingness to ‘do the right thing’ both by the general public and professionals, which is largely under-utilized due to lack of information, support or means to change behaviour;• Technological interventions are effective in reducing some pharmaceutical micropollutants but present their own challenges in terms of monetary and energy costs;• Training, education and awareness raising, together with good stakeholder management and effective communication, are crucial for the success of all forms of intervention.• There appears to be no single ‘silver bullet’ intervention point, and the whole medicinal product chain needs to be considered for multi-point, targeted intervention