Demographic, epidemiological and lifestyle changes such as an ageing population, the rise of chronic health conditions and the availability of inexpensive generic treatments have been key drivers for increased pharmaceutical usage in OECD countries (OECD, 2021[1]). About 4 000 active pharmaceutical ingredients (APIs) are being administered worldwide in prescription medicines, over-the-counter therapeutic drugs and veterinary drugs (Burns et al., 2018[2]). Over the past two decades, per-capita consumption of lipid-modifying agents has increased by a factor of nearly four and per-capita consumption of anti-diabetic and anti-depressants has doubled (OECD, 2021[1]).
Pharmaceuticals are essential for human and animal health but become an environmental concern if their residues enter freshwater systems. Aquatic pollution can occur when residues are excreted after consumption or when unused or expired medicine (UEM) is discarded inappropriately. Pharmaceutical residues are now ubiquitous in surface water, groundwater and seawater worldwide (OECD, 2019[3]). Pharmaceuticals have been found in 75 different countries and 771 substances have been detected in the environment, sometimes above pollution thresholds (German Environment Agency, 2019[4]).
The health and environmental impacts of freshwater contamination vary strongly across the types of pharmaceuticals. Some pharmaceuticals have an endocrine function, meaning that they affect the hormone system. Endocrine-disrupting pharmaceuticals have been found to have adverse effects on wildlife, even at very low concentrations. For example, steroidal hormones in contraceptive pills have been proven to impair reproduction of exposed fish populations and psychiatric drugs were found to alter fish behaviour (Brodin et al., 2013[5]; Nash et al., 2004[6]). Furthermore, the discharge of antibiotics in water bodies can be linked to the spread of pathogenic organisms that are resistant to antimicrobials, causing an alarming public health threat worldwide (BIO Intelligence Service, 2013[7]; Ferreira da Silva et al., 2007[8]; OECD, 2018[9]).
Unused pharmaceuticals also pose a health risk due to misuse and (un)intentional poisonings. In the US, seven out of ten people who abuse prescription drugs get them from friends and family (Hughes et al., 2016[10]) and drug overdose has become the leading cause of accidental death in the US, before car accidents (Trust for America’s Health, 2015[11]). According to the 2018 National Survey on Drug Use and Health, 9.9 million US citizens misused controlled prescription drugs (SAMHSA, 2019[12]).
Additionally, UEM represents a wasted healthcare resource. Several studies estimate the costs of unused or expired drugs to be in the order of billions of USD (Law et al., 2015[13]; Bach et al., 2016[14]; Trueman et al., 2010[15]).
Various policy interventions can be taken across the lifecycle to reduce the environmental and health impacts of UEM. Whilst waste prevention is critical, fully eliminating unused medicines is difficult. For instance, patients may recover more rapidly than foreseen, change their treatment or not adhere to the prescribed treatments. Patients may also preventively stock over-the-counter drugs, which expire before being completely utilised. Proper collection and disposal of unavoidable UEM is therefore indispensable.
This report reviews pharmaceutical waste management systems in different OECD countries and is structured as follows. Chapter 2 outlines the dominant sources and pathways of pharmaceuticals entering the environment. Chapter 3 reviews estimated amounts and disposal practices of UEM in different OECD countries. Chapter 4 provides an overview of the current policy landscape for pharmaceutical waste management and reviews a selection of waste collection schemes. Chapter 5 concludes the analysis with policy recommendations and considerations.
