It is no secret that the pharmaceutical industry in Canada is a thriving business. In 2021, the total value of pharmaceuticals sold reached $34.1 billion, with roughly 33,000 people employed in manufacturing these drugs (Government of Canada, 2024). Many of us rely on these medications, whether you are popping an Advil for that annoying headache, or reaching for the antihistamines for those seasonal allergies. But have you ever wondered where these consumed medications go after they’ve done their job? You might assume they’re completely used up by your body to cure your ailments, but that’s not always the case.

Unfortunately, the drugs we consume can have a devastating impact on the environment. From drug metabolites that are excreted in urine to improper disposal of medications by the consumer, pharmaceuticals can unintentionally seep into ecosystems. Drugs such as oral contraceptives, over-the-counter (OTC) painkillers, and antibiotics can all impact the environment in different ways.

Estrogen Overflow: Worries in our Waterways

Take estrogen, a major component of many birth control pills. Estrogen is secreted from the body through urine, and can end up in wastewater systems and harm aquatic life. A study found that the levels of estrogen and estrogen-like compounds found within wastewater can decrease fertility and lead to population collapse of fathead minnows when introduced to lakes (Kidd et al., 2007). Ecosystems require a delicate balance, and the loss of a species can reduce biodiversity and lead to imbalances within food chains. Since wastewater treatment plants are not entirely effective in removing these compounds (Ternes et al., 1999), improving these systems is critical to minimizing environmental contamination of these medications.

Fishy Painkillers: Diclofenac’s Effects on Aquatic Life

In Sweden, the OTC painkiller diclofenac poses a threat to the environment (Villén et al., 2023). Diclofenac is a non-steroidal anti-inflammatory drug (NSAID) like Advil. It has been found to cause liver poisoning in rainbow fish trout (Laville et al., 2004). Well known for its negative effects within aquatic life, diclofenac impedes larval growth in mussels, shrimp and urchins and disrupts reproductive health in freshwater fish (Bonnefille et al., 2018). Despite the efforts for environmentally friendly practices and waste water management, the widespread use of topical diclofenac medications within many countries increases the likelihood of environmental run-off (Villén et al., 2023). Topical diclofenac is an ointment type medication applied to the skin, and due to this property it easily gets washed away in the drain as people wash their hands. This residual diclofenac can end up in nearby seas, lakes and rivers. It is a serious risk to the wildlife in these aquatic ecosystems as it affects their growth and reproductive health.

Superbug Stressors: Antibiotic Resistance

Pharmaceutical pollution not only harms the environment but also human health. Antibiotic resistance occurs when bacteria adapt to and survive against drugs that are meant to kill them. While using a different drug may work against the bacteria briefly, bacteria that become resistant to multiple drugs are called “superbugs”. This multi-resistance against the treatments we provide can make it difficult to treat bacterial infections. With the rise of antibiotic resistance leading to superbugs, there is an increasing threat to the way we treat bacterial infections and the effectiveness of our current therapies.

A major contributor to antibiotic resistance in aquatic wildlife is exposure to pharmaceutical factory wastewater. The increase of antibiotic resistant microorganisms in lower and middle income nations are associated with poor management of wastewater treatments and pharmaceutical factory production (Rayan, 2023). When wastewater treatment plants are not properly managed, the antibiotic runoff produced from pharmaceutical factories can get into the aquatic environment, where bacteria exposed can develop antibiotic resistance. These antibiotic resistant bacteria can live on aquatic life that people eat and can also make their way into drinking water, causing illness. These poorly managed facilities are not only affecting the wildlife around them, but also the vulnerable communities that have to face increased outbreaks of difficult-to-treat infections.

Green Medicine: Innovations for an Eco-Friendly Future

Although the environmental impact of pharmaceuticals is alarming, there are current initiatives to mitigate these issues. Ongoing research into effective water treatments seeks to protect aquatic life. Additionally, the development of more environmentally friendly versions of pharmaceuticals is gaining momentum. The GREENER concept, a proposal to help reduce environmental impacts through all stages of drug development is a great example of progress (Moermond et al., 2022). While making the drug, the GREENER concept suggests manufacturers should consider the drug’s ability to biodegrade into the environment. That way, when clinical trials and FDA approval occurs and people consume the drug, there are less active pharmaceutical ingredients (APIs) that can bleed into water sources and affect wildlife. Creating drugs with targeted delivery methods specific to patients provides personalized medicine, but also reduces APIs from harming wildlife, as some drugs can act on similar body systems in other species as they do in humans.

As academics and drug companies work together to apply the GREENER concept in drug discovery and research, they can help protect the environment while ensuring patient health comes first. Adding environmental effects on drug labels and educating drug prescribers about environmental impacts (Villén et al., 2023) can influence environmentally sensitive practices in clinics and hospitals.

Taking Action: What Can You Do To Help?

Check the label for disposal instructions and make sure to properly dispose of your medications.
Don’t flush drugs down the toilet—go to pharmacies and clinics that offer take-back programs for unused or expired medications.
Avoid stockpiling OTC medications to reduce potential waste from expired drugs that you could not finish in time.
When prescribed antibiotics, complete the course to avoid leftover medication and lessen the risk of antibiotic resistance.
Donate to programs such as Health Care Without Harm (HCWH) that advocate for reducing environmental impacts in healthcare.

From oral contraceptives that disrupt aquatic ecosystems to superbugs that threaten our public health, it is clear that the impact of pharmaceuticals on the environment is an ongoing issue that requires action. Tackling this issue requires improvements at every level in healthcare, whether it be eco-friendly drug development by researchers and pharmaceutical industries, or raising awareness of greener medicine to consumers and healthcare providers. Each of us can make decisions in our daily lives to contribute to a more sustainable world that values human health and the well-being of our planet. Together, we can work towards a future where prescription no longer leads to pollution.