A study of the University of York, which is the most comprehensive study to date on the subject has found rivers across the world polluted from drugs and pharmaceuticals barring only two places in the world – Iceland and a Venezuelan village where the indigenous people do not used medicines. However, conditions prevailing in India is one of the most dangerous for its people and all forms of lives, since the most contaminated samples were predominantly found from sampling campaigns in Africa and Asia. The Asian countries include Pakistan, India, Armenia, Palestine, and China. The study specifically mentions Delhi as among some of the “most polluted cities on the planet” from where samples were collected. The study monitored 1,052 sampling sites along 258 rivers in 104 countries of all continents, thus representing the pharmaceutical fingerprint of 471.4 million people.

While discussing the countries for highest drug concentrations in their rivers, including India and Nigeria, the researchers concluded that the phenomena may be due to people having enough income to buy pharmaceuticals but live in places without good sewerage systems capable of removing drugs from water.

Given the limitation of the study, the impact of the drug pollution in river water may be more frightening than we presently know. There are over 2,500 modern drugs in use, but the current technology allows the analysis of only 50-100 from the single sample. That is why the researchers focused only on the drugs that are the most commonly used. It may also be mentioned that the study did not include the illegal drugs such as cocaine and MDMA which have also been detected in several rivers at dangerous levels that are harmful to humans, wildlife, and aquatic life forms. We are likely only considering the “tip of the iceberg” as concentrations of some APIs are likely to be orders-of-magnitude greater in unstudied regions than the focused region of Europe and North America that tend to have limited regulation, poorer treatment infrastructures, and higher disease prevalence.

Environmental exposure to active pharmaceutical ingredients (APIs) can have negative effects on the health of ecosystems and humans. Though the study finds it difficult to quantify the scale of the problem, but highest cumulative APIs concentrations were observed in three regions – South Asia (India and Pakistan), Africa and South America. The most contaminated sites were in low- to middle-income countries and were associated with areas with poor wastewater and waste management infrastructure and pharmaceutical manufacturing.

The most frequently detected APIs were carbamazepine, metformin, and caffeine, a compound also arising from lifestyle use. Carbamazepine is an anti-epileptic drug which is hard to break down. Metformin is a drug to contron diabetes. Not only that antibiotics were found at dangerous levels at one in five sites. The other major drugs detected on all continents except Antarctica were the antidepressants citalopram and venlafaxine, antihistamines ceetirizine and fexofenadine, the antibiotic trimethoprim and an anaestehtic lidocaine. Detection frequencies of some APIs (e.g., carbamazepine, metformin, caffeine, nicotine, acetaminophen/ paracetamol, and cotinine) were similar across continents.

The pollution by pharmaceuticals and other biologically active compounds is known to harm humans, aquatic, and wild life. Even fish in the rivers are adversely affected. Antibiotics pollution is driving up the risk of making us humans drug resistant which is considered as the greatest threat for humanity.

John Wilkinson who led the study has even said, “The World Health Organization (WHO) and UN and other organisations say antimicrobial resistance is the single greatest threat to humanity – it’s a next pandemic.”

We still don’t know the level of threat, but a research published last month had estimated some 5 million people died in 2019 from bacterial infections after the patients had become resistant to antibiotics.

When the river pollution and the regions that are suffering from this problem are compared, they seem to be closely aligning with each other suggesting that the pollution has been making people drug resistant.

It is also worth mentioning that an earlier study had found that drug pollution from antidepressants had been adversely affecting wildlife and causing starlings to feed less. The contraceptive drugs were found to be causing decline in fish population. Thus ecological risks could well be greater than predicted for single APIs due to toxicological interactions of these mixtures, the study said.

The reasons of drug pollution also include leakage from the drug manufacturing companies, apart from use of pharmaceuticals by humans and livestock, and their disposal. Good sewage connectivity and wastewater treatment is the key to minimizing, despite the fact that these may be extremely expensive, says Wilkinson the scientist who led the study. He had therefore suggested more careful use of medicines, particularly antibiotics. (IPA Service)