Public health care management of water pollution with pharmaceuticals: Environmental classification and analysis of pharmaceutical residues in sewage water

The occurrence of pharmaceuticals in surface water is an emerging problem in developed countries. If such pollution is transferred to drinking water, the resulting involuntary low-dose medication of large population groups may compromise public health. In addition, aquatic life may be compromised. The Stockholm County Council, the provider of public healthcare in the Stockholm, Sweden region, has introduced a classification of pharmaceutical drugs according to their potential for accumulation in surface water and interference with aquatic life. The classification utilizes producer-supplied data on biodegradation, bioaccumulation, and eco-toxicity. The purpose of the classification is to increase the awareness of patients, doctors, and producers that pharmaceuticals may have side effects outside the patient. Hence, doctors and patients may make a more multi-factorial selection of drug in cases where several therapeuticallt-equivalent alternatives are available. The program will be evaluated by annual analyses of pharmaceuticals in regional surface water and sewage treatment plant effluents. In the first classification, 12 of 22 antibiotics and virus inhibitors were considered to pose little risk to public health via surface water accumulation or to aquatic life. Detectable levels of quinolones, sulfamethoxazole, trimethoprim, and metronidazole were found in all sewer treatment plant effluents investigated. In the surface water samples pharmaceutical residues were observed only occasionally.