Residues of Pharmaceuticals: An International Conference and a National Plan to Combat Micropollutants

Originally expected in June, the second “National Micropollutants Plan” was officially launched on September 8. Ségolène Royal, the Minister of the Environment, made the announcement at the opening of the first international conference on the risks associated with pharmaceutical residues in the environment, organized in Paris by the National Academy of Pharmacy. Covering the period 2016–2021, this strategic plan aims to reduce pollutant emissions into water and preserve the quality of aquatic environments and biodiversity. It has three objectives: to reduce emissions at the source, to consolidate knowledge in order to tailor response efforts, and to identify and prioritize the substances that require action.   Medications, heavy metals, PCBs, hormones, etc.: there are countless substances capable of having toxicity in natural environments, even at very low concentrations. Furthermore, the cost of water pollution caused by micropollutants is high: for example, removing 1 kg of pesticides from water to produce drinking water costs between €60,000 and €200,000. According to the Court of Auditors, the cost of remedial treatment per cubic meter of water is, moreover, 2.5 times higher than that of preventive treatment . In light of these findings, the Ministries of Ecology, Health, and Agriculture have decided to develop, by 2021, initiatives aimed at reducing micropollutants at the source. Over the past six to eight years, three action plans to combat pollution of aquatic environments by these micropollutants have been implemented in France. Now that those plans have come to an end, the new “Micropollutants Plan to Preserve Water Quality and Biodiversity” is taking over. Building on the findings of the previous plans, it is structured around 3 objectives (reduce, understand, prioritize), 14 levers, and 39 actions (see below) . Currently, while the presence of pharmaceutical residues in water is well established, the range of molecules present, the level of exposure, and the effects on fauna, flora, and human health remain largely unknown. In particular, the effects of interactions with other pollutants have not been assessed. Regarding antimicrobial resistance, there is also a lack of knowledge about the numerous mechanisms by which bacteria in municipal or hospital wastewater acquire resistance. These residues originate from the pharmaceutical industry, from medications and diagnostic products disposed of with household waste, from urban or hospital wastewater, as well as from industrial livestock farming and land-applied sludge. While the impacts on wildlife and the environment are cause for concern (proliferation of antibiotic-resistant bacteria in certain waterways, disrupted fish reproduction due to residues of endocrine disruptors, etc.), the concentrations found in drinking water—at least in developed countries—are fortunately much lower. As for food, uncertainties remain, again due to a lack of data. At the international conference on September 8 and 9, some 250 experts gathered in Paris to discuss research challenges related to the issue of these pharmaceutical residues in the environment and to take stock of the knowledge gained over the past decade. In her opening remarks, Ségolène Royal emphasized the importance of data sharing to better understand the risks and the level of exposure to human and veterinary drug residues in water: “To date, no reliable database exists on the physicochemical, toxicological, and ecotoxicological properties of drugs. Centralizing this data would make it possible to more effectively prioritize molecules based on their risk of ending up in water or exceeding threshold levels.” The minister also announced, in the preamble to the second action plan, that she had referred the matter to the French Agency for Food, Environmental and Occupational Health & Safety (ANSES) in order to “objectively assess the mechanisms involved in the development of antimicrobial resistance in the environment and define new risk-reduction measures regarding the interface between human medicine, veterinary medicine, and the environment.” In addition, her ministry will fund “a systematic review intended to take stock of current knowledge on the contamination of the environment with antibiotics, biocides, and resistant bacteria.” With regard to reducing or eliminating emissions, one of the identified levers is to address marketing authorizations (MA) for drugs, which now include new procedures requiring the assessment of ecotoxicity. Monitoring of emerging compounds, relevant substances, pollutants specific to ecological status, and hazardous substances will provide the necessary information before granting or revising a marketing authorisation. A steering committee for the new micropollutants plan will meet at least once a year to review the progress of the actions. It will be chaired by the Ministries of Ecology, Health, and Agriculture. In addition, measures addressing pharmaceutical residues may be expanded following the development of a strategy by the European Commission to combat this form of water pollution.   * http://www.developpement-durable.gouv.fr/IMG/pdf/Plan_micropolluants_2016-_2021.pdf  

A plan with 3 objectives and 39 actions

> Objective 1: Immediately reduce emissions of known micropollutants present in water and aquatic environments

- Action 1 : Develop an operational guide on non-domestic connections for local authorities. - Action 2 : Implement the recommendations of the guide on the proper management of pharmaceutical waste and liquid waste in healthcare and medical-social facilities. - Action 3 : Monitor the decontamination plan for equipment containing PCBs at concentrations between 50 and 500 ppm and conduct environmental monitoring of classified installations for environmental protection (ICPE) that process PCBs. - Action 4 : Strengthen monitoring of industrial discharges and implement appropriate reduction plans. - Action 5 : Carefully manage contaminated sediments during environmental and onshore operations; recycle non-hazardous contaminated sediments. - Action 6 : Establish demonstration projects showcasing best practices for reducing micropollutant emissions in select craft trades. - Action 7 : Study the management of unused medications from healthcare and medical-social facilities, as well as addiction treatment and prevention centers, and propose improvements. - Action 8 : Draw conclusions from the pilot program on the dispensing of medications by the unit. - Action 9 : Examine the relevance of the Swedish index for classifying active ingredients based on their environmental impact and assess healthcare professionals’ acceptance of implementing a similar classification index for medications in France. - Action 10 : Protect 1,000 priority water intake sites from nitrates or pesticides to help safeguard water resources. - Action 11 : Develop and implement a training strategy to support the plan. - Action 12 : Improve information on the status of surface water bodies. - Action 13: Improve communication with the general public, professionals, and local governments. - Action 14: Draft and distribute these guides, drawing in particular on the experiences of innovative local governments selected as part of the national call for projects launched in 2014. - Action 15: Understand public perception of the issues related to the presence of micropollutants in water resources and identify opportunities for behavioral change.  

> Objective 2: Consolidate knowledge to adapt strategies for combating water pollution and preserving biodiversity

- Action 16 : Better assess pollutant emissions into the environment from urban stormwater, agricultural runoff and drainage, and urban and industrial wastewater. - Action 17 : Continue research on hazardous substances in raw water and in treated wastewater from wastewater treatment plants, and explore measures to reduce these substances. - Action 18 : Analyze new solutions, both upstream and downstream of wastewater treatment plants, specifically to limit water pollution. - Action 19 : Develop a methodology for the recovery and recycling of non-hazardous mineral waste in marine or submerged structures. - Action 20 : Assess the impact of using scrap tires in stormwater storage structures. - Action 21 : Better characterize mercury flows downstream of former mining sites in French Guiana to limit mercury discharges into waterways. - Action 22 : Continue to support project sponsors and field operators to improve the reliability of monitoring data on water, sediments, and biota. - Action 23 : Use environmental sample banks to assess the baseline condition and contamination trends in aquatic environments. - Action 24 : Gain a better understanding of the levels of contamination in aquatic environments by priority pollutants and better understand the transfer of these pollutants between different environmental compartments. - Action 25 : Evaluate innovative monitoring and diagnostic methods and technologies. - Action 26 : Conduct proactive monitoring of emerging molecules in rivers, groundwater, coastal waters, and water intended for human consumption. - Action 27 : Inventory and characterize storage sites for residues from former extractive industries. - Action 28 : Map groundwater bodies impacted by perchlorate ions of agricultural origin and those resulting from the destruction of munitions from major wars, and identify any associated micropollutant mixtures. - Action 29 : Assess the effect of micropollutants on aquatic flora and fauna, particularly the synergistic potential of micropollutant mixtures, including those associated with endocrine disruption. - Action 30 : Improve the baseline assessment conducted as part of the implementation of the Water Framework Directive. - Action 31 : Work on the availability and sharing of data to assess the hazard and exposure associated with residues of human and veterinary medicinal products in water. - Action 32 : Continue to develop and update data dissemination portals for chemicals. - Action 33 : Capitalize on international knowledge regarding environmental and health risks associated with micropollutants in aquatic environments. - Action 34 : Develop reference values and methodologies to better assess the quality of surface and groundwater, taking into account endocrine disruptors and relevant metabolites. - Action 35 : Assess the health risks associated with the presence of micropollutants in water intended for human consumption.  

> Objective 3: Compile lists of pollutants requiring action

- Action 36 : Identify metabolites of plant protection products and assess laboratories’ analytical capabilities to enable early placement under surveillance. - Action 37 : Classify molecules according to environmental knowledge needs. - Action 38 : Classify molecules based on the risks of failing to achieve good environmental status (surface water, groundwater, coastal waters). - Action 39 : Classify molecules based on the necessity and feasibility of reducing emissions.