Published online Oct 19, 2021. doi: 10.5498/wjp.v11.i10.791
Peer-review started: February 23, 2021
First decision: June 18, 2021
Revised: June 18, 2021
Accepted: August 31, 2021
Article in press: August 31, 2021
Published online: October 19, 2021
Among all contaminants of emerging interest, drugs are the ones that give rise to the greatest concern. Any of the multiple stages of the drug's life cycle (production, consumption and waste management) is a possible entry point to the different environmental matrices. Psychiatric drugs have received special attention because of two reasons. First, their use is increasing. Second, many of them act on phylogenetically highly conserved neuroendocrine systems, so they have the potential to affect many non-target organisms. Currently, wastewater is considered the most important source of drugs to the environment. Furthermore, the currently available wastewater treatment plants are not specifically prepared to remove drugs, so they reach practically all environmental matrices, even tap water. As drugs are designed to produce pharmacological effects at low concentrations, they are capable of producing ecotoxicological effects on microorganisms, flora and fauna, even on human health. It has also been observed that certain antidepressants and antipsychotics can bioaccumulate along the food chain. Drug pollution is a complicated and diffuse problem characterized by scientific uncertainties, a large number of stakeholders with different values and interests, and enormous complexity. Possible solutions consist on acting at source, using medicines more rationally, eco-prescribing or prescribing greener drugs, designing pharmaceuticals that are more readily biodegraded, educating both health professionals and citizens, and improving coordination and collaboration between environmental and healthcare sciences. Besides, end of pipe measures like improving or developing new purification systems (biological, physical, chemical, combination) that eliminate these residues efficiently and at a sustainable cost should be a priority. Here, we describe and discuss the main aspects of drug pollution, highlighting the specific issues of psychiatric drugs.
Core Tip: Psychiatric drugs have received special attention as contaminants of emerging interest because of two reasons: First, their use is increasing. Second, many act on phylogenetically conserved neuroendocrine systems, potentially affecting many non-target organisms. Drug pollution is a complicated problem involving many stakeholders with different values and interests. Solutions can be applied at source, using medicines more rationally, prescribing greener drugs or designing pharmaceuticals that are more biodegradable. Besides, end of pipe measures, e.g., developing new purification systems will also be crucial. Finally, educating both health professionals and citizens, and collaboration between environmental and healthcare sciences is going to be essential.