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In 2018, the global drug market rose by 5% compared to the previous year. The sector is expected to grow even more over the next few years as demand increases still further. France (the 5^th global consumer of medicines and the 2^nd country in Europe after Germany, according to the report of the French National Academy of Pharmacy “Drugs and the Environment” published in March 2019), will certainly be part of this dynamic.

Drug residues, a disaster for health and the environment

While this growth in the drug market is partly due to an ageing population and an increase in the middle classes across the world, it is also a warning. Drug residues (discarded in household waste or washed into waste water) inevitably end up in water and soil and ultimately in our food chain. This is bad for our health and for the environment.

This risk was highlighted in 2009 in the study “Four mineral elements as biomarkers of medical activities in wastewaters”. It was initiated and coordinated by Dr. Joël Spiroux, a medical doctor and environmental-health expert when chairman of the Health/Environment commission of the regional union of independent medical practitioners for Haute Normandie (Union Régionale des Médecins Libéraux de Haute Normandie – URML HN), together with the university laboratories of Professors Jean-Pierre Goullé and Michel Guerbet.

The methodology used a kinetic study to detect and quantify drug residues (25 substances) discharged from Rouen University Hospital (CHU) during 30 consecutive days. The study monitored the substances detected between the outlet from the CHU and the outlet from the water treatment plant (Station d’Épuration – STEP) at 5 sampling points: university-hospital outlet, and STEP inlet, middle and outlet. The study also looked for markers specific to hospital activity such as gadolinium (Gd).

Two sources of pollution were clearly identified: one of them from hospital activity, the other from the “distributed” environment, i.e. consumption of medicines at home.

After analysis of four elements widely used in medicine: silver, iodine, platinum and gadolinium: the results show that their concentrations in hospital waste water are between 3 and 27 times greater than those in waste water from urban areas. Nevertheless, given their respective discharge rates, it is clear that the quantity of metal discharged in waste water by hospitals represents only about 1% – 9% of the total quantity discharged by urban areas. In other words, pollution by medicines is much higher at town outlets, because of our daily consumption of drugs, than at hospital outlets. The results show that most of the chemicals in the study that are present at the STEP inlet are still there at the STEP outlet.

Results:

The amount of the 25 substances per year is:

• At the CHU outlet: 1.2kg/year
• At the STEP inlet: 392kg/year*
• At the STEP outlet (and so in the Seine): 300kg/year.

* It should be noted that at the STEP inlet, drugs discharged both from the CHU (1.2kg/year) and from the town are measured, so that the discharge is 390.8kg/year.

In the light of these results, we can conclude that to date STEPs are not very effective in eliminating medicinal compounds discharged from the university hospital and the town. 

Ms Roselyne Bachelot, French Minister of Health, used the results of this study, which were presented at the first European Congress on Environmental Pathologies in 2009 (ECEP 2009), to set up a national steering committee on drug residues, which was followed by the launch of the national plan for drug residues in waters (PNRM), on 30 May 2011, by Ms Nathalie Kosciusko-Morizet, French Minister of Ecology.

The study was followed by three reviewed publications, one in French: Goullé et al. 2011(1); Goullé et al. 2012(2); Saussereau et al. 2013(3).

After an initial assessment published in 2015, measures were put in place to reduce drug residues upstream. This plan will now continue under the title Micropollutant Programme 2016-2021, with three main objectives: to reduce micropollutant discharge; to consolidate knowledge in order to tailor anti-pollution measures; and to draw up lists of pollutants on which to work.  The main issue is to change the sewage-treatment plants (STEP) so they can retain small drug molecules, and also dioxins, phthalates, PCBs, bisphenols and other xenobiotics.

Despite this collective awareness, the Organisation for Economic Co-operation and Development (OECD) published a report (7) in 2019 in which it warns of the persistence of this phenomenon and the effects on the environment. “Because pharmaceuticals are intentionally designed to interact with living organisms at low doses, even low concentrations in the environment can have unintended, negative impacts on freshwater ecosystems”, according to the OECD.

Medicines harmful to water ecosystems include oral contraceptives that result in feminization of fish and amphibians. Antidepressants can alter fish behaviour, for instance making them more vulnerable to predators. And the overuse of antibiotics exacerbates the problem of antimicrobial resistance, both in animals and humans. The OECD has warned that “The overuse and discharge of antibiotics to water bodies could cause more deaths globally than cancer by 2050”.

“Homeopathic drugs are the only family with no side effects”

With no known adverse side effects, homeopathic drugs are one solution that limits drug residues. The therapy is natural and gentle, and leaves no residue in water and soils.

According to Dr Christelle Besnard-Charvet, a gynaecologist and obstetrician, “It is the only class of drugs that causes no side effects or dependency, and the drugs do not interact. They can be used to manage pregnant and breastfeeding women, children, the elderly or those taking multiple drugs for whom we have few alternatives.”

In addition, for an equally severe disease, patients treated by a homeopath consume half the quantity of antibiotics (4),half the quantity of anti-inflammatories (5) and a third the quantity of psychotropic drugs (6).

The medicine therefore has its proper place in the healthcare pathway, both because of its approach to the patient and its effect on the environment.