Pharmaceutical Residues in Freshwater: Hazards and Policy Responses

Foreword
Acknowledgements
Abbreviations
Executive Summary
	Advances in monitoring can help close the knowledge gap and support policy responses
	Moving towards proactive policy action to curb pharmaceutical pollution
OECD Policy Recommendations on addressing pharmaceutical residues in freshwater
	Cross-cutting recommendations
	Source-directed recommendations. Pharmaceutical life cycle stages: design, marketing authorisation, manufacturing, post-authorisation
	Use-orientated recommendations. Pharmaceutical life cycle stages: Prescription and use
	End-of-pipe recommendations. Pharmaceutical life cycle stages: collection and disposal, and wastewater treatment and reuse
1 Defining the challenge of managing pharmaceuticals in water
	1.1. Key messages
	1.2. Introduction
	1.3. Origins, entry-pathways, sinks and concentration patterns of pharmaceuticals in the environment
		1.3.1. A typology for pharmaceuticals in the environment
		1.3.2. Sources and entry-pathways
			Pharmaceutical manufacturing
			Household and hospital consumption (usage)
			Agriculture and aquaculture
		1.3.3. Concentration patterns
		1.3.4. Environmental sinks
		1.3.5. Future projections on pharmaceuticals in the environment
	1.4. Effects of pharmaceuticals in the environment on human and freshwater ecosystem health
		1.4.1. Proven and potential adverse effects and costs
		1.4.2. Pharmaceutical characteristics that affect environmental risks
			Persistence
			Mobility
			Bioaccumulation
			Toxicity
	References
	Notes
2 Opportunities to build a policy-relevant knowledge base
	2.1. Key messages
	2.2. Environmental risk assessment and authorisation of pharmaceuticals
		2.2.1. Introduction
		2.2.2. Environmental risk assessment of new pharmaceuticals in practice
		2.2.3. Concerns with current environment risk assessment of pharmaceuticals
	2.3. Existing frameworks for monitoring pharmaceuticals in water
	2.4. Advances in water quality monitoring and potential benefits for risk assessments and water quality policy making
		2.4.1. The value of integrating monitoring approaches
	2.5. The added value of system modelling
	References
	Notes
3 Emerging policy instruments for the control of pharmaceuticals in water
	3.1. Key messages
	3.2. Introduction
	3.3. Source-directed approaches
		3.3.1. Environmental quality norms and water quality standards
		3.3.2. Green pharmacy
		3.3.3. Water safety planning
		3.3.4. Good manufacturing practices, best available techniques and green public procurement
	3.4. Use-orientated approaches
		3.4.1. Health-care practices and consumer choices
		3.4.2. Veterinary and agricultural practices
	3.5. End-of-pipe measures
		3.5.1. Upgrading wastewater treatment plants with advanced removal technologies
			Removal effectiveness and cost efficiency
			Financing WWTP upgrades
		3.5.2. Pharmaceutical waste management and collection programmes
	References
4 Recommendations for the management of pharmaceuticals in freshwater
	4.1. Key messages: A life cycle, multi-sector approach to managing pharmaceutical residues in freshwater
	4.2. A policy toolbox for a life cycle, multi-sector approach
	4.3. The interlinkages between freshwater, pharmaceutical, and human and animal health policies
		4.3.1. Improvements to environmental risk assessment and marketing authorisation of pharmaceuticals
		4.3.2. Overcoming barriers to facilitate green pharmacy
		4.3.3. Data sharing and institutional coordination to reduce the knowledge gaps
		4.3.4. Decision- and policy-making under uncertainty
	4.4. A life cycle, multi-sector approach: Experience from selected OECD countries
		4.4.1. Germany: a multi-stakeholder dialogue to reduce contaminants of emerging concern in water
		4.4.2. France: Priority actions to reduce pharmaceuticals in water and empower local stakeholders
		4.4.3. Sweden: Increased consideration of the environmental risks of human pharmaceuticals
		4.4.4. United Kingdom: A “whole catchment” approach to managing pharmaceuticals in the environment
		4.4.5. The Netherlands: “Chain approach” to pharmaceutical residues in water
		4.4.6. European Union: A Strategic Approach to Pharmaceuticals in the Environment
	References
	Notes
Glossary