Patients should be encouraged to return unused medicines to pharmacies so they can be disposed of correctly, to help protect the environment, experts have said.

Speaking on Sky News (16 February), global health adviser and pharmacy lecturer at University College London, Oksana Pyzik, said that too many people were flushing medicines ‘down the toilet’ instead of returning them to pharmacies. This is contributing to pollution of the world's rivers, she claimed.

‘There must be a larger awareness’ around the ‘dangers’ of throwing drugs away or disposing of them in toilets, Ms Pyzik said.

This comes after research found traces of commonly used drugs, such as antibiotics, in rivers globally. Paracetamol, nicotine, caffeine and epilepsy and diabetes drugs were widely detected in a University of York study.

In response to the research, Elen Jones, director of the Royal Pharmaceutical Society in Wales, told The Pharmacist that pharmacy teams must further educate the public on how they can help tackle pharmaceutical pollution.

She said that pharmacy teams should encourage patients to always return unused medicines to a community pharmacy, to never dispose of medicines in a sink or toilet, and to always finish courses of antibiotics.

According to the research, published in Proceedings of the National Academy of Sciences journal, rivers in Pakistan, Bolivia and Ethiopia were among the most polluted in the world. While rivers in Iceland, Norway and the Amazon rainforest had little to no levels of pharmaceutical waste in their waters.

Pollution poses a risk to freshwater habitats and wildlife and could contribute to the build-up of antimicrobial resistance, researchers explained.

The research said the increased presence of antibiotics in rivers could also lead to the development of resistant bacteria, damaging the effectiveness of medicines and ultimately posing ‘a global threat to environmental and global health’.

Ms Jones said she was ‘aware’ of ongoing research which is looking into which medicines have the biggest impact on water pollution.

‘Hopefully, ongoing research in this area will support prescribers in considering the environment when deciding which medicine to prescribe in situations where multiple medicines work equally well for treatment,’ she added.

How can we fix this?

‘This is a hidden problem and one that we’re sweeping under the rug,’ Ms Pyzik told Sky News.

The research proved the extent to which current water filtration systems used around the world are unable to effectively remove waste, such as pharmaceuticals.

‘When you take a medicine and you excrete it by urine or faeces, that medicine - which is still an active biological compound – can interact with species in water and social systems,’ she explained.

‘Even the most modern and advanced wastewater treatment plants aren't able to completely remove these compounds before they end up in rivers or lakes.’

Ms Pyzik called for pharmaceutical and policy advancements to limit pharmaceutical pollution in the future.

‘All pharmaceutical companies, before they get market authorisation for a drug, need to do an en risk assessment where the active compounds are evaluated to assess their impact on the environment. But these definitely need to be strengthened,’ she explained.

She also said there is a ‘proposition’ for green pharmaceuticals, which are drugs purposely created to be are less toxic to the environment when excreted.

There has recently been a surge in new cases of antibiotic-resistant sexually transmitted infections.

This comes as antimicrobial resistance is reportedly the leading cause of death worldwide. A study in The Lancet, published this month, found that antimicrobial resistance kills about 3,500 people every day worldwide.