Expert stakeholders' views on the management of human pharmaceuticals in the environment.

Human pharmaceuticals are ubiquitous water contaminants that may have subtle detrimental effects on aquatic organisms, and possibly also on human health. The risks of pharmaceuticals, or pharmaceutically active compounds, remain poorly understood. Awareness of the presence of pharmaceuticals in the environment, coupled with evidence of effects such as fish feminization, however, suggest that precautionary management action to reduce the release of pharmaceuticals to the environment should be considered. The purpose of our study was to evaluate the scope of the issue and possible management strategies from the perspectives of expert stakeholders, drawn from government, academia, and the pharmaceutical and consulting industries, involved in scientific research or policy and management activity, from Canada, the United States, and Europe. Twenty-seven interviewees were asked about their views on management strategies such as pharmaceutical-return programs and incentives for the development of "green" pharmaceuticals. Interviewees generally believed that pharmaceuticals in the environment represented a concern for both human and ecosystem health, although they were more concerned about impacts on aquatic ecosystems. They believed that advanced wastewater treatment technology, education of medical professionals to reduce overprescription, pharmaceutical-return programs coupled with public education, and requirements for all municipalities to have a minimum of secondary wastewater treatment were the most effective management strategies to reduce the environmental impacts of pharmaceuticals. These strategies should be considered by governments interested in managing the risks of human pharmaceuticals in the environment. Combinations of management strategies will likely be most effective in mitigating the risks presented by pharmaceuticals.