Environmental exposure to active pharmaceutical ingredients (APIs) can have negative effects on the health of ecosystems and humans. While numerous studies have monitored APIs in rivers, these employ different analytical methods, measure different APIs, and have ignored many of the countries of the world. This makes it difficult to quantify the scale of the problem from a global perspective. Furthermore, comparison of the existing data, generated for different studies/regions/continents, is challenging due to the vast differences between the analytical methodologies employed. Here, we present a global-scale study of API pollution in 258 of the world’s rivers, representing the environmental influence of 471.4 million people across 137 geographic regions. Samples were obtained from 1,052 locations in 104 countries (representing all continents and 36 countries not previously studied for API contamination) and analyzed for 61 APIs. Highest cumulative API concentrations were observed in sub-Saharan Africa, south Asia, and South America. The most contaminated sites were in low- to middle-income countries and were associated with areas with poor wastewater and waste management infrastructure and pharmaceutical manufacturing. The most frequently detected APIs were carbamazepine, metformin, and caffeine (a compound also arising from lifestyle use), which were detected at over half of the sites monitored. Concentrations of at least one API at 25.7% of the sampling sites were greater than concentrations considered safe for aquatic organisms, or which are of concern in terms of selection for antimicrobial resistance. Therefore, pharmaceutical pollution poses a global threat to environmental and human health, as well as to delivery of the United Nations Sustainable Development Goals.

Many of the products and drugs used commonly contain chemical components which may persist through sewage treatment works (STW) and eventually enter the aquatic environment as parent compounds, metabolites, or transformation products. Pharmaceuticals and personal care products (PPCPs) and other emerging contaminants (ECs) have been detected in waters (typically ng/L) as well as more recently bound to sediment and plastic particles (typically ng/g). Despite significant advancement of knowledge since the late 1990s, the fate of these contaminants/transformation products once introduced into the aquatic environment remains relatively unresolved. This review provides a unique focus on the fate of seven major groups of PPCPs/ECs in the aquatic environment, which is frequently not found in similar works which are often compound or topic-specific and limited in background knowledge. Key findings include: a) some replacements for regulation precluded/banned chemicals may be similarly persistent in the environment as those they replace, b) the adsorption of potentially bioactive chemicals to micro- and nanoplastics is a significant topic with risks to aquatic organisms potentially greater than previously thought, and c) micro-/nanoplastics are likely to remain of significant concern for centuries after regulatory limitations on their use become active due to the slow degradation of macro-plastics into smaller components. An interdisciplinary perspective on recent advances in the field is presented here in a unique way which highlights both the principle science and direction of research needed to elucidate the fate and transport patterns of aquatic PPCPs/ECs. Unlike similar reviews, which are often topic-specific, here we aim to present an overarching review of the field with focus on the occurrence, transformation and fate of emerging contaminants. Environmental presence of seven major classes of contaminants (analygesics, antibiotics, antineoplastics, beta-blockers, perfluorinated compounds, personal care products and plasticisers), factors affecting contaminant fate, association with plastic micro-/nanoparticles and photochemical transformation are comprehensively evaluated.

Much of the current understanding of pharmaceutical pollution in the aquatic environment is based on research conducted in Europe, North America and other select high-income nations. One reason for this geographic disparity of data globally is the high cost and analytical intensity of the research, limiting accessibility to necessary equipment. To reduce the impact of such disparities, we present a novel method to support large-scale monitoring campaigns of pharmaceuticals at different geographical scales. The approach employs the use of a miniaturised sampling and shipping approach with a high throughput and fully validated direct-injection High-Performance Liquid Chromatography-Tandem Mass Spectrometry method for the quantification of 61 active pharmaceutical ingredients (APIs) and their metabolites in tap, surface, wastewater treatment plant (WWTP) influent and WWTP effluent water collected globally. A 7-day simulated shipping and sample stability assessment was undertaken demonstrating no significant degradation over the 1–3 days which is typical for global express shipping. Linearity (r2) was consistently ≥0.93 (median = 0.99 ± 0.02), relative standard deviation of intra- and inter-day repeatability and precision was <20% for 75% and 68% of the determinations made at three concentrations, respectively, and recovery from Liquid Chromatography Mass Spectrometry grade water, tap water, surface water and WWTP effluent were within an acceptable range of 60–130% for 87%, 76%, 77% and 63% of determination made at three concentrations respectively. Limits of detection and quantification were determined in all validated matrices and were consistently in the ng/L level needed for environmentally relevant API research. Independent validation of method results was obtained via an interlaboratory comparison of three surface-water samples and one WWTP effluent sample collected in North Liberty, Iowa (USA). Samples used for the interlaboratory validation were analysed at the University of York Centre of Excellence in Mass Spectrometry (York, UK) and the U.S. Geological Survey National Water Quality Laboratory in Denver (Colorado, USA). These results document the robustness of using this method on a global scale. Such application of this method would essentially eliminate the interlaboratory analytical variability typical of such large-scale datasets where multiple methods were used.

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