UNIVERSITY OF GOTHENBURG Department of Earth Sciences Geovetarcentrum/Earth Science Centre Occurrence and treatment of pharmaceuticals in drinking water and sewage water: A review of the current situation in Sweden Amanda Suoranta ISSN 1400-3821 B938 Bachelor of Science thesis Göteborg 2016 Mailing address Address Telephone Telefax Geovetarcentrum Geovetarcentrum Geovetarcentrum 031-786 19 56 031-786 19 86 Göteborg University S 405 30 Göteborg Guldhedsgatan 5A S-405 30 Göteborg SWEDEN Abstract Pharmaceuticals and personal care products (PPCP) are increasingly used in Sweden and the rest of the world, which is due to both population growth and increased consumption per capita. Both the production and sales of pharmaceuticals are anticipated to continue to increase. This is a problem because this will increase the pharmaceutical concentrations in the sewage water and drinking water, as well as in the environment. The purpose of this study was to shed light on the current situation in Sweden regarding pharmaceutical substances in the aquatic environment. Collecting data and information has been done by reviewing previous studies and through online questionnaires sent out to all municipalities in Sweden. This study shows that there are currently no concrete restrictions regarding pollution by pharmaceuticals in Sweden and there are no clear threshold values for pharmaceutical content in sewage or drinking water. Sewage treatment plants (STP) and drinking-water treatment plants do not remove pharmaceuticals actively and only a few municipalities have analyzed their drinking water (6%) and sewage water (25%) for pharmaceutical content. Only 3% of the municipalities that answered the survey on drinking water intend to analyze for pharmaceutical content in the drinking water within two years. 11% of the sewage treatment plants will analyze their water for pharmaceutical substances within two years. Studies have shown that some active pharmaceutical ingredients (API) are unintentionally removed in STPs to some extent, while other can pass through the STP unaltered. The most common pharmaceuticals sold over-the-counter (OTC) in Sweden in 2015 were Xylometazoline, Ibuprofen and Paracetamol. Sodium fluoride, Xylometazoline and Ibuprofen were the most common pharmaceuticals sold in pharmacies the same year. Key words: Pharmaceuticals, occurrences, sewage water, drinking water, aquatic environment. List of abbreviations: API: Active pharmaceutical ingredient DDD: Defined daily dosage EPPP: Environmental persistent pharmaceutical pollutant OTC: Over-the-counter sold pharmaceuticals PPCP: Pharmaceuticals and personal care products STP: Sewage treatment plant Table of contents 1. Introduction ................................................................................................. 5 1.1 Aim of study .............................................................................................. 5 1.2 Background ............................................................................................... 6 1.2.1 Pharmaceuticals .................................................................................. 6 1.2.2 Drinking water and sewage water ....................................................... 6 2. Method ........................................................................................................ 7 2.1 Literature study ......................................................................................... 7 2.2 Questionnaires .......................................................................................... 8 2.3 Case Study ................................................................................................. 8 3. Results ......................................................................................................... 9 3.1 Literature study ......................................................................................... 9 3.1.1 Global perspective ............................................................................... 9 3.1.2 Previous pharmaceutical studies carried out in Sweden ................... 12 3.1.3 Most common pharmaceuticals sold in Sweden in 2014 and 2015 ... 13 3.1.5 Water treatment in Sweden .............................................................. 14 3.1.6 Swedish laws and restrictions............................................................ 15 3.1.7 Ongoing projects ............................................................................... 16 3.2 Questionnaires ........................................................................................ 16 3.2.1 General information of the drinking-water treatment plants ............ 17 3.2.2 Analyzes made by the municipalities ................................................. 17 3.2.3 Future investigations ......................................................................... 20 3.3 Detailed interview about drinking water with Mönsterås municipality ... 21 4. Discussion .................................................................................................. 21 4.1 The pharmaceutical situation in general ................................................. 21 4.2 Pharmaceuticals of specific concern ........................................................ 22 4.2.1 Diclofenac ......................................................................................... 22 4.2.2 Antibiotics and veterinary pharmaceuticals ...................................... 23 4.3 Water treatment ..................................................................................... 23 4.3.1 Removal in STPs and drinking-water treatment plants ...................... 24 4.4 Recommended precautions .................................................................... 25 5. Conclusions ................................................................................................ 26 6. Acknowledgements .................................................................................... 26 7. References ................................................................................................. 26 Appendix 1 Questions asked in the survey on drinking water. Questions are in Swedish. ........................................................................................................... 31 Appendix 2: Questions asked in the survey on sewage water. Questions are in Swedish. ........................................................................................................... 32 Appendix 3: Survey results from the drinking water questionnaire .................. 33 Appendix 4: Survey results from the sewage water questionnaire ................... 58 Stockholms Universitet, & Stockholms läns landsting, 2005). This, however, does not provide information on where the 1. Introduction pharmaceuticals are released or in what Pharmaceuticals and personal care products quantities. Furthermore, as of today there is no (PPCP) are increasingly used in Sweden and the direct law in Sweden that restricts the release of rest of the world, which is due to both pharmaceuticals into the environment. There population growth and increased consumption are some norms and systems about how to per capita (Wennmalm & Gunnarsson, 2005). It handle pharmaceuticals. One such system is that is also believed that pharmaceuticals will keep doctors in Sweden are required to prescribe the increasing in production and sales across the least environmentally damaging drug to the globe (Oldenkamp et al., 2013), which increases client whenever possible (Lyons, 2014). the environmental impact (EEA, 2010). The The biggest input of pharmaceuticals into the pharmaceuticals are sold both over-the-counter aquatic system is via sewage water and sewage (OTC) and as prescription drugs in pharmacies treatment plants (STP) (World Health (World Health Organization, 2011), and the Organization, 2011). Medicines are designed to disposal of pharmaceuticals into the be biologically active, which makes them a environment is not regulated (Joakim Larsson & danger to aquatic wildlife once they reach the Fick, 2009). environment (Lyons, 2014). The long term Pharmaceutical occurrences in the impact of low quantities of pharmaceuticals environment are a growing concern (Carlsson, substances in the environment is not well Johansson, Alvan, Bergman, & Kühler, 2006). studied, and there is little knowledge on what Since it was realized that pharmaceuticals might the effects of combined pharmaceuticals might pose a danger to the environment, several be (World Health Organization, 2011). This is one hundreds of studies have been made and reason for why it is important to start analyzing hundreds of reports and articles have been the pharmaceutical situation, not just in Sweden, written (Kümmerer, 2009; Läkemedelsverket, but globally as well. Larsson, & Lööf, 2013). Many of these studies have confirmed the presence of pharmaceuticals 1.1 Aim of study in groundwater and surface water (World Health This study attempts to address the current Organization, 2011). It has also been proven that situation in Sweden regarding pharmaceutical some pharmaceuticals cause changes in aquatic substances in the aquatic environment. The species. The active pharmaceutical ingredients main focus of this study will be on (API) ethinylestradiol and levonorgestrel in pharmaceutical occurrences in sewage water hormonal substances are examples for this. They and drinking water, as well as on what STPs and can affect the fertility in fish at very low drinking-water treatment plants do to prevent