Human and environmental health risks of drugs in the environment

Abstract

The proliferation of pharmaceutical residues as emerging contaminants presents growing concerns for environmental and human health worldwide. These pollutants originate from diverse sources and persist across environmental matrices. This systematic review aims to synthesize current evidence on pharmaceutical contamination and its implications for human and ecosystem health within a One Health framework. A comprehensive literature search was conducted across PubMed, Scopus, Web of Science, and Google Scholar. Out of 500 records screened, 46 peer-reviewed studies met the eligibility criteria following PRISMA guidelines. Study quality was assessed using the CASP checklist and Newcastle–Ottawa Scale. Studies were thematically categorized into occupational exposure (n = 4), adverse drug reactions/antimicrobial resistance (n = 7), waste disposal (n = 14), environmental contamination (n = 6), and epidemiological trends (n = 15). Pharmaceutical residues including antibiotics, analgesics, antidepressants, and hormones were detected in surface waters, groundwater, soils, and biota at concentrations capable of disrupting physiological processes. Documented effects include endocrine disruption, neurotoxicity, reproductive toxicity, and propagation of antimicrobial resistance (AMR). This review confirms that pharmaceutical pollutants represent a multidimensional One Health challenge. Primary recommendations include: (1) strengthening pharmaceutical waste management systems and medication take-back programs; (2) implementing advanced wastewater treatment technologies (ozonation, activated carbon); (3) expanding environmental monitoring programs in low- and middle-income countries; and (4) prioritizing research on chronic, low-dose, and mixture exposures.