The study specifically mentions Delhi as among some of the “most polluted cities on the planet” from where samples were collected.The study monitored 1,052 sampling sites along 258 rivers in 104 countries of all continents, thus representing the pharmaceutical fingerprint of 471.4 million people.While discussing the countries with highest drug concentrations in their rivers, including India and Nigeria, the researchers concluded that the phenomena may be due to people having enough income to buy pharmaceuticals but living in places without good sewerage systems capable of removing drugs from water.Given the limitation of the study, the impact of the drug pollution in river water may be more frightening than we presently know. There are over 2,500 modern drugs in use, but the current technology allows the analysis of only 50-100 from the single sample. That is why the researchers focused only on the drugs that are the most commonly used.It may also be mentioned that the study did not include illegal drugs such as cocaine and MDMA which have also been detected in several rivers at dangerous levels that are harmful to humans, wildlife, and aquatic life forms.We are likely only considering the “tip of the iceberg” as concentrations of some APIs are likely to be in order of magnitude greater in unstudied regions than the focused region of Europe and North America that tend to have limited regulation, poorer treatment infrastructures, and higher disease prevalence.Environmental exposure to active pharmaceutical ingredients (APIs) can have negative effects on the health of ecosystems and humans. Though the study finds it difficult to quantify the scale of the problem, but highest cumulative APIs concentrations were observed in three regions – South Asia (India and Pakistan), Africa 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. Carbamazepine is an anti-epileptic drug which is hard to break down. Metformin is a drug to control diabetes.Not only that, antibiotics were found at dangerous levels at one in five sites.The other major drugs detected on all continents except Antarctica were the antidepressants citalopram and venlafaxine, antihistamines cetirizine and fexofenadine, the antibiotic trimethoprim and an anaesthetic lidocaine.Detection frequencies of some APIs (e.g., carbamazepine, metformin, caffeine, nicotine, acetaminophen/ paracetamol, and cotinine) were similar across continents.
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