Scientists have known for more than 20 years that the drugs we take for diseases like headaches and diabetes can end up in our waterways, where they can harm the environment.

Most research on pharmaceuticals has been done in North America, Europe and China. A variety of sampling and analysis methods make it difficult to compare results. Scientists might be missing a big piece of the pollution puzzle.

There is a new paper in the Proceedings of the National Academy of Sciences. A network of 127 scientists studied 258 rivers in 104 countries for 61 different chemicals and found a "pharmaceutical fingerprint" of half a billion people.

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In areas and countries that have been largely forgotten by the scientific community, many of the most drug-polluted rivers are located. Lower-middle-income countries with insufficient wastewater infrastructure were more likely to have waterways with the biggest concentrations of pharmaceutical drugs.

On every continent, there were four compounds that showed up, including cotinine. All of the other drugs were traced on all of the world's continents. Antimalarials were found in African samples.

The study shows that more of this kind of global assessment of aquatic pollution is needed, particularly for other chemicals that pose more of a human health risk. She says that it suggests that we need wastewater treatment.

Graphic shows average concentration of drugs in water sampled from rivers in each of 134 countries of various income levels.
Credit: Amanda Montañez; Source: “Pharmaceutical Pollution of the World’s Rivers,” by John L. Wilkinson et al., in Proceedings of the National Academy of Sciences USA, Vol. 119; February 22, 2022.