The presence of pharmaceuticals in rivers poses a threat to global health

According to the study, the Blue River in Tunis has one of the highest pharmaceutical concentrations.

According to a report, medicines and pharmaceutical products pollute the world's rivers, posing a "threat to environmental and global health." In a University of York study, paracetamol, nicotine, caffeine, epilepsy, and diabetes drugs were all reported. The study is one of the most comprehensive ever conducted on a global scale. Pakistan's, Bolivia's, and Ethiopia's rivers were among the most polluted. The cleanest rivers were in Iceland, Norway, and the Amazon rainforest.

Many of the most commonly used pharmaceutical compounds have yet to be studied in rivers. However, it is well known that dissolved human contraceptives have an influence on fish development and reproduction, and scientists are concerned that the increased presence of antibiotics in rivers will reduce their performance as medications.

The study took water samples from over 1,000 test sites in over 100 countries. In total, more than a quarter of the 258 rivers tested had "active pharmaceutical ingredients" present at levels that were deemed harmful to aquatic organisms. "Typically, we take these chemicals, they have some intended impact on us, and then they leave our bodies," said Dr. John Wilkinson, the study's lead author.

"We now know that even the most contemporary, effectual sewage treatment plants are incapable of entirely breaking down these substances before they eventually wind up in rivers or lakes."

Carbamazepine, which is used to treat epilepsy and nerve pain, and metformin, which is used to treat type 2 diabetes, were the two most commonly identified pharmaceuticals. High levels of so-called "lifestyle consumables" such as caffeine (coffee) and nicotine (cigarettes), as well as the pain reliever paracetamol, were also discovered. Artemisinin, which is used in anti-malarial medicine, was also found in high concentrations in Africa.

"This is only going to get worse as we increasingly rely on pharmacological treatments for any illness, physical or mental." According to the report, the increased presence of antibiotics in rivers may also lead to the development of resistant bacteria, reducing the effectiveness of medicines and posing a "global threat to environmental and global health."

The most polluted sites were mostly in low- to middle-income countries, near sewage dumpsites, poor sewage treatment, and pharmaceutical manufacturing. "We have seen contaminated rivers in Nigeria and South Africa with very high levels of pharmaceutical drugs, and this is primarily due to a lack of infrastructure in sewage treatment," said Dr Mohamed Abdallah, associate professor of emerging contaminants at Birmingham University in the United Kingdom.

"This is especially concerning because it exposes the most vulnerable communities with the least access to healthcare." Dr Wilkinson, the report's lead author, has a somewhat pessimistic outlook on what can be done. "It's going to take a lot of people much smarter than me to solve the problem," he said. "The proper use of medicine is one of the few things that could have an effect right now." This would imply making antibiotics more difficult to obtain and imposing stricter dose restrictions.

The full report has been published in the Proceedings of the National Academy of Sciences journal.

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