{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T19:58:54Z","timestamp":1791921534880,"version":"4.3.4"},"reference-count":71,"publisher":"MDPI AG","issue":"14","license":[{"start":{"date-parts":[[2022,7,7]],"date-time":"2022-07-07T00:00:00Z","timestamp":1657152000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Pharmaceutical products, including active pharmaceutical ingredients and inactive ingredients such as packaging materials, have raised significant concerns due to their persistent input and potential threats to human and environmental health. Discourse on reducing pharmaceutical waste and subsequent pollution is often limited, as information about the toxicity of pharmaceuticals in humans is yet to be fully established. Nevertheless, there is growing awareness about ecotoxicity, and efforts to curb pharmaceutical pollution in the European Union (EU), United States (US), and Canada have emerged along with waste disposal and treatment procedures, as well as growing concerns about impacts on human and animal health, such as through antimicrobial resistance. Yet, the outcomes of such endeavors are often disparate and involve multiple agencies, organizations, and departments with little evidence of cooperation, collaboration, or oversight. Environmental health disparities occur when communities exposed to a combination of poor environmental quality and social inequities experience more sickness and disease than wealthier, less polluted communities. In this paper, we discuss pharmaceutical environmental pollution in the context of health disparities and examine policies across the US, EU, and Canada in minimizing environmental pollution.<\/jats:p>","DOI":"10.3390\/ijerph19148292","type":"journal-article","created":{"date-parts":[[2022,7,7]],"date-time":"2022-07-07T07:51:56Z","timestamp":1657180316000},"page":"8292","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":64,"title":["Comparing Environmental Policies to Reduce Pharmaceutical Pollution and Address Disparities"],"prefix":"10.3390","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9054-1844","authenticated-orcid":false,"given":"Meghana","family":"Desai","sequence":"first","affiliation":[{"name":"Health Analytics Network LLC, Pittsburgh, PA 15237, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9471-5175","authenticated-orcid":false,"given":"Anuli","family":"Njoku","sequence":"additional","affiliation":[{"name":"Department of Public Health, College of Health and Human Services, Southern Connecticut State University, New Haven, CT 06515, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lillian","family":"Nimo-Sefah","sequence":"additional","affiliation":[{"name":"Department of Public Health, College of Health and Human Services, Southern Connecticut State University, New Haven, CT 06515, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,7,7]]},"reference":[{"key":"ref_1","unstructured":"World Health Organization (2022, January 30). Global Analysis of Health Care Waste in the Context of COVID-19. Available online: www.who.int\/publications\/i\/item\/9789240039612."},{"key":"ref_2","unstructured":"(2022, January 30). Practice Greenhealth. Available online: https:\/\/practicegreenhealth.org\/topics\/waste."},{"key":"ref_3","unstructured":"World Health Organization (2022, January 30). Available online: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/health-care-waste."},{"key":"ref_4","unstructured":"World Health Organization (2022, January 30). Available online: https:\/\/www.who.int\/publications\/i\/item\/WHO-2019-nCoV-IPC-WASH-2020.4."},{"key":"ref_5","unstructured":"(2022, January 30). Sustainability. WM ESG Resource Hub, Available online: https:\/\/sustainability.wm.com\/esg-hub\/company\/hard-to-handle-materials."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s11783-021-1407-5","article-title":"Repercussions of COVID-19 pandemic on solid waste generation and management strategies","volume":"15","author":"Liang","year":"2021","journal-title":"Front. Environ. Sci. Eng."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"126683","DOI":"10.1016\/j.cej.2020.126683","article-title":"Increased plastic pollution due to COVID-19 pandemic: Challenges and recommendations","volume":"405","author":"Silva","year":"2021","journal-title":"Chem Eng. J."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"7760","DOI":"10.1021\/acs.est.0c02178","article-title":"COVID-19 pandemic repercussions on the use and management of plastics","volume":"54","author":"Prata","year":"2020","journal-title":"Environ. Sci. Technol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"109883","DOI":"10.1016\/j.rser.2020.109883","article-title":"Minimizing the present and future plastic waste, energy and environmental footprints related to COVID-19","volume":"127","author":"Yee","year":"2020","journal-title":"Renew. Sustain. Energy Rev."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1177\/0141076819890554","article-title":"Plastics in healthcare: Time for a re-evaluation","volume":"113","author":"Rizan","year":"2020","journal-title":"J. R. Soc. Med."},{"key":"ref_11","unstructured":"Healthcare Plastics Recycling Council (2022, January 11). Available online: https:\/\/www.hprc.org\/hospitals."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Blair, J., and Mataraarachchi, S. (2021). A Review of Landfills, Waste and the Nearly Forgotten Nexus with Climate Change. Environments, 8.","DOI":"10.3390\/environments8080073"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"754","DOI":"10.1016\/j.wasman.2021.03.046","article-title":"Climate change impacts of introducing carbon capture and utilisation (CCU) in waste incineration","volume":"126","author":"Christensen","year":"2021","journal-title":"Waste Manag."},{"key":"ref_14","unstructured":"(2022, July 01). Study on the Environmental Risks of Medicinal Products. Final Report. Executive Agency for Health and Consumers, Available online: https:\/\/ec.europa.eu\/health\/system\/files\/2016-11\/study_environment_0.pdf."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"20130587","DOI":"10.1098\/rstb.2013.0587","article-title":"Pharmaceuticals in the environment: Scientific evidence of risks and its regulation","volume":"369","author":"Adler","year":"2014","journal-title":"Philos. Trans. R. Soc. B"},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Swan, G., Naidoo, V., Cuthbert, R., Green, R.E., Pain, D.J., Swarup, D., Prakash, V., Taggart, M., Bekker, L., and Das, D. (2006). Removing the Threat of Diclofenac to Critically Endangered Asian Vultures. PLoS Biol., 4.","DOI":"10.1371\/journal.pbio.0040066"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1725","DOI":"10.1289\/ehp.7209","article-title":"Long-term exposure to environmental concentrations of the pharmaceutical ethynylestradiol causes reproductive failure in fish","volume":"112","author":"Nash","year":"2004","journal-title":"Environ. Health Perspect."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"2786","DOI":"10.1002\/etc.678","article-title":"Toxicity of the Fluoroquinolone Antibiotics Enrofloxacin and Ciprofloxacin to Photoautotrophic Aquatic Organisms","volume":"30","author":"Ebert","year":"2011","journal-title":"Environ. Toxicol. Chem."},{"key":"ref_19","unstructured":"UN Environment (2022, January 30). Available online: https:\/\/www.unep.org\/resources\/frontiers-2017-emerging-issues-environmental-concern."},{"key":"ref_20","first-page":"1","article-title":"Human pharmaceuticals in the aquatic environment: A review of recent toxicological studies and considerations for toxicity testing","volume":"218","author":"Brausch","year":"2012","journal-title":"Rev. Environ. Contam. Toxicol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"513","DOI":"10.1080\/02705060.2019.1629546","article-title":"Influences of the antidepressant fluoxetine on stream ecosystem function and aquatic insect emergence at environmentally realistic concentrations","volume":"34","author":"Richmond","year":"2019","journal-title":"J. Freshw. Ecol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1038\/s41467-018-06822-w","article-title":"A diverse suite of pharmaceuticals contaminates stream and riparian food webs","volume":"9","author":"Richmond","year":"2018","journal-title":"Nat. Commun."},{"key":"ref_23","unstructured":"Pharmaceutical Pollutants (2022, May 08). Knowledge Platform of the Strategic Approach to International Chemicals Management (SAICM). Available online: https:\/\/saicmknowledge.org\/program\/pharmaceutical-pollutants."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"2950","DOI":"10.1021\/acs.est.8b05592","article-title":"Hormones and pharmaceuticals in groundwater used as a source of drinking water across the United States","volume":"53","author":"Bexfield","year":"2019","journal-title":"Environ. Sci. Technol."},{"key":"ref_25","unstructured":"U.S. Department of Health and Human Services (2022, March 01). Available online: https:\/\/www.healthypeople.gov\/2020\/topics-objectives\/topic\/social-determinants-of-health."},{"key":"ref_26","unstructured":"World Health Organization (2022, March 01). Available online: https:\/\/www.who.int\/health-topics\/social-determinants-of-health#tab=tab_1."},{"key":"ref_27","unstructured":"World Health Organization (2022, June 17). Available online: https:\/\/apps.who.int\/iris\/bitstream\/handle\/10665\/78335\/9789241505178_eng.pdf;jsessionid=85C111FD861E02760C27FC65BD24BDCF?sequence=1."},{"key":"ref_28","unstructured":"World Health Organization (2022, June 17). Available online: https:\/\/www.who.int\/health-topics\/health-equity#tab=tab_1."},{"key":"ref_29","unstructured":"World Health Organization (2022, June 17). Available online: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/human-rights-and-health."},{"key":"ref_30","unstructured":"U.S. Department of Health and Human Services (2022, March 01). Disparities, Available online: https:\/\/www.healthypeople.gov\/2020\/about\/foundation-health-measures\/Disparities#6."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1645","DOI":"10.1289\/ehp.7074","article-title":"Environmental health disparities: A framework integrating psychosocial and environmental concepts","volume":"112","author":"Gee","year":"2004","journal-title":"Environ. Health Perspect."},{"key":"ref_32","unstructured":"U.S. Department of Health and Human Services (2022, March 03). Available online: https:\/\/www.niehs.nih.gov\/research\/supported\/translational\/justice\/index.cfm."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1177\/030913259501900111","article-title":"Race, class, and environmental justice","volume":"19","author":"Cutter","year":"1995","journal-title":"Prog. Hum. Geogr."},{"key":"ref_34","first-page":"23","article-title":"The threat of environmental racism","volume":"7","author":"Bullard","year":"1993","journal-title":"Nat. Resour. Environ."},{"key":"ref_35","unstructured":"Environmental Protection Agency (2022, April 25). Environmental Justice, Available online: https:\/\/www.epa.gov\/environmentaljustice."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"em0079","DOI":"10.21601\/ejeph\/10999","article-title":"COVID-19 and environmental racism: Challenges and recommendations","volume":"5","author":"Njoku","year":"2021","journal-title":"Eur. J. Environ. Public Health"},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Njoku, A., Joseph, M., and Felix, R. (2021). Changing the Narrative: Structural Barriers and Racial and Ethnic Inequities in COVID-19 Vaccination. Int. J. Environ. Res. Public Health, 18.","DOI":"10.3390\/ijerph18189904"},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Kenny, C., and Priyadarshini, A. (2021). Review of current healthcare waste management methods and their effect on global health. Healthcare, 9.","DOI":"10.3390\/healthcare9030284"},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Shannon, A.L., and Woolridge, A. (2011). Medical waste. Waste, 329\u2013339.","DOI":"10.1016\/B978-0-12-381475-3.10023-3"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s40572-020-00261-w","article-title":"Synthetic Chemical Trade as a Potential Driver of Global Health Disparities and Data Gaps on Synthetic Chemicals in Vulnerable Populations","volume":"7","author":"Goodman","year":"2020","journal-title":"Curr. Environ. Health Rep."},{"key":"ref_41","unstructured":"(2022, May 06). Crown-Indigenous Relations and Northern Affairs Canada (CIRNAC), Available online: https:\/\/www.rcaanc-cirnac.gc.ca\/eng\/1100100013785\/1529102490303."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"133","DOI":"10.17269\/s41997-021-00499-3","article-title":"Pharmaceuticals in source waters of 95 First Nations in Canada","volume":"112","author":"Schwartz","year":"2021","journal-title":"Can. J. Public Health"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1016\/j.emcon.2015.07.001","article-title":"Occurrence, sources and fate of pharmaceuticals and personal care products in the groundwater: A review","volume":"1","author":"Sui","year":"2015","journal-title":"Emerg. Contam."},{"key":"ref_44","unstructured":"United States Government (2022, March 03). Federally recognized Indian Tribes and Resources for Native Americans, Available online: https:\/\/www.usa.gov\/tribes."},{"key":"ref_45","unstructured":"EJnet (2022, April 25). The Toxic Threat to Indian Lands. Available online: http:\/\/www.ejnet.org\/ej\/toxicthreattoindianlands.pdf."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"355","DOI":"10.1007\/s00267-002-2857-6","article-title":"The tribal environment: Solid waste in Indian Country","volume":"31","author":"Ortiz","year":"2003","journal-title":"Environ. Manag."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"em0040","DOI":"10.29333\/ejeph\/8200","article-title":"Rural America and Coronavirus epidemic: Challenges and solutions","volume":"4","author":"Ameh","year":"2020","journal-title":"Eur. J. Environ. Public Health"},{"key":"ref_48","doi-asserted-by":"crossref","unstructured":"Liotta, P.H., Mouat, D.A., Kepner, W.G., and Lancaster, J.M. (2008). Environmental Justice and Health Disparities in Appalachia, Ohio. Environmental Change and Human Security: Recognizing and Acting on Hazard Impacts, Springer.","DOI":"10.1007\/978-1-4020-8551-2"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1016\/j.jenvman.2015.01.039","article-title":"International governance structures for health-care waste management: A systematic review of scientific literature","volume":"153","author":"Caniato","year":"2015","journal-title":"J. Environ. Manag."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"754","DOI":"10.1016\/j.wasman.2010.11.008","article-title":"Clinical solid waste management practices and its impact on human health and environment\u2014A review","volume":"31","author":"Hossain","year":"2011","journal-title":"Waste Manag."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"34","DOI":"10.2174\/1876325101810010034","article-title":"A review of medical waste management in South Africa","volume":"10","author":"Olaniyi","year":"2018","journal-title":"Open Environ. Sci."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"356","DOI":"10.1108\/09526860810880153","article-title":"Medical waste management practices in a Southern African hospital","volume":"21","author":"Abor","year":"2008","journal-title":"Int. J. Health Care Qual. Assur."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1007\/s40609-020-00195-z","article-title":"Environmental catastrophe of COVID-19: Disposal and management of PPE in Bangladesh","volume":"8","author":"Shammi","year":"2021","journal-title":"Glob. Soc. Welf."},{"key":"ref_54","unstructured":"U.S. Food and Drug Administration (2022, June 17). FDA Announces Implementation of GFI #213, Outlines Continuing Efforts to Address Antimicrobial Resistance, Available online: https:\/\/wayback.archive-it.org\/7993\/20190423131636\/https:\/\/www.fda.gov\/AnimalVeterinary\/NewsEvents\/CVMUpdates\/ucm535154.htm."},{"key":"ref_55","unstructured":"U.S. Food and Drug Administration (2022, June 17). FDA Finalizes Guidance to Bring Remaining Approved Over-the-Counter Medically Important Antimicrobial Drugs Used for Animals Under Veterinary Oversight, Available online: https:\/\/www.fda.gov\/animal-veterinary\/cvm-updates\/fda-finalizes-guidance-bring-remaining-approved-over-counter-medically-important-antimicrobial-drugs."},{"key":"ref_56","unstructured":"Government of Canada (2022, June 17). Federal Action Plan on Antimicrobial Resistance and Use in Canada: Building on the Federal Framework for Action, Available online: https:\/\/www.canada.ca\/en\/health-canada\/services\/publications\/drugs-health-products\/federal-action-plan-antimicrobial-resistance-canada.html."},{"key":"ref_57","unstructured":"European Commission (2022, March 05). EU Action on Antimicrobial Resistance. Available online: https:\/\/ec.europa.eu\/health\/antimicrobial-resistance\/eu-action-antimicrobial-resistance_en#eu-one-health-action-plan-against-amr."},{"key":"ref_58","unstructured":"Environmental Protection Agency (2022, February 25). Medical Waste, Available online: https:\/\/www.epa.gov\/rcra\/medical-waste."},{"key":"ref_59","unstructured":"(2022, May 15). Final Rule: Management Standards for Hazardous Waste Pharmaceuticals and Amendment to the P075 Listing for Nicotine, Environmental Protection Agency, Available online: https:\/\/www.epa.gov\/hwgenerators\/final-rule-management-standards-hazardous-waste-pharmaceuticals-and-amendment-p075."},{"key":"ref_60","unstructured":"(2022, February 25). Canadian Biosafety Handbook, Available online: https:\/\/www.canada.ca\/en\/public-health\/services\/canadian-biosafety-standards-guidelines\/handbook-second-edition\/chapter-16-20.html."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"118","DOI":"10.1503\/cmaj.109-4032","article-title":"Medical waste-management practices vary across Canada","volume":"183","author":"Walkinshaw","year":"2011","journal-title":"CMAJ"},{"key":"ref_62","unstructured":"Environment and Natural Resources Canada (2022, February 25). Guidelines for the Management of Biomedical Waste in the NWT, Available online: https:\/\/www.enr.gov.nt.ca\/sites\/enr\/files\/guidelines\/biomedical_waste.pdf."},{"key":"ref_63","unstructured":"European Commission (2022, February 25). Pharmaceuticals and the Environment. Available online: https:\/\/ec.europa.eu\/health\/medicinal-products\/pharmaceuticals-and-environment_en."},{"key":"ref_64","unstructured":"European Commission (2021, February 25). Strategic Approach to Pharmaceuticals in the Environment. Available online: https:\/\/ec.europa.eu\/environment\/water\/water-dangersub\/pharmaceuticals.htm."},{"key":"ref_65","unstructured":"Pollution Probe (2022, June 25). Reducing the Impact of Pharmaceuticals in the Great Lakes. Available online: http:\/\/www.pollutionprobe.org\/wp-content\/uploads\/Pollution-Probe-Pharmaceuticals-Great-Lakes-Full-Report.pdf."},{"key":"ref_66","unstructured":"Committee for Medicinal Products for Human Use (CHMP) (2006). Guideline on the Environmental Risk Assessment of Medicinal Products for Human Use. Ref EMEA\/CHMP\/SWP\/4447\/00 corr 2, European Medicines Agency."},{"key":"ref_67","doi-asserted-by":"crossref","unstructured":"Alshemari, A., Breen, L., Quinn, G., and Sivarajah, U. (2020). Can We Create a Circular Pharmaceutical Supply Chain (CPSC) to Reduce Medicines Waste?. Pharmacy, 8.","DOI":"10.3390\/pharmacy8040221"},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"517","DOI":"10.1111\/jiec.12610","article-title":"Product design in a circular economy: Development of a typology of key concepts and terms","volume":"21","author":"Bakker","year":"2017","journal-title":"J. Ind. Ecol."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"5336","DOI":"10.1021\/acs.est.5b00302","article-title":"Improving Environmental Risk Assessment of Human Pharmaceuticals","volume":"49","author":"Berg","year":"2015","journal-title":"Environ. Sci. Technol."},{"key":"ref_70","unstructured":"Daughton, C.G. (2003, January 19\u201321). Environmental Stewardship of Pharmaceuticals: The Green Pharmacy. Proceedings of the 3rd International Conference on Pharmaceuticals and Endocrine Disrupting Chemicals in Water: National Ground Water Association, Minneapolis, MN, USA."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"312","DOI":"10.1016\/j.yrtph.2014.01.002","article-title":"Critical review on the environmental risk assessment of medicinal products for human use in the centralised procedure","volume":"68","author":"Caneva","year":"2014","journal-title":"Regul. Toxicol. Pharmacol."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/14\/8292\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T23:43:49Z","timestamp":1760139829000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/14\/8292"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,7,7]]},"references-count":71,"journal-issue":{"issue":"14","published-online":{"date-parts":[[2022,7]]}},"alternative-id":["ijerph19148292"],"URL":"https:\/\/doi.org\/10.3390\/ijerph19148292","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,7,7]]}}}