Tackling pharmaceutical pollution under the One Health framework

Pharmaceuticals have played a major role in supporting human and animal health over the last century. As a consequence of this use, pharmaceuticals are now ubiquitous in the environment and are recognized as organic pollutants affecting multiple non-target organisms. Pollution by pharmaceuticals can impact organisms directly or indirectly through food-chain-mediated effects, affecting terrestrial, freshwater, and marine ecosystems. Moreover, antimicrobial residues and psychotropic drugs, including antidepressants, are known to facilitate the evolution and transmission of resistant microorganisms in the environment, affecting the health of humans, animals, and ecosystems. One important step in tackling this global challenge is to raise awareness about the sources, transmission routes, environmental risks, and impacts of pharmaceuticals. Here, we aim to disentangle knowns and unknowns of pharmaceuticals related to environmental sources, occurrence, behavior, exposure, and toxicity; possible treatment technologies; bioremediation; and implementation of environmental policies. Therefore, in this review, we present a synthesis of current knowledge regarding pharmaceutical pollution and provide recommendations for citizens, scientists, and governments to improve the environmental management of pharmaceuticals, innovate mitigation technologies, and inform global and local policies, using a “One Health” framework.