We talk a lot about waste these days.

The mountains of rubbish on beaches in Ghana picked over by barefooted children; the Great Pacific Garbage Patch, a sea of floating plastic covering an area three times the size of France; and, on an individual level, we can accumulate over 50,000 microplastic particles in our bodies during our lifetimes.

Yet it is rarely mentioned that prescribed medication is included in the generation of this waste. In 2022/23, 1.08 billion items were dispensed from pharmacies in the UK. Each prescription either involves a plastic bottle or a blister pack and that evil combination of plastic and foil is notoriously difficult to recycle. If you are keen to save the planet, try hoarding your blister packs – just for the sense of horror when you witness the rapidly growing pile of shiny plastic – and you will realise how much crap we’re putting into our bodies and waste we’re throwing onto the earth.

If this is grim reading, it’s even worse when we consider the waste that comes from our bodies. The revelation that water companies routinely dump our untreated sewage into streams and rivers across the country with the tacit agreement of the government shocked many in the UK. It brought home the reality that waste isn’t just about what we throw in the bin, but also about what we flush down the toilet.

We know that raw sewage is polluting, but we don’t think about what happens to drugs as they pass through our bodies. Our organs identify drugs as toxins and process a good deal of what we put in straight out the other end. Physicians know this and most doses are adjusted to take account of this. So, if you need 10mg of a drug as a therapeutic dose you may be prescribed 100mg as most of it goes down the toilet. As an example, over 95% of the lithium we take is excreted, unchanged, through the kidneys.1

These facts become more alarming when considered alongside the massive increase in prescribing that has happened over the last few decades.2 It’s hard to find anyone who isn’t consuming some kind of prescribed drug, and a lot of it is simply passing through us and entering the sewage system.

And what happens when we flush? We don’t know what proportion of the drugs we excrete are removed by the sewage treatment process. There’s evidence that antibiotics in the water system are contributing to antibiotic resistance, and drugs like diclofenac are commonly found even in treated wastewater. More importantly, when raw sewage is dumped into rivers, it is not treated at all.

Any residual medication is released into the environment, a rich cocktail of cancer drugs, painkillers, anti-emetics, statins – the list goes on. And, of course, a significant part of that cocktail is medication prescribed for mental health conditions; anti-depressants, anti-psychotics, lithium and the rest are all pissed out of our bodies. If one 250g paracetamol capsule can give your cat fatal liver damage, then maybe we should start to consider the harm that drugs might be causing in our environment.

There is an increasing body of evidence showing that drugs have similar, or worse, effects on other species. One study found that the benzodiazapine Oxazepam caused increased activity, reduced sociality, and a higher feeding rate in European fish.3 Lab-based studies have shown that anti-depressants can harm the brain development, hormones, breeding behaviour and biology of marine life.4 Anti-depressants can also affect spawning and larval release in bivalves, disrupt locomotion and reduce fertility in snails, and affect crayfish aggression and daphnid reproduction.5

As we dump increasing amounts of untreated sewage into rivers and streams, we increase the concentrations of these drugs in the water system. Even when sewage is treated, most systems simply aren’t set up to remove drugs from water, so ultimately there can be traces in drinking water. It has also been observed that certain anti-depressants and anti-psychotics can bioaccumulate along the food chain.6 This means that tiny creatures absorb trace amounts of drugs and, as they are eaten by larger animals, the concentration of drugs increases as we move up the food chain. And guess who is top of the food chain? Also – since water treatment does not necessarily remove drugs from drinking water – when it is recycled, concentrations of drugs in the water can increase, again affecting human health.

If we don’t address this now, we are cooking up a mess of trouble for the future. As the consumption of drugs increases, and the regulation of water treatment degenerates, the accumulation of drugs in the environment could contribute to environmental degradation and potential collapse.

When we consider the often poor effectiveness of psychiatric drugs and their side-effects, it’s ironic that they are so widely and easily prescribed. If medication helps then all well and good, but for many people the journey is one of dismissal and a lack of empathy from healthcare providers. Asylum readers know this only too well. Perhaps pausing before lifting the prescription pad might help save the planet.

Endnotes

[1] Türck D, Heinzel G, Luik G. (2000) Steady-state pharmacokinetics of lithium in healthy volunteers receiving concomitant meloxicam. Br J Clin Pharmacol. 50(3):197-204..

2 Naser, A.Y., Alwafi, H., Al-Daghastani, T. et al. (2022) Drugs utilization profile in England and Wales in the past 15 years: a secular trend analysis. BMC Prim. Care 23, 239

3 Brodin, Thomas, et al. (2013) “Dilute concentrations of a psychiatric drug alter behavior of fish from natural populations.” Science 339.6121: 814-815.

4 https://theconversation.com/a-fishy-problem-how-antidepressants-may-impact-the-health-of-our-aquatic-ecosystems-197514

5 Peter P. Fong, Alex T. Ford, (2014) The biological effects of antidepressants on the molluscs and crustaceans: A review,

Aquatic Toxicology. 151: 4-13.

6 Argaluza J, Domingo-Echaburu S, Orive G, Medrano J, Hernandez R, Lertxundi U. (2021) Environmental pollution with psychiatric drugs. World J Psychiatry. 11(10): 791-804.

Meg Allen is an independent researcher and long-time Asylum subscriber. She lives in West Yorkshire.

This is a Sample Article from the Winter 2023 issue of Asylum [30:4].  To read more . . .  Subscribe to Asylum Magazine.