effluents, and affect the environment or public health; until now numerous studies
show negative outcomes for both aquatic and terrestrial organisms, suggesting that
they are given both to bioaccumulation and uptake in plants [33]. Given the volume
of prescriptions, toxicity, and their presence in the environment, NSAIDs are one of
the most studied pharmaceutical groups [34]. According to Miarov et al. [33],
monitoring or treating pharmaceutical substances after their release into the environment is not a common practice internationally; however, there are several
regulatory initiatives in some countries that have paid attention to this problem
and that can be classified into three levels according to the intensity of the measures
taken to regulate pharmaceutical pollutants in the environment:
(a) Level 1. Advanced regulatory framework: where the country/state has taken
systematic legal measures to regulate pharmaceutical residues in order to reduce
their volume in the environment. An example is California, where Recycled
Water Policy requires treatment plants which discharge recycled water for the
purposes of groundwater recharge to monitor groundwater recharge reuse (surface or subsurface application) for 17β-estradiol, gemfibrozil, and iopromide
[35]. Although only these three pharmaceuticals are recommended to be monitored, in practice, the Groundwater Replenishment System (GWRS) voluntarily
monitors a wider range of pharmaceutical substances on a quarterly basis in the
purified recycled water: 17a-estradiol, 17a-ethynylestradiol, 17b-estradiol, atenolol, diclofenac, diethylstilbestrol, dilantin, epitestosterone, equilin, estriol,
estrone, fluoxetine, iohexol, iopromide, meprobamate, naproxen, progesterone,
testosterone, trimethoprim, acetaminophen, azithromycin, carbamazepine,
erythromycin, gemfibrozil, ibuprofen, sulfamethoxazole, and triclosan; and the
reports suggest that California’s GWRS effectively eliminates these pharmaceutical contaminants from water supply [36, 37]. On the other hand, another
country that is making great efforts to regulate the presence of pharmaceuticals
in the environment is Switzerland, since it has a more comprehensive environmental program that includes monitoring pharmaceuticals in several media of the
aquatic environment, for which the National Surface Water Quality Monitoring
Program (NAWA) conducted their first pilot study in 2013 and measured only a
small group of pharmaceuticals [38]; however, in 2018, the original NAWA
testing program grew, adding 13 pharmaceuticals to regular measurements
(atenolol, azithromycin, bezafibrate, carbamazepine, clarithromycin, diclofenac,
mefenamic acid, metoprolol, naproxen, sotalol, sulfamethazine, sulfamethoxazole, and trimethoprim). But this country does not conform to monitoring only;
since it has begun to act to reduce its presence and from 2016, hundreds of the
country’s municipal wastewater treatment plants will be improved over the next
20 years to remove micropollutants, such as pharmaceuticals [39].
(b) Level 2. Basic monitoring guidelines: where monitoring of pharmaceuticals is
conducted on a regular basis, without a formal statutory requirement. Like
Australia, monitoring and reporting contaminants associated with production
of recycled effluents are the responsibilities of the state or territorial government,
and officially the Australian Department don’t regulate pharmaceuticals in
332
J. D. Cardoso-Vera et al.
show negative outcomes for both aquatic and terrestrial organisms, suggesting that
they are given both to bioaccumulation and uptake in plants [33]. Given the volume
of prescriptions, toxicity, and their presence in the environment, NSAIDs are one of
the most studied pharmaceutical groups [34]. According to Miarov et al. [33],
monitoring or treating pharmaceutical substances after their release into the environment is not a common practice internationally; however, there are several
regulatory initiatives in some countries that have paid attention to this problem
and that can be classified into three levels according to the intensity of the measures
taken to regulate pharmaceutical pollutants in the environment:
(a) Level 1. Advanced regulatory framework: where the country/state has taken
systematic legal measures to regulate pharmaceutical residues in order to reduce
their volume in the environment. An example is California, where Recycled
Water Policy requires treatment plants which discharge recycled water for the
purposes of groundwater recharge to monitor groundwater recharge reuse (surface or subsurface application) for 17β-estradiol, gemfibrozil, and iopromide
[35]. Although only these three pharmaceuticals are recommended to be monitored, in practice, the Groundwater Replenishment System (GWRS) voluntarily
monitors a wider range of pharmaceutical substances on a quarterly basis in the
purified recycled water: 17a-estradiol, 17a-ethynylestradiol, 17b-estradiol, atenolol, diclofenac, diethylstilbestrol, dilantin, epitestosterone, equilin, estriol,
estrone, fluoxetine, iohexol, iopromide, meprobamate, naproxen, progesterone,
testosterone, trimethoprim, acetaminophen, azithromycin, carbamazepine,
erythromycin, gemfibrozil, ibuprofen, sulfamethoxazole, and triclosan; and the
reports suggest that California’s GWRS effectively eliminates these pharmaceutical contaminants from water supply [36, 37]. On the other hand, another
country that is making great efforts to regulate the presence of pharmaceuticals
in the environment is Switzerland, since it has a more comprehensive environmental program that includes monitoring pharmaceuticals in several media of the
aquatic environment, for which the National Surface Water Quality Monitoring
Program (NAWA) conducted their first pilot study in 2013 and measured only a
small group of pharmaceuticals [38]; however, in 2018, the original NAWA
testing program grew, adding 13 pharmaceuticals to regular measurements
(atenolol, azithromycin, bezafibrate, carbamazepine, clarithromycin, diclofenac,
mefenamic acid, metoprolol, naproxen, sotalol, sulfamethazine, sulfamethoxazole, and trimethoprim). But this country does not conform to monitoring only;
since it has begun to act to reduce its presence and from 2016, hundreds of the
country’s municipal wastewater treatment plants will be improved over the next
20 years to remove micropollutants, such as pharmaceuticals [39].
(b) Level 2. Basic monitoring guidelines: where monitoring of pharmaceuticals is
conducted on a regular basis, without a formal statutory requirement. Like
Australia, monitoring and reporting contaminants associated with production
of recycled effluents are the responsibilities of the state or territorial government,
and officially the Australian Department don’t regulate pharmaceuticals in
332
J. D. Cardoso-Vera et al.