Executive summary 1

List of acronyms 3

1. Introduction 4

2. Key pharmaceutical groups of environmental concern 6

3. Sources and pathways of pharmaceutical releases 8

  3.1 Sources of releases across the life cycle 8

  3.2 Major release pathways 10

4. Presence, effects and costs of inaction 18

  4.1 Effects on ecosystems 21

  4.2 Potential implications for human health 23

  4.3 The costs of inaction 24

5. Priority areas for action 26

  5.1 Strengthen institutional, regulatory and policy frameworks 28

  5.2 Raise awareness and strengthen education across key stakeholder groups 31

  5.3 Strengthen environmental monitoring, risk assessment and prioritization 32

  5.4 Advance Green and Sustainable Chemistry across the pharmaceutical value chain 34

  5.5 Prevent unnecessary pharmaceutical use and strengthen responsible prescribing, dispensing and use 37

  5.6 Ensure environmentally sound end-of-life management 39

6. Concluding remarks 43

References 45

Annex 1 56

Hotspot analysis for mapping the release of pharmaceutical residues and prioritizing mitigation actions: A guidance for policymakers and key stakeholders

  A.1 Introduction 56

  A.2 Development of hotspot analysis to mapping the release of pharmaceutical residues 59

  A.3 Final considerations 65

  Annex 1 references 65