the effects of prolonged exposure to pharmaceuticals in drinking water". community-based programs should be developed to monitor exposure and health outcomes. we should encourage the pharmaceutical industry to develop technology that extracts pharmaceuticals from waterways. "extensive research must be conducted to determine the amount of pharmaceutical contamination in the environment and its effects on animals and marine life". many pharmaceuticals pass through the human body unchanged, so there are advantages when human excreta does not go into waterways, even after conventional sewage treatment, which also does not remove most of these chemicals. it is therefore preferable for human feces and urine to go into fertile soil, where they will receive more effective treatment by numerous microbes found there, over longer amounts of time, and stay away from waterways.: 15 this can be achieved via the use of urine-diverting dry toilets, composting toilets, and arborloos. environmental while the full effects of most ppcps on the environment are not understood, there is concern about the potential they have for harm because they may act unpredictably when mixed with other chemicals from the environment or concentrate in the food chain. additionally, some ppcps are active at very low concentrations, and are often released continuously in large or widespread quantities. a class of antidepressants may be found in frogs and can significantly slow their development. because of the high solubility of most ppcps, aquatic organisms are especially vulnerable to their effects. researchers have found that a class of antidepressants may be found in frogs and can significantly slow their development. the increased presence of estrogen and other synthetic hormones in waste water due to birth control and hormonal therapies has been linked to increased feminization of exposed fish and other aquatic organisms. the chemicals within these ppcp products could either affect the feminization or masculinization of different fishes, therefore affecting their reproductive rates. in addition to being found only in waterways, the ingredients of some ppcps can also be found in the soil. since some of these substances take a long time or cannot be degraded biologically, they make their way up the food chain. information pertaining to the transport and fate of these hormones and their metabolites in dairy waste disposal is still being investigated, yet research suggest that the land application of solid wastes is likely linked with more hormone contamination problems. not only does the pollution from ppcps affect marine ecosystems, but also those habitats that depend on this polluted water. there are various concerns about the effects of pharmaceuticals found in surface waters and specifically the threats against rainbow trout exposed to treated sewage effluents. analysis of these pharmaceuticals in the blood plasma of fish compared to human therapeutic plasma levels have yielded vital information providing a means of assessing risk associated with medication waste in water. rainbow trout were exposed to undiluted, treated sewage water at three different sits in sweden. they were exposed for a total of 14 days while 25 pharmaceuticals were measured in the blood plasma at different levels for analysis. the progestin levonorgestrel was detected in fish blood plasma at concentrations between 8.5 and 12 ng ml-1 which exceed the human therapeutic plasma level. the measured effluent level of levonorgestrel in the three areas was shown to reduce the fertility of the rainbow trout. the three sites chosen for field exposures were in located in stockholm, gothenburg, and umeå. they were chosen according to their varying degrees of treatment technologies, geographic locations, and size. the effluent treatment includes active sludge treatment, nitrogen and phosphorus removal (except in umeå), primary clarification, and secondary clarification. juvenile rainbow trout were procured from antens fiskodling ab, sweden and umlax ab, sweden. the fish were exposed to aerated, undiluted, treated effluent. since all of the sites underwent sludge treatment, it can be inferred that they are not representative of the low end of treatment efficacy. of the 21 pharmaceuticals that were detected in the water samples, 18 were identified in the effluent, 17 in the plasma portion, and 14 pharmaceuticals were found in both effluent and plasma. current research there are traces pharmaceuticals in waterways that have an adverse effect on the environment. starting in the mid-1960s, ecologists and toxicologists began to express concern about the potential adverse effects of pharmaceuticals in the water supply, but it wasn't until a decade later that the presence of pharmaceuticals in water was well documented. studies in 1975 and 1977 found clofibric acid and salicylic acids at trace concentrations in treated water. widespread concern about and research into the effect of ppcps largely started in the early 1990s. until this time, ppcps were largely ignored because of their relative solubility and containment in waterways compared to more familiar pollutants like agrochemicals, industrial chemicals, and industrial waste and byproducts. since then, a great deal of attention has been directed to the ecological and physiological risk associated with pharmaceutical compounds and their metabolites in water and the environment. in the last decade, most research in this area has focused on steroid hormones and antibiotics. there is concern that steroid hormones may act as endocrine disruptors. some research suggests that concentrations of ethinylestradiol, an estrogen used in oral contraceptive medications and one of the most commonly prescribed pharmaceuticals, can cause endocrine disruption in aquatic and amphibian wildlife in concentrations as low as 1 ng/l. current research on ppcps aims to answer these questions: what is the effect of exposure to low levels of ppcps over time? what is the effect of exposure to mixtures of chemicals? are the effects acute (short-term) or chronic (long-term)? are certain populations, such as the elderly, very young, or immuno-compromised, more vulnerable to the effects of these compounds? jaipur cows eating trash, which may contain medicines and supplements that will pass through their system and enter the environmentwhat is the effect of ppcps on bacterial, fungal, and aquatic life? are the levels of antibiotics in the aquatic environment sufficient to promote antibiotic resistance? what is the effect of exposure to steroid hormones on animal and human populations? pharmacoenvironmentology pharmacoenvironmentology is an extension of pharmacovigilance as it deals specifically with the environmental and ecological effects of drugs given at therapeutic doses. pharmacologists with this particular expertise (known as a pharmacoenvironmentologist) become a necessary component of any team assessing different aspects of drug safety in the environment. we must look at the effects of drugs not only in medical practice, but also at its environmental effects. any good clinical trial should look at the impact of particular drugs on the environment. things we need to address in pharmacoenvironmentology are drugs and their exact concentration in different parts of the environment. pharmacoenvironmentology is a specific domain of pharmacology and not of environmental studies. this is because it deals with drugs entering through living organisms through elimination. ecopharmacovigilance pharmacovigilance is a new branch of science, which was born in 1960 after the incidence of the thalidomide disaster. thalidomide is a teratogen and caused horrific birth abnormalities. the thalidomide disaster lead to the present day approach to drug safety and adverse event reporting. according to the epa, pharamacovigilance is science aiming to capture any adverse effects of pharmaceuticals in humans after use. however, ecopharmacovigilance is the science, and activities concerning detection, assessment, understanding, and prevention of adverse effects of pharmaceuticals in the environment which affect humans and other animal species. there has been a growing focus among scientists about the impact of drugs on the environment. in recent years, we have been able to see human pharmaceuticals that are being detected in the environment which most are typically found on surface water. the importance of ecopharmacovigilance is to monitor adverse effects of pharmaceuticals on humans through environmental exposure. due to this relatively new field of science, researchers are continuously developing and understanding the impacts of pharmaceuticals in the environment and its risk on human and animal exposure. environmental risk assessment is a regulatory requirement in the launch of any new drug. this precaution has become a necessary step towards the understanding and prevention of adverse effects of pharmaceutical residue in the environment. it is important to note that pharmaceuticals enter the environment from the excretion of drugs after human use, hospitals, and improper disposal of unused drugs from patients. ecopharmacology ecopharmacology concerns the entry of chemicals or drugs into the environment through any route and at any concentration disturbing the balance of ecology (ecosystem), as a consequence. ecopharmacology is a broad term that includes studies of "ppcps" irrespective of doses and route of entry into environment. the geology of a karst aquifer area assists with the movement of ppcps from the surface to the ground water. relatively soluble bedrock creates sinkholes, caves and sinking streams into which surface water easily flows, with minimal filtering. since 25% of the population get their drinking water from karst aquifers, this affects a large number of people. a 2016 study of karst aquifers in southwest illinois found that 89% of water samples had one or more ppcp measured. triclocarban (an antimicrobial) was the most frequently detected ppcp, with gemfibrozil (a cardiovascular drug) the second most frequently detected. other ppcps detected were trimethoprim, naproxen, carbamazepine, caffeine, sulfamethoxazole, and fluoxetine. the data suggests that septic tank effluent is a probable source of ppcps. fate of pharmaceuticals in sewage treatment plants sewage treatment plants use physical, chemical, and biological processes to remove nutrients and contaminants from waste water. sewage treatment plants (stp) work with physical, chemical, and biological processes to remove nutrients and contaminants from waste water. usually the stp is equipped with an initial mechanical separation of solid particles (cotton buds, cloth, hygiene articles etc.) appearing in the incoming water. following this there may be filters separating finer particles either occurring in the incoming water or developing as a consequence of chemical treatment of the water with flocculating agents. many stps also include one or several steps of biological treatment. by stimulating the activity of various strains of microorganisms physically their activity may be promoted to degrade the organic content of the sewage by up to 90% or more. in certain cases more advanced techniques are used as well. the today most commonly used advanced treatment steps especially in terms of micropollutants are membranes (which may be used instead of the biological treatment), ozonation, activated carbon (powdered or granulated), uv treatment, treatment with potassium ferrate and sand filtration (which is sometimes added as a last step after the aforementioned). ppcps are difficult to remove from wastewater with conventional methods. some research shows the concentration of such substances is even higher in water leaving the plant than water entering the plant. many factors including environmental ph, seasonal variation, and biological properties affect the ability of an stp to remove ppcps. a 2013 study of a drinking water treatment plant found that of 30 ppcps measured at both the source water and the drinking water locations, 76% of ppcps were removed, on average, in the water treatment plant. ozonation was found to be an efficient treatment process for the removal of many ppcps. however, there are some ppcps that were not removed, such as deet used as mosquito spray, nonylphenol which is a surfactant used in detergents, the antibiotic erythromycin, and the herbicide atrazine. several research projects are running to optimize the use of advanced sewage treatment techniques under different conditions. the advanced techniques will increase the costs for the sewage treatment substantially. in a european cooperation project between 2008 and 2012 in comparison four hospital waste water treatment facilities were developed in switzerland, germany, the netherlands and luxembourg to investigate the elimination rates of concentrated waste water with pharmaceutical "cocktails" by using different and combined advanced treatment technologies. especially the german stp at marienhospital gelsenkirchen showed the effects of a combination of membranes, ozone, powdered activated carbon and sand filtration. but even a maximum of installed technologies could not eliminate 100% of all substances and especially radiocontrast agents are nearly impossible to eliminate. the investigations showed that depending on the installed technologies the treatment costs for such a hospital treatment facility may be up to 5.50 € per m3. other studies and comparisons expect the treatment costs to increase up to 10%, mainly due to energy demand. it is therefore important to define best available technique before extensive infrastructure investments are