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    Questions and answers

    1. What is the PILLS objective?

    The presence of pharmaceuticals in the water is a growing concern. All experts agree that actions are needed to be taken to reduce this contamination. As current state of the art sewage treatment plants do not remove pharmaceutical residues from the water, the PILLS-partners intent to find out which wastewater treat­ment methods are best suited to eliminate pharmaceutical residues from the water. Therefore they construct pilot plants at high concentrated point sources as e.g. hospitals. Moreover, they would like to highlight the problem of contamination of the water with pharma­ceutical re­sidues across Europe and raise the awareness for a sustainable approach to face this problem.

    2. What is the key message for the PILLS project?

    An integrated approach needs to be undertaken to face the problem, because once found in the surface water, the total elimination of micropollutants is impossible. Advanced wastewater treatment at point sources might be one useful action among others - this is what the PILLS project would like to find out. But further actions to reduce the pharmaceutical burden are needed in the whole life cycle of pharmaceuticals - including their production, their consumption and their dis­posal.

    3. Which pharmaceutical residues can be detected in the surface water?

    Due to the improvements in analytic methods, an increasing number of micropollutants, including phar­ma­ceuticals, are found in the aquatic environment. From the thousands of different licensed phar­maceutical products, about 180 can be measured and are found in the surface water (e.g. x-ray contrast media, analgesics).

    4. Which pharmaceutical residues can be detected in the drinking water?

    Traces of some highly persistent active substances have been detected in drinking water (e.g. x-ray contrast media).

    5. Are the pharmaceutical residues found in surface or in drinking water dangerous to humans?

    The concentrations of residues of medicinal products, which are detected in surface waters or in drin­king water, are very low and according to the current state of knowledge do not have any effect on humans. For example in different studies, residues of diclofenac were de­tected at levels of up to 1 µg per litre in surface waters. In order to consume the quantity as a low-dose tablet (25 mg), a person would have to - if the water was taken from the waters without further treat­ment - drink 25,000 litres at one time.

    6. Are there studies about the danger of pharmaceutical residues found in the water system?

    It is unclear what effects these residues have on the water habitat - for example on microorganisms. Studies show, for example, that there is a link between the burdening of the waters with substances that are hormonally effective - such as the hormone ethinylestradiol contained in con­traceptive pills - and the reproductive rate of the fish.

    7. Is the water from hospitals more dangerous than `normal´ wastewater?

    There is a higher concentration of pharmaceutical residues in hospital wastewater than in `normal´ wastewater. But as here other substances as e.g. heavy metals from industry might be lower, we cannot say that it is `more dangerous´.

    8. Is it possible to eliminate all residues from the wastewater?

    Using the conventional treatment methods, it is not possible to eliminate all pharmaceutical residues from the wastewater, hence advanced treatment techniques are necessary. By utilizing these, the elimination of substances to a very low level or be non-detectable may be possible.

    9. Why do hospitals join the PILLS project?

    As e.g. Marjanne Sint, chair of the Board of Governors of the Isala Klinieken, Zwolle, The Netherlands, said: ´The Isala Klinieken believe that the future, the environment and quality of life are all important con­siderations. That´s why our hospital applies strict rules, for instance on dealing with waste products. Isala´s plans for new construction offer an excellent opportunity to find a different method of sanitary water disposal to deal with drug residues. Isala will be co-operating enthusiastically with the project, given our social duty to minimise our impact on the environment and on nature.´

    10. Why do care homes not join the PILLS project or those people who are taking a lot of pharma­ceu­ticals at home?

    The PILLS project needed to find a starting point and this was the reason why each PILLS partner de­cided to cooperate with a local hospital. It might be a good idea to inte­grate care homes for future projects.

    11. Why are conventional wastewater treatment plants not able to eliminate the pharmaceutical residues from the wastewater?

    Conventional wastewater treatment plants using mechanical and biological processes have generally been designed to remove nitrate and phosphate as well as biodegradable organic substances. Some micropollutants such as the active substances of medicinal products, are only partially eliminated by these methods. Therefore many of these substances can pass unchanged through conventional treatment plants.

    12. The Swiss partner finished its pilot in 2010: What are the new features of this pilot?

    The pilot plant consists of a pre-treatment, a main biological treatment, an advanced treatment and a post-treatment. It could be demonstrated that the biological treatment of hospital wastewater is feasible and important as first treatment step, but does not eli­mi­nate pharma­ceuticals sufficiently. Only additional, advanced steps like ozonation or addition of pow­dered activated carbon enable a better elimination of the pharmaceuticals.

    13. Which advanced purification methods are being used in the PILLS project?

    The elimination of pharmaceutical residues is possible only by using advanced chemical and physical pro­cess technologies like: filtration with dense membranes (reverse osmosis), adsorption onto activated carbon and ad­vanced oxidation processes (i.e. ozone, hydrogen peroxide, UV-light).

    14. Are these treatment technologies dangerous?

    The oxidation process possibly generates by-products which may have toxic effects. To remove those substances, a post-treatment is recommended and applied at some pilot plants.

    15. What are the results of the PILLS project?

    Advanced treatment methods are investigated at pilot plants which are installed locally to find out whether the pharmaceutical load can be reduced to a low concentration. Research work has been implemented to collect results regarding the effectiveness of advanced treatment tech­niques. This provides information about the efficiency of elimination rates of the pharmaceuticals as well as the related costs. Furthermore the whole life cycle of the technologies is assessed to find out whether the advanced treatment causes `environmental impacts´ at another point - e.g. because this advanced treatment might require a high energy consumption with again negative impacts to the environment. In the end the PILLS project will be able to provide data about the question, under which condition might it be useful to install advanced treatment techniques.

    16. The Luxembourgish partner won the DEXIA prize. Why did it win this prize?

    The jury chose this project because it is innovative and it stimulates others to install locally advanced techniques for the treatment of pharmaceutically burdened wastewater. The DEXIA prize was founded with the aim to honour municipalities as well as public and private companies that contribute to sustainable development. The aim of the prize is to raise awareness of society to important challenges and stimulate others to engage in sustainable behaviour.

    17. What does the PILLS project give as advice in order to face this problem?

    An integrated approach is necessary where all players among the whole life cycle of pharmaceuticals take responsibility in their field. Only if all involved parties - from industrial producers to medical doctors to users of human or veterinary medicine to wastewater management companies - take precautions in their respective fields then the burden on the water system can be effectively eased by removing as many pharmaceutical substances and as many emission points as possible.

    18. Which approach is the most appropriate - the prevention or the end-of-pipe approach?

    There is not one way to reduce the emissions into the environment sustainably. As mentioned in question 17 actions need to be taken among the whole life cycle of pharmaceuticals - this means that precautionary actions are important and end-of-pipe actions are also relevant in different cases.

    19. How can advanced treatment techniques be financed?

    This question cannot be answered at the moment. This is a political decision which needs a broad discussion in each society of the different States. It is not clear whether the PILLS project will be able to give advice on this aspect.

    20. What are the results of the Life cycle Analysis?

    The whole life cycle of the technologies is assessed to find out whether the advanced treatment causes `environmental impacts´ at another point - e.g. because this advanced treatment might require a high energy consumption with again negative effects to the environment.

    21. What are the results of the Multi-Criteria Analysis?

    In the Multi-Criteria Analysis several aspects are examined and assessed in an integrated manner.

    22. What can I do to help protecting the environment?

    Everybody can do something: Purchase medicinal products in small pack sizes to avoid unused drugs entering the environ­ment Store medicinal products correctly and safely in order to avoid unused drugs having to be disposed Correctly dispose of medicinal products - do not dispose of them via the toilet or the sink!

    23. What can politics do to face the problem?

    The legislative body can create incentives which promote the use of more environmentally friendly sub­stances already at the production process of medicinal products (for example via their approval). Furthermore restrictions for emissions of pharmaceutical substances can be established. But for all these measures, a political discussion about the problem is necessary.

    24. Will the PILLS project influence any national/EU regulation?

    The PILLS project aims at feeding knowledge into the debate about how to deal with pharma­ceu­tical micropollutants. The PILLS project will generate knowledge about the occurrence of phar­ma­ceuticals, the different wastewater treatment possibilities and about their elimination efficiencies. Discussions on how to deal with residues are discussed in different EU-coun­tries. Each partner and partner state will profit from the comparison of different treatment tech­no­logies which are investigated at the various sites, in order to have a broader knowledge base which might help formulate a strategy concerning the emission of pharmaceuticals from hospitals.

    25. Is the PILLS project unique in Europe?

    There are further projects dealing with this issue on international level. Nevertheless the PILLS project is the only project where science and operators work closely together and where possible treatment techniques are tested on full-scale treatment plants which are operating under real conditions.

    26. How does the PILLS project think about pharmaceuticals coming from veterinary medicine into the water cycle?

    Pharmaceutical residues entering the water system because of the veterinary treatment are potentially problematic, too. The PILLS project needed to find a starting point and so the partners are currently concentrating their expertise on dealing with wastewater regarding human pharmaceuticals.

    27. Is it foreseen to start a follow-up project (PILLS 2)?

    This aspect needs to be discussed by the PILLS partners. To date there are no concrete plans to work together in a follow-up project.