Granular activated carbon (GAC) filters can be used to reduce emissions of organic micropollutants via municipal wastewater, but it is still uncertain to which extent biological degradation contributes to their removal in GAC filters. ¹⁴C-labeled organic micropollutants were therefore used to distinguish degradation from adsorption in a GAC-filter media with associated biofilm. The rates and extents of biological degradation and adsorption were investigated and compared with other biofilm systems, including a moving bed biofilm reactor (MBBR) and a sand filter, by monitoring ¹⁴C activities in the liquid and gas phases. The microbial cleavage of ibuprofen, naproxen, diclofenac, and mecoprop was confirmed for all biofilms, based on the formation of ¹⁴CO₂, whereas the degradation of ¹⁴C-labeled moieties of sulfamethoxazole and carbamazepine was undetected. Higher degradation rates for diclofenac were observed for the GAC-filter media than for the other biofilms. Degradation of previously adsorbed diclofenac onto GAC could be confirmed by the anaerobic adsorption and subsequent aerobic degradation by the GAC-bound biofilm. This study demonstrates the potential use of ¹⁴C-labeled micropollutants to study interactions and determine the relative contributions of adsorption and degradation in GAC-based treatment systems.

In the MORPHEUS project we estimated the occurrence and load of pharmaceuticals in four areas of the South Baltic Sea. This included the released loads from selected WWTPs as well as the environmental occurrence of pharmaceutical substances downstream of the WWTPs in the coastal regions Skåne (Sweden), Mecklenburg (Germany),Pomerania (Poland) and Klaipėda (Lithuania).In this article, we report on some of the findings from the Swedishmodel area Skåne and Kristianstad Municipality in the north eastpart of Skåne (Scania) as an example of a local assessment.

In the MORPHEUS project three Swedish Wastewater Treatment Plants (WWTPs) were investigated for their release of pharmaceuticals into the recipient. One of these was Degeberga WWTP which discharges its treated wastewater into the Segesholmsån river, ending in the Baltic Sea. Segesholmsån river has a length of 23 km and an average flow of roughly 0.6 m3/s (Figure 1).

In this project the release of 15 pharmaceuticals from three different WWTPs into three different recipients inKristianstad Municipality, Region Skåne was investigated. All three WWTPs are situated within the borders of thefirst UNESCO Biosphere Reserve in Sweden, Kristianstads Vattenrike – “Vattenriket®”, established in 2005. Pharmaceutical included were: 1. Atenolol 2. Azithromycin 3. Carbamazepine 4. Ciprofloxacin 5. Clarithromycin 6. Diclofenac 7. Erythromycin 8. Estrone 9. Ibuprofen 10. Naproxen 11. Metoprolol 12. Propranolol 13. Oxazepam 14. Paracetamol 15. Sulfamethoxazole

Under våren 2017 togs prover på avloppsvatten från Skånes Universitetssjukhus (SUS) i Lund i samarbete mellan Region Skåne och Högskolan Kristianstad (HKR). Totalt analyserades fyraprovpunkter med avseende på förekomst av 23 läkemedel, antibiotika och andra mikroföroreningar. De fyra provpunkterna var 1. Pumpgrop för uppsamling, 2. Onkologen, 3. Infektion samt 4. Avlopp från Centralblocket. Resultaten redovisas baserat på olika behandlingsfunktion, vilketinnefattar grupperna J - Antiinfektiva medel för systemiskt bruk, C - Hjärta och Kretslopp, N -Nervsystemet, M - Rörelseapparaten samt övriga ämnen. Resultaten visar att vissa läkemedelsläpps ut från SUS i högre koncentration jämfört med utgående avloppsvatten från ettreningsverk (se rapporten ”Läkemedelsutsläpp från Skånska avloppsreningsverk 2017” nedan). Noterbara ämnen är ciprofloxacin, sulfamethoxazole och trimethoprim, samtligaantibiotika. Resultaten vi-sar också att olika avdelningar medicinerar sina patientgrupper olika och att avdelningarna därmed kan vara lokala punktkällor för vissa typer av antibiotika. Koncentrationen av läkemdelsrester i avloppsvattnet påverkas förstås också av den totala vattenanvändningen, som i sin tur är en konsekvens av antal anställda, antal patienter, antal toaletter och arbetsmetoder/vattenanvänd-ning per avloppsspunkt mm. De uppmätta halternavisar att det är önskvärt, i en uppföljande studie, att analysera och fastställa, företrädesvis för antibiotika, vilka andra preparat som används på SUS, och i vilken omfattning. Det är viktigt att poängtera att resultaten från denna undersökning kommer från ett provtagningstillfälle där provtagningen bestod av ett stickprov. En uppföljande studie behöver innehålla fler analystillfällen samt söka svar på om förekomsten av höga halter av antibiotika kan föranleda resistensutveckling i sjukhusens avloppssystem. Vidare behöver man undersöka vilka eventuella åtgärder som behöver vidtas, vid sjukhusen och/eller vid avloppsreningsverken, för att förhindra att höga halter av läkemedelsrester belastar vattenmiljön med dess djur och växtliv. Hänsyn måste då också tas inte bara till vilka ämnen som specifikt härrör från sjukhuset utan också i vilka mängder och i vilken omfattning de når reningsverket i aktiv form.

This study is the first to investigate the pharmaceutical burden from point sources affecting the UNESCO Biosphere Reserve Kristianstads Vattenrike, Sweden. The investigated Biosphere Reserve is a >1000 km(2) wetland system with inflows from lakes, rivers, leachate from landfill, and wastewater-treatment plants (WWTPs). We analysed influent and treated wastewater, leachate water, lake, river, and wetland water alongside sediment for six model pharmaceuticals. The two WWTPs investigated released pharmaceutical residues at levels close to those previously observed in Swedish monitoring exercises. Compound-dependent WWTP removal efficiencies ranging from 12 to 100 % for bendroflumethiazide, oxazepam, atenolol, carbamazepine, and diclofenac were observed. Surface-water concentrations in the most affected lake were ≥100 ng/L for the various pharmaceuticals with atenolol showing the highest levels (>300 ng/L). A small risk assessment showed that adverse single-substance toxicity on aquatic organisms within the UNESCO Biosphere Reserve is unlikely. However, the effects of combinations of a large number of known and unknown pharmaceuticals, metals, and nutrients are still unknown.

Under februari 2019 togs 7 dygnsprover på det totala utgående flödet av avloppsvatten från Skånes Universitetssjukhus (SUS) i Malmö samt på det totala inkommande flödet av avlopssvatten till Sjölunda avloppsreningsverk i Malmö, som är Malmös största reningsverk. Syftet var att få kunskap om utgående koncentrationer av läkemedel från sjukhuset i relation till de inkommande koncentrationerna till avloppsreningsverket. Proverna togs från måndag till söndag under en och samma vecka och analyserades med avseende på förekomst av 33 läkemedel, antibiotika och andra mikroföroreningar. Detta innefattade 9 st antibiotika, 19 st läkemedel samt 5 andra kemikalier.

There is not much knowledge about pharmaceutical residues in Norwegian horse manure. In this project we have further developed a method that enables the analysis of various antibiotics and anthelmintics in a single sample. The method is designed for the analysis of solid substrates, such as horse manure. Manure from treated horses and horse manure with additions of controlled amounts of medicines were composted outdoors in a windrow consisting of horse manure and freshly cut grass. In a pot trail earthworms were added to some of the manure from the treated horses to study the effect of worm action on the biodegradation of pharmaceutical residues. - At the start of the project, several veterinary medicines were considered. The developed analysis method covers several active ingredients in the most commonly used equine medicines. The antibiotic Tribrissen vet inj with the active ingredients sulfadiazine and trimethoprim, and the equine anthelmintics Panacur (active ingredient fenbendazole) and Banminth (active ingredient pyrantel embonate) were included in the entire preliminary study. In total, 70 samples of horse manure and horse manure compost were analysed. We found that dried manure from treated horses could be analysed directly, thus making it unnecessary to freeze-dry samples prior to sending them further for analysis. The method can be used to analyse all four active ingredients at the same time. - Contents of pharmaceutical residues in horse manure are highest 1-2 days after the horse has been treated, with some variation between substances. After this peak, residue contents in manure decrease rapidly. Degradation of the added medicines was slow in the composting trials. In the compost windrow, the contents of medicines decreased gradually throughout a 60-day period, with slightly different degradation curves for the various substances. Three of the tested active ingredients were still detectable in the compost after 60 days. The earthworm trials have to be improved and repeated, among other things, because many worms died in the untreated horse manure plots. - Our trials show that manure from treated horses should be kept apart from other manure for the first 1-3 days after medical treatment. Strategies for the management of such manure have to be developed so that this resource can be used safely in plant production. Additional studies are needed to assess the degradation rate of pharmaceutical residues using different composting methods. Important factors that need to be studied in greater detail under Norwegian conditions include temperature development, windrow dimensions, moisture conditions and earthworm survival. We did not study the contents of pharmaceutical residues in urine. - We performed a survey on soil and fertilizer products among 100 garden centre customers. The results showed that there is a certain interest for peat-free, locally produced soil and fertilizer products. Approximately half of the respondents replied that they are willing to pay as much as 20 % more for such products. Consumers preferred soil amendments that contain nutrients and are typically ”all-purpose”, i.e. a single product that can be used across a wide range of applications. - This project has been important for the project partners due to its development of an analysis for pharmaceutical residues in solid horse manure. Furthermore, it provided a basis for the further development of horse manure as a pharmaceutical residue-free product.

The constant release of pharmaceuticals into the environment can lead to pollution of water and soils which might constitute a risk to human and other living organisms. Residues of common pharmaceuticals such as painkillers, antimicrobials, antidepressants, contraceptives or antiparasitics may enter the environment during manufacturing and disposal processes. The main sources of releases, however, are human consumption and veterinary use. Due to the metabolic stability of some pharmaceuticals up to 90% of the active ingredients are excreted and end up in the wastewater system and finally in the environment – e.g. accumulated in the Baltic Sea and its living organisms.The EU and its Member States have in the past few years increasingly recognised the challenge of pharmaceuticals in the environment (PIE). This is exemplified first and foremost by the European Commission’s Strategic Approach to Pharmaceuticals in the Environment, but also initiatives at the national level aiming at closing main knowledge gaps in the field, comprehensive monitoring systems and more surveys to detect the occurrence of pharmaceuticals in surface and ground water. Moreover, the OECD has recently published a report on pharmaceutical residues in freshwater that calls for a better understanding of the effects of pharmaceuticals in the environment and policy actions.However, this has not yet led to the development of indicators and threshold values at the EU level that aid Member States in implementing systematic monitoring schemes for PIE. As long as this situation persists and as long as we still do not sufficiently understand the effects of pharmaceutical residues on the ecosystem and on human health, the question arises: What can be done about PIE at the regional level? The answer to this lies in the precautionary principle – i.e. taking action to prevent harm to the environment even without having exact knowledge of all facets of the problem.

This  report  of  MORPHEUS  Project  Partners  documents  the  outcome  of  WP3  –  consumption patterns.   Herein,   the   project   aims   to   identify   and   quantify   the   emission   of   selected pharmaceuticals   especially   discharged   via   wastewater   of   WWTP.   A   comprehensive   data research was performed and prioritized pharmaceutical consumption loads have been calculated for the model areas in Lithuania, Poland, Sweden and Germany. The outcome of this report can be summarized in the following key facts:

1.    Consumption data is based on either sales data of wholesalers/pharmacies or data from health care institutions. The unit of consumption is number of reimbursed packages andDDD, respectively.

2.    The resolution and  data coverage (only partly including OTC, hospital etc.) is  country- specific:  The  best  time-resolution  was  found  in  Poland  (monthly),  the  best  spatial resolution in Lithuania (population group <3000).

3.    Country-specific  consumption  was  comparable  by  a  developed  value  intake  load  per inhabitant per year.

4.    For   Swedish   and   German   data,   a   comparison   of   different   distributing   sites   of pharmaceuticals   was   possible   (over   the   counter   sales,   application   in   hospitals, prescriptions/pharmacies).

5.    For Lithuanian data, the high spatial resolution enabled a potential correlation with the local demographic data in regard of consumption of beta blocking pharmaceuticals.

6.    For Polish data, a seasonal variation can be clearly shown for antibiotics.

7.    For  German  data,  an  accumulation  within  the  river  catchment  shows  that  a  complete picture   of   the   whole   system   is   essential   to   understand   the   actual   burden   of pharmaceuticals in the environment.

8.    Comparing the model areas, all results have been in the same order of magnitude more or  less  depending  on  consumption  and  doses.  Metformin  and  diverse  analgesics revealed high intake loads.  In general, mostly German intake loads exceed the  others which  may  lies  in  the  fact  that  the  selection  of  pharmaceuticals  is  mostly  based  on German literature and statistics  due to availability/accessibility.  An  adjustment to  each country-specific list may lead to other results.

9.    Some  substances  remain  unclear:  Contrast  media  and  hormones  are  still  a  matter  of burden  to  the  environment  but  caused  some  difficulties  during  data  collection  andresearch.

Wastewater treatment processes are monitored mainly in terms of biogenic substances removal efficiency. Only recently they started to be perceived as a potential sources of pharmaceutical residues to their recipients the and hot-spots for antibiotic resistance dissemination among bacteria. The scale of the problem has not been fully investigated and understood – missing data on the pharmaceuticals consumption, unidentified and dispersed point sources and non-unified sampling strategy of monitoring programs have been identified as the examples of problematic areas. I n scope of project REPHIRA (Reduction of Pharmaceutical Emissions from Dispersed Point Sources in Rural Areas), financed from the Interreg Baltic Sea Region Seed Money, the cooperation has been established between five partners located in the Baltic Sea catchment area: Poland, Germany, Denmark, Sweden and Finland. In order to fulfill the knowledge gap, a preliminary study was conducted by Polish partner on four wastewater treatment plants (WWTPs) localized in the coastal area in northern Poland. Objects differ in terms of load, people equivalent, treatment technology and the recipient of WWTP effluent. The amount of human gut related indicator organism, E. coli has been estimated in raw and treated wastewater, as well as in the receiver, using classical microbiology approach and cultivation method. Additionally, the bacterial resistance to cefotaxime – an antibiotic belonging to third-generation cephalosporin family – has been tested.

The accumulation of micropollutants (MPs) and their increasing concentration in the aquatic environment are an emerging issue for water quality in the world. The complex web of exposure pathways, as well as the variety in the chemical structure and potency of MPs, represents enormous challenges for researchers and policy initiatives. In order to manage MPs, it has to be decided which of them have to be reduced and to what extent, where in the water cycle this would be the most efficient and which technical means that should be applied to be sustainable. All of these aspects require a knowledge of MPs abundance, properties, fate and impact in the environment, which is essentially determined by two related features: the sources and the physico-chemical characteristics of MPs. Micropollutants including pharmaceuticals, antibiotics and hormones can enter the aquatic environment through both diffuse and point sources, but in urbanised regions wastewater treatment plants (WWTPs) play a crucial role in their dissemination. Conventional WWTPs are effective in removal of macropollutants (e.g. nutrients, suspended solids and some trace elements), while MPs may go through the treatment unchanged or be removed at different rates. Most of the EU countries are convinced that the presence of MPs in the environment poses a serious problem, particularly in highly populated regions where surface water resources serve as a source of potable water. Presently, various technical solutions are available and have been proven possible to integrate with existing treatment processes in an expedient manner. The solutions that have been evaluated are mainly based on ozonation and/or activated carbon treatment technologies which may definitely be considered the most effective compared to the costs incurred.

Over the past 30 years a vast number of studies have demonstrated the presence of pharmaceutical residues in the environment. But still knowledge is scarce regarding the interaction of these emerging pollutants with various matrices in nature. A chromatographic system with on-line detection was developed to perform a sorption study of six selected pharmaceuticals to four natural sediments and dewatered digested sewage treatment plant sludge with differing physicochemical characteristics. Sorption effects, measured as asymmetry factors and recoveries, differed pronouncedly among the pharmaceuticals and between the matrices, which could be explained by basic physicochemical properties of the investigated compounds in relation to matrix characteristics. Protonated and deprotonated molecular properties had the greatest importance for sorbate–sorbent interactions. Atenolol, with cationic properties, showed the highest degree of sorption regardless of the matrix studied. Diclofenac and furosemide, both acids, showed the least tendency towards interactions to natural matrices. Among the neutral compounds bendroflumethiazide, carbamazepine and oxazepam, weaker forces, such as van der Waals, aromatic electron donor–acceptor interactions, and hydrogen forces, seemed more important to determine sorption differences. Results revealed that sorption of pharmaceuticals on natural sediments decreased in the order: atenolol (+) > bendroflumethiazide > oxazepam > carbamazepine > diclofenac (−) > furosemide(–). The matrix content of organic matter measured as total organic carbon (TOC) clearly dictated drug sorption. Beside from studying matrix interaction, these results and the developed technique and methodology might find use in the development of new removal processes of pharmaceuticals from wastewater based on improved knowledge concerning chemical interactions to filter materials.

Two green chemistry extraction systems, an in-house stainless-steel column Pressurized Hot Water Extraction system (PHWE) and a commercially available Espresso machine were applied for analysing 23 active pharmaceutical ingredients (APIs) in sewage sludge. Final analysis was performed on UPLC-MS/MS using two different chromatographic methods: acid and basic. When analysing all 23 APIs in sewage sludge both extraction methods showed good repeatability. The PHWE method allowed for a more complete extraction of APIs that were more tightly bound to the matrix, as exemplified by much higher concentrations of e.g., ketoconazole, citalopram and ciprofloxacin. In total, 19 out of 23 investigated APIs were quantified in sewage sludge, and with a few exceptions the PHWE method was more exhaustive. Mean absolute recoveries of 7 spiked labelled APIs were lower for the PHWE method than the Espresso method. Under acid chromatographic conditions mean recoveries were 16% and 24%, respectively, but increased to 24% and 37% under basic conditions. The difference between the PHWE method and the Espresso method might be interpreted as the Espresso method giving higher extraction efficiency; however, TIC scans of extracts revealed a much higher matrix co-extraction for the PHWE method. Attempts were made to correlate occurrence of compounds in sewage sludge with chemical properties of the 23 APIs and there are strong indications that both the number of aromatic rings and the presence of a positive charge is important for the sorption processes to sewage sludge.

By using an innovative, positive pressure sample loading technique in combination with an in-line filter of finely ground sand the bottleneck of solid phase extraction (SPE) can be reduced. Recently published work by us has shown the proof of concept of the technique. In this work, emphasis is put on the SPE flow rate and method validation for 26 compounds of emerging environmental concern, mainly from the 1st and 2nd EU Watch List, with various physicochemical properties. The mean absolute recoveries in % and relative standard deviations (RSD) in % for the investigated compounds from spiked pure water samples at the three investigated flow rates of 10, 20, and 40 mL/min were 63.2% (3.2%), 66.9% (3.3%), and 69.0% (4.0%), respectively. All three flow rates produced highly repeatable results, and this allowed a flow rate increase of up to 40 mL/min for a 200 mg, 6 mL, reversed phase SPE cartridge without compromising the recoveries. This figure is more than four times the maximum flow rate recommended by manufacturers. It was indicated that some compounds, especially pronounced for the investigated macrolide molecules, might suffer when long contact times with the sample glass bottle occurs. A reduced contact time somewhat decreases this complication. A very good repeatability also held true for experiments on both spiked matrix-rich pond water (high and low concentrations) and recipient waters (river and wastewater) applying 40 mL/min. This work has shown that, for a large number of compounds of widely differing physicochemical properties, there is a generous flow rate window from 10 to 40 mL/min where sample loading can be conducted. A sample volume of 0.5 L, which at the recommended maximum flow rate speed of 10 mL/min, would previously take 50 min, can now be processed in 12 min using a flow rate of 40 mL/min. This saves 38 min per processed sample. This low-cost technology allows the sample to be transferred to the SPE-column, closer to the sample location and by the person taking the sample. This further means that only the sample cartridge would need to be sent to the laboratory, instead of the whole water sample, like today's procedure.

In this work the habitual behaviour of low pH in environmental organic trace analysis is challenged by investigating the full potential of building a multi-component UHPLC-ESI-MS/MS method adapted to cover common emerging contaminants of many different polarities, minimizing the elements of compromise in the performance of the final analytical separation and detection. Contributes have been made by taking advantage of common commercially available technology in understanding the impact from solvent components and the ionization of analytes which can facilitate future development of robust, sensitive and precise UHPLC-MS/MS methods. All contaminants were evaluated and optimized without prejudices regarding historical residence in terms of chromatographic conditions and ESI mode; increasing multi-method's flexibility that can be implemented in routine analysis in response to new requests as well as to emerging contaminants yet to be discovered. Our data strongly supports the questioning of the assumption that equilibrium concentrations of ions in solution reflect those produced during the electrospray process. ESI responses of [M+H](+) and limits of detection were comparable, or often better at high pH compared to acidic eluents. Presence of nitrogen basic groups such as tertiary and secondary amines in a compound increased the intensity of the ESI+ signal, and was even further elevated in basic eluent. The proton affinity probably changes for many nitrogen-containing compounds during the ionization process, making the gas-phase processes very important in generation of these ions by ESI+. There were also an unexpected large number of compounds showing their highest response at pH 7 and weak ionic strength. A flow optimized, buffert free, neutral UHPLC-MS/MS method enhanced the sensitivity for the environmental important synthetic hormone ethinyl estradiol significantly.

Läkemedelsverket gav i september 2015 ut en rapport med titeln ”Miljöindikatorer inom ramen för nationella läkemedelsstrategin (NLS)”. Rapporten indikerar bland annat stora kvalitetsbrister i tidigare utförda analyser av läkemedel i miljön under åren 2002-2013, men betonar också vikten av att samordna framtida nationella läkemedelsanalyser för att bättre använda våra offentliga resurser. I rapporten skriver man följande: ”Allra högst prioriterad ansåg arbetsgruppen att indikatorn ”mäta halter av läkemedelssubstanser i miljö” vara. Detta beroende på att det utöver att det är av stor vikt att följa utvecklingen av läkemedelsrester i miljön över tid för att utvärdera effekten av genomförda insatser, så ansåg arbetsgruppen att det finns stora möjligheter att optimera användningen av de offentliga resurserna genom en bättre samordning av mätningar i miljön. Många mätningar har gjorts historiskt av olika offentliga aktörer utan någon samordning.” Mot bakgrund av detta, och som svar på ett nationellt behov, åtog sig Högskolan Kristianstad (HKR) genom Ola Svahn och Erland Björklund, båda verksamma vid MoLab, Krinova Incubator and Science Park i Kristianstad, att leda denna interkalibreringsstudie för läkemedelsanalys i miljö-vattenprover av olika typ. Arbetet har skett på uppdrag av Havs- och Vattenmyndigheten som finansierat arbetet via bidrag ur havs- och vattenmiljöanslaget och i samarbete med fyra andra analyslaboratorier vid Umeå Universitet (UU), Sveriges Lantbruksuniversitet Uppsala (SLU), Svenska miljöinstitutet Stockholm (IVL) samt Aarhus Universitet Danmark (AU). Total deltog därmed 5 laboratorier, alla med tidigare erfarenhet av läkemedelsanalys i miljöprover.

I projektet LUSKA (Läkemedelsutsläpp från Skånska Avloppsreningsverk) deltog 6 olika reningsverksorganisationer,    geografiskt fördelade över hela Skåne; Höganäs, Klippan, Höör/Hörby, Svedala, Kristianstad och Simrishamn. Provtagning utfördes i april 2017 på fyra platser vid varje reningsverk. Tre av dessa platser valdes enligt förslag från Länsstyrelsen Skånes tillsynsvägledning; uppströms, nedströms och utgående vatten från reningsverket. Dessutom ingick en fjärde provpunkt bestående av inkommande vatten till reningsverken. I studien analyserades total 21 av 22 läkemedel enligt Läkemedelsverkets föreslagna lista på ämnen från 2015. Analysresultaten från de 8 avloppsreningsverken, samt tillhörande recipient i form av åar och sjöar visar tydligt att stora mängder läkemedel hamnar i våra omgivande skånska vatten varje år. Detta sker som en konsekvens av att reningsverken inte förmår rena läkemedelsutsläpp med befintlig teknik baserad på aktivt slam. Studien visade att de 8 reningsverken släpper ut minst 71 kg läkemedel varje år till skånska vatten enbart av dessa 21 ämnen. Den stora bulken av de uppmätta ämnena utgjordes av blodtryckssänkaren metoprolol och smärtstillaren diklofenak. Men även ämnen som karbamazepin, losartan, naproxen och oxazepam förekom i betydande koncentrationer i avloppsvattnet. Dessa ämnen innefattar flera läkemedelstyper och representerar tre generella och relativt vanliga sjukdomstillstånd som högt blodtryck, inflammation och smärta, samt depression och ångest. Baserat på resultaten i LUSKA-projektet kan man uppskatta att när ett reningsverk behandlar en miljon kubikmeter (1 000 000 m3) avloppsvatten passerar det samtidigt ut ca 4 kg av de 21 läkemedel som Läkemedelsverket tagit upp på sin övervakningslista. Enligt en grov beräkning, innefattande en majoritet av de skånska reningsverken, skulle detta innebära att nästan 600 kg kilo läkemedel läcker ut varje år från skånska reningsverk av Läkemedelsverkets föreslagna ämnen. Samtidigt måste man beakta att dessa 21 ämnen endast utgör en liten del av flera hundra läkemedelssubstanser som används för behandling av sjukdomar. Med stor sannolikhet läcker ett till flera ton läkemedel ut årligen i skånsk recipient. Mätningar i åar och sjöar visar att även om koncentrationerna sjunker nedströms verken som  en konsekvens av företrädesvis utspädning så finns det lokaler där koncentrationerna är an-märkningsvärt höga utifrån ett hållbarhetsperspektiv.

The project LUSKA (a Swedish acronym meaning ‘to figure out’ formed from the name LäkemedelsUtsläpp från SKånska Avloppsreningsverk - Pharmaceutical emissions from Scanian wastewater treatment plants) comprised six different participating wastewater treatment organisations, geographically distributed throughout the whole of the Scania region in Sweden (Skåne): Höganäs, Klippan, Höör/Hörby, Svedala, Kristianstad and Simrishamn. Sampling was done in April 2017 in four locations at each treatment plant. Three of these locations were chosen as suggested by the County Administrative Board of Skåne’s supervisory guide: upstream, downstream and outlet water from the treatment plant. In addition, a fourth sample point was included consisting of inlet water to the treatment plants. In the study, a total of 21 out of 22 pharmaceuticals were analysed according to the Swedish Medical Products Agency’s proposed substance watchlist from 2015. The analysis results from the eight treatment plants and associated recipients in the form of streams and lakes clearly shows that large amounts of pharmaceuticals end up in our surrounding Scanian waters every year. This takes place as a consequence of the wastewater treatment plants not being able to separate pharmaceutical emissions with existing technology based on activated sludge. The study showed that the eight treatment plants release at least 71 kg of pharmaceuticals every year to Scanian waters of these 21 substances alone. The major bulk of the measured substances were comprised of the blood pressure lowering drug metoprolol and the analgesic diclofenac. But even such substances as carbamazepine, losartan, naproxen and oxazepam occurred in significant concentrations in the wastewater. These substances include several pharmaceutical types and represent three general and relatively common illnesses: high blood pressure, inflammation and pain, and depression and anxiety. Based on the results in the LUSKA project, it can be estimated that when a treatment plant treats one million cubic metres (1,000,000 m3) of wastewater, at the same time approximately 4 kg pass of the 21 drugs that the Swedish Medical Products Agency included on its watchlist. According to a rough estimate, including a majority of the Scanian wastewater treatment plants, this would mean that nearly 600 kg of drugs on the Swedish Medical Products Agency’s proposed substances watchlist leak out from Scanian treatment plants every year. At the same time, it must be taken into account that these 21 substances only comprise a small part of the several hundred pharmaceutical substances used for the treatment of diseases. In all likelihood, one or more tonnes of drugs leak out into Scanian recipients annually. Measurements in lakes and streams show that even if the concentrations drop downstream of the plants, probably as a consequence of dilution, there are locales where the concentrations are remarkably high from a sustainability perspective.

In environmental trace analysis there is often a need to enrich the compounds of interest from a large sample volume, where the use of solid phase extraction (SPE) is more or less the standard technique. The presence of the sample matrix can cause clogging of the SPE-column, especially at the end of a sample load. Swedish surface waters are often humic rich making the use of traditional sample loading by a vacuum manifold very limited. This obstacle forced the development of a different sample loading technique, based on compressed air and sand as an in-line-filter, designed to load larger sample volumes as needed in trace level analysis of hormones in surface water. The developed technique, combined with a UPLC MS/MS method, showed promising reproducibility and accuracy, and enabled increased sensitivity for the analysis of hormones in humic rich surface water.

Thermal degradation of antibiotics has been studied for decades in a broad range of disciplines including food production, agriculture and analytical chemistry. Yet, there is a lack of thermal stability data for many antibiotics. Here we systematically investigated the thermal stability of ten commonly prescribed antibiotics applying a laborsaving automated inhouse pressurized dynamic flow-through system. The design of the system allowed a fast access to a large number of data at medium to subcritical water temperatures, ranging from 50-250 °C. The five ß-lactams cefadroxil, cefuroxime, amoxicillin, penicillin V, and penicillin G showed a high degree of stability with a maximum degradation of less than 30 % at 150 °C. The two quinolones ciprofloxacin and norfloxacin showed a very high thermal stability up to 200 °C, as did trimethoprim andsulfamethoxazole. At 250 °C all antibiotics were either partly of fully removed. The tetracycline doxycycline showed a specific removal pattern probably involving both binding to metal surfaces at lower temperatures as well as degradation at increased temperatures.