Potential Environmental Issues Relevant to OTC Drugs and Dietary Supplements

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Donald J Versteeg, PhD
Environmental Toxicologist
EcoStewardship LLC


This report summarizes findings on issues associated with OTC drugs and dietary supplements1 in the environment with a focus on emerging issues and chemicals of concern. Information was obtained through reviews of the internet and primary literature for OTC drugs, pharmaceuticals, and PPCPs in the environment using appropriate search terms. This report focuses on the period from November 2021 to May 2022. The areas addressed and key findings include:

  • Environmental Fate, Toxicity, and Risk – Key study reported cumulative surface water concentrations of 61 active pharmaceuticals in 104 countries demonstrating that poorer countries have greater concentrations than richer countries. A preliminary risk assessment suggests ciprofloxacin (antibiotic resistance), citalopram, clarithromycin (resistance), enrofloxacin (resistance), fluconazole (resistance), loratadine, propranolol, sulfamethoxazole, and verapamil exceed ‘safe’ levels at 1 - 13% of sites in North America.
  • Sunscreen Actives – A widespread coral bleaching even at the Great Barrier Reef was observed with the lead cause stated to be increased water temperatures. Other studies and some experts support the fact that sunscreen actives may not be related to coral decline. However, another study of Hanauma Bay indicates oxybenzone may be partially responsible for adverse effects. The FDA will initiate a public scoping process and possibly an environmental impact assessment on oxybenzone and octinoxate in sunscreens.
  • Perfluoro Alkyl Substances – PFAS is an active area of environmental research with studies ranging from toxicity to coral organisms, bioconcentration in aquatic organisms, analysis in a variety of environmental compartments, and potential impacts on wildlife.
  • Recycling and Plastics – The major recycling news is EPA’s update of its National Recycling Strategy which calls for all stakeholders to work together to provide recycling for all Americans and create a circular economy to solve the recycling dilemma facing the country. Microparticles are being measured throughout the environment and the adsorption of other pollutants (like PFAS) to particles may be a concern. However, to date, there have been limited risks associated with microplastics in the environment.

This report is a broad-based survey of issues associated with these topics. In some cases, like the pharmaceutical monitoring program or the sunscreen-Hanauma Bay study, additional efforts to fully evaluate these studies and their assertions of potential risk should be considered.


CHPA scientists have asked for EcoStewardship LLC to monitor publications and other activities (NGOs, leading consumer groups) for information related to OTC medicines and dietary supplements in the environment, with a particular focus on emerging issues and chemicals of concern. This activity has been ongoing for several years with each new report providing updates (i.e., information published since the last report/update). Two reports are produced annually, one in May and one in October with each report highlighting key information most relevant to issues relevant to CHPA member companies, especially on the fate, effects, and risk of PPCPs in the environment

OTC medicines and dietary supplements are often referred to in the literature as emerging chemicals, pharmaceuticals in the environment (PIE), chemicals of environmental concern (CEC), and pharmaceutical and personal care products (PPCP) and represent active areas of scientific study with thousands of studies, opinions, news articles, etc. published annually. This body of information has been queried through scientific literature reviews, and reviews of news articles. Reports and studies with the potential to have the greatest impact on thought-leaders are summarized.


During this review period, a number of publications (Citations) appeared in the peer reviewed literature on OTC medicines and their components (i.e., PPCPs, PIE, CEC, etc.). These studies focused on environmental fate, toxicity, and risk, sunscreen actives, PFAS, and plastics (especially microparticles) in the environment.

Environmental Fate, Toxicity, & Risk

One of the most impactful studies of 2022 is the pharmaceutical monitoring study of Wilkerson et al. (2022)2 who monitored pharmaceutical concentrations in 258 of the world’s rivers and provided a preliminary risk assessment. Samples were obtained from 1,052 locations in 104 countries and analyzed for 61 active pharmaceuticals. Based on cumulative concentrations, the most contaminated samples were predominately from African (e.g., Ethiopia>Tunisia>Democratic Republic of Congo>Kenya>Nigeria) and Asian (Pakistan>India>Armenia>Palestine>China) countries. The most contaminated sites were in low- to middle-income countries and were associated with areas with poor wastewater and waste management infrastructure and pharmaceutical manufacturing. Eleven US sites were sampled with cumulative concentrations ranging from 0.015 – 10.2 µg/L. Little information is available on exactly where samples were collected (possibly downstream of wastewater treatment plants). Globally, the most frequently detected compounds were carbamazepine, metformin, and caffeine, which were detected at over half of the sites monitored. The highest average concentrations were reported for paracetamol/acetaminophen, caffeine and metformin (average concentrations > 100µg/L). Importantly, concentrations of at least one compound at 25.7% of the sampling sites were greater than concentrations considered safe for aquatic organisms, or which are of concern for antimicrobial resistance. For this analysis, published safe levels were used to assess risk. Note, there are issues with the risk approach used, that said, the study reports for North America (which includes Central America) that ciprofloxacin (resistance), citalopram, clarithromycin (resistance), enrofloxacin (resistance), fluconazole (resistance), loratadine, propranolol, sulfamethoxazole, and verapamil exceed ‘safe’ levels at 1 - 13% of sites. The authors concluded that pharmaceutical pollution poses a global threat to environmental and human health. The huge amount of data from this study are available in online in Excel files and could be further mined for information, perspective, and to assess risk.

The results of this study was summarized by a variety of NGO and news organizations including the World Economic Forum3, CARB-X4, NBC5, BBC6, and many other NGO and news outlets.

A review paper by Maculewicz et al. (2022)7 focused on pharmaceutical transformation products. This review discussed the metabolites of compounds belonging to six major pharmaceutical groups: SSRIs, anticancer drugs, antibiotics, antihistamines, NSAIDs and opioids. The data presented indicates that some transformation products may be as harmful as their parent compound suggesting that data on the transformation products may be as important as data on the parent compound to conduct a complete risk assessment.

Mejias et al. (2022)8 reviewed the literature on the distribution and toxicities of enantiomers of chiral pharmaceuticals reporting enantioselective toxicity towards aquatic organisms have been established for ten out of 36 chiral pharmaceuticals found in wastewater or surface water samples. Differences in the biodegradation and toxicity of enantiomers suggests additional research is needed to fully understand the fate, toxicity, and risk of these compounds in the environment.

Baker et al. (2022)9 analyzed surface water and sediment samples for 150 chemicals of concern at multiple locations in the Lake Huron to Lake Erie corridor. Surface water was analyzed for pharmaceutical and personal care products (PPCPs), pesticides, and per- and polyfluoroalkyl substances (PFAS). Sediment was analyzed for PFAS. Fifty compounds were detected at ng/L or ng/kg levels. Synthetic sweeteners accounted for 55.7% of the cumulative concentration of all compounds detected across sampling events, followed by pesticides (27.5%), pharmaceuticals (11.7%), and stimulants (3.5%), with 14 compounds consistently detected: acesulfame-potassium, sucralose, sulfamethoxazole, acetaminophen, lidocaine, atenolol, gemfibrozil, iohexol, atrazine, diaminochlorotriazine, deethyl-atrazine, deisopropylatrazine, 2,4-dichlorophenoxyacetic acid, and caffeine.

During this review period, there were a number of papers on the presence of drugs and pharmaceuticals in various compartments of the environment (groundwater, sediments, soils. etc.), novel treatment methods, removal during wastewater treatment, toxicity to aquatic organisms (generally at elevated levels), and significant risk to the environment typically in regions with greater concentrations (i.e., Asia). These papers were not individually reviewed.

During this review period there were also several papers on Chemicals of Emerging Artic Concern (CEAC). These papers posit that due to the unique climate and ecology of the Artic, that more effort is needed to better understand traditional persistent organic pollutants like PFAS, flame retardants, pesticides, etc. as well as pharmaceuticals and microplastics. This new area of concern was led by the Artic Monitoring and Assessment Programme from the Artic Council (leading intergovernmental forum promoting cooperation in the Arctic; both USA & Canada are members).

Sunscreen Actives

Discussion of the role of sunscreen actives on organisms in the environment continued with some in the scientific community starting to recognize that these actives are not responsible for environmental impacts like coral bleaching (see below). Meanwhile, governments and some retailers continue to ban certain ingredients from sunscreens to protect the environment through the use of reef-safe sunscreen products. For example, the retailer Holland & Barrett banned the sale of all sun care products containing the oxybenzone and octinoxate from all stores and on its website10. This corresponded with the launch of its own sunscreen product line which use mineral actives. Last August, Thailand became the latest country to ban sunscreens containing certain actives (oxybenzone, octinoxate, 4-methylbenzylidene camphor or butylparaben)11.

One of the major environmental news stories of the year is extensive coral bleaching in the Great Barrier Reef. The Great Barrier Reef Marine Park Authority (Australia’s lead management agency for the Great Barrier Reef) observed significant reef bleaching in its recent/spring aerial surveys. This bleaching event was widely reported by news agencies (BBC, NPR, ABC, CBS, etc.). Importantly, the Authority reported that water temperatures in parts of the reef had been up to 4°C above the March average and was the lead cause of the bleaching event. This is the fourth time in six years that such severe and widespread damage occurred with the damage being ascribed to warm sea. For perspective, only two mass bleaching events had ever been recorded until 2016. In reporting on the bleaching event, sunscreen actives were not specifically mentioned as a causative factor. In a widely reported scientific publication, Wheate and Ellis (2022)12 reported that concentrations of sunscreen actives are in the ng/L range in marine and fresh water systems but that the effects of sunscreen actives on aquatic life under laboratory conditions typically occur only at µg/L to mg/L concentrations (1,000 to 1,000,000 times higher). They conclude by stating there are often other causes that are more likely impacting aquatic life including changes in water temperature, water turbidity, elevated nutrient levels, and the presence of pesticides and medicines used for human and animal health (emphasis added, no data provided linking drugs/pharmaceuticals to environmental effects). The finding that water temperatures are a leading factor in coral impacts agrees with a NOAA report13. This study provided a report card on reef health and not was not a study of causality, but the report stated “all coral reefs are highly impacted by climate change, and climate impacts were more pronounced than expected on remote reefs.” Finally, as mentioned in previous CHPA environmental reports, a study from the NAS on sunscreen risk in the environment is still expected in 2022.

In other news, some scientists are questioning the theory that sunscreen chemicals have significant impacts on coral reefs. Both Timothy Bargar, PhD, ecotoxicologist at the U.S. Geological Survey’s Wetland and Aquatic Research Center and Michael Gonsior, PhD, associate professor, University of Maryland Center for Environmental Science call into question whether sunscreen actives have a proven link to environmental effects. They note that laboratory studies are conducted at concentrations that are 1,000 times higher than what you’d find in a natural environment14. While this does not completely remove these materials from concern, some scienctists may be headed in the right direction.

In contrast, Downs et al. (2022) reported concentrations of oxybenzone at up to 28 µg/L in Hanauma Bay Hawaii15. The study then used US EPA and EU risk approaches to find low to high levels of acute risk (i.e., high risk defined as risk ratios >0.5) depending on the risk approach used (EU approach showing the greatest risk). Effect levels were largely based on earlier toxicity studies by this group which included in vitro testing which is difficult to extrapolate to whole organism effects, much less risk.

The US FDA has announced that it will initiate a public scoping process to consider potential environmental impacts associated with the use of oxybenzone and octinoxate in sunscreens. Depending on the findings of the scoping process, FDA may prepare an environmental impact statement. FDA is taking this action in part because it is aware that the NOAA Coral Reef Conservation Program is currently evaluating coral reef health including the potential impacts of oxybenzone and octinoxate on coral reefs and other aquatic systems and that some regions have banned these ingredients.

In the discussion over organic sunscreens, inorganic or mineral based ingredients, notably ZnO and TiO2, are typically seen as environmentally benign but without a thorough review. For example, in a recent update of their website, the National Park Service promotes sunscreens containing ZnO and TiO2 (and nothing else) without providing data in support16. In contrast, a recent literature review on nano-TiO2 and nano-ZnO, Yuan et al. (2022) reported that the primary nanoparticle characteristics and coating materials significantly affect the environmental behavior and fate of inorganic UVFs and that additional information is needed on the sources, fate, effects and risks of these materials in the environment17. Hong et al. (2021)18 reviewed the toxicity and fate literature on ZnO and TiO2 from all sources (production and use) into the environment. Risk ratios for TiO2 were far less than 1.0 (very safe) while ZnO risk ratio ranged from 0.86 – 1.2.

Perfluro Alkyl Substances (PFAS)

Per-and polyfluoroalkyl substances (PFAS) are a large (>4,700 separate compounds), heterogeneous group of fluorinated synthetic compounds characterized by the presence of at least one perfluorinated methyl or methylene group (−CF2−), a variable number of carbon atoms, and the presence of other chemical groups (e.g., sulfonate, phosphate, alcohol). PFAS are ubiquitous in environment, mainly due to their wide dispersive use, thermal, chemical, and biological stability, and volatility. These characteristics lead to long-range transport of at least some members of the PFAS family19. These characteristics also lead to significant amounts of research on these compounds including:

  • A linkage between the susceptibility of coral organisms to heat stress and PFAS exposure20,
  • A study reporting bioconcentration factors > 5,000 L/kg in aquatic organisms21,
  • Findings that some PFAS components are biomagnified in the Lake Huron food web22,
  • Off-loading of PFAS from adult female turtles to eggs and the finding of potential impacts on offsprings23,
  • Potential impact on wildlife24,
  • Potential association between PFAS and microplastics in biosolids which can be inhaled when winds create dust25,
  • Presence of PFAS in indoor dust including daycare centers26
  • Measurement of PFAS in US surface waters27, soil28, groundwater and drinking water29.

There are also studies ongoing to better improve PFAS analytical methods30, understand degradation and removal from water (including wastewater)31, find replacements for PFAS chemicals32, and better understand risk to humans and the environment33. Note that for each of these topics, there are typically dozens of recent studies that could be cited. Further, PFAS is a large complex set of chemicals which should not, as is almost always done, be lumped into one group (i.e., not all individual chemicals have all or any of the negative attributed discussed).

Regulatory action on PFAS is ongoing. As part of its strategy to reduce PFAS in commerce, the US EPA announced34 (March, 2022) efforts to identify, understand and address PFAS contamination leaching from fluorinated containers and that the agency will remove two PFAS from its Safer Chemical Ingredients List (SCIL). The leaching of PFAS into plastics, the agency is notifying companies of their obligation to comply with existing requirements under TSCA to ensure unintentional PFAS contamination does not occur. EPA also added 172 PFAS chemicals to the TRI reporting list. These actions were added to other recent actions by EPA including expanding PFAS monitoring in drinking water and a request to the Science Advisory Board to review four draft documents that indicate that negative health effects may occur at much lower levels of exposure to PFOA and PFOS than previously understood and that PFOA is a likely carcinogen35.

A number of states have set limits on PFAS in drinking water and the Environmental Council of States updated its white paper on state activities in March 202236. California introduced a bill (AB1817)37 in 2022 which would prohibit any person from distributing, selling, or offering for sale any textile articles that contain regulated PFAS, and requires a manufacturer to use the least toxic alternative when removing regulated PFAS in textile articles. This bill is supported by Breast Cancer Prevention Partners and the California Product Stewardship Council (and others). Finally, in April 2022, NRDC released a report38 that PFAS chemicals are found in water, food and clothing and advising consumers how to reduce exposure to these compounds.

Recycling & Plastics in the Environment

Recycling: In November, 2021, the US EPA released its long awaited revision of the National Recycling Strategy. This Strategy represents the next step in moving beyond the current policy of “Reduce, Reuse, and Recycle” to pave the way for sustainable management of resources. The Strategy is integrated with the National Recycling Goal and together support the ultimate goal of improving recycling and increasing circularity within the United States. The methodology to measure the recycling goal and its key metrics is under development and expected to be finalized later this year. The Strategy is focused on enhancing and advancing the national municipal solid waste (MSW) recycling system and identifies strategic objectives and stakeholder-led actions to create a stronger, more resilient and cost-effective recycling system. It is part one of a series dedicated to building a circular economy for all. The Strategy focuses on improving the nation’s MSW recycling system and broadens the vision to achieve environmental justice priorities. The US MSW recycling system currently faces a number of challenges, including confusion about what materials can be recycled, recycling infrastructure that has not kept pace with today’s diverse and changing waste stream, reduced markets for recycled materials, and varying methodologies to measure recycling system performance. The Strategy identifies actions to address these challenges and builds on the collaborative efforts by stakeholders from across the recycling system.

The Strategy recognizes that recycling efforts in the United States comprise more than just the processing of MSW at materials recovery facilities (MRFs) and include many other materials, such as electronics, textiles and food waste. Future strategies will address these and other aspects of a circular economy for all.

The Strategy discusses formation of a circular economy which is a change to the model in which resources are mined, made into products, and become waste. A circular economy reduces materials use, redesigns materials and products to be less resource-intensive, and recaptures “waste” as a resource to manufacture new materials and products. Circularity is embraced within the sustainable materials management (SMM) approach that EPA and other federal agencies have pursued since 2009.

The Strategy supports implementation of the National Recycling Goal to increase the recycling rate to 50% by 2030 and includes five strategic objectives to create a more resilient and cost-effective national recycling system:

  1. Improve Markets for Recycling Commodities.
  2. Increase Collection and Improve Materials Management Infrastructure.
  3. Reduce Contamination in the Recycled Materials Stream.
  4. Enhance Policies to Support Circularity.
  5. Standardize Measurement and Increase Data Collection.

Each of these strategic objectives contains additional sub-objectives to help achieve the circular economy.

Next steps for EPA are to develop an implementation plan providing more specificity about the actions and their organizational leads. The implementation plan will identify the resources and investments needed, balance risk reductions with costs, clarify the roles and responsibilities of participating entities, and articulate EPA’s role in implementing the Strategy. Stakeholders include waste haulers, waste management companies, non-profit organizations, governments, academia, industry, community members and others who wish to be involved.

EPA’s Strategy calls for increased efforts to move towards a circular economy. Towards that end, there are a number of relevant meetings.

Creating a Circular Economy in Hawaii April 27th (6-7:30 PM ET)

This webinar is being hosted by Think BIG. It will offer participants with insight on the principles and practices of circular economics and provide an overview of how it can lead to a more sustainable Hawaii. Expert panelists from the National Stewardship Action Council, ReGen Villages, and Hawaii Federated Industries will be present.

Circularity 22 May 17-19th, Atlanta, GA

As the leading convening of professionals building the circular economy, Circularity 22 offers thought-provoking keynotes, informative breakouts, a solutions-oriented expo and engaging networking opportunities. The goal of this conference is to encourage moving beyond individual action to catalyze systems change and accelerate the circular economy. Tracks include next-gen products and packaging, bio-based solutions, policy and infrastructure, and more.

Re|Focus Sustainability & Recycling Summit May 23-25th, Cincinnati, OH

Hosted by the Plastics Industry Association, the Refocus Sustainability and Recycling Summit addresses the real-world challenges you face as your company pushes recycled content and sustainable manufacturing from goals and promises to action.

Plastic Waste Free World North America Conference and Expo June 8-9th, Atlanta, GA

The Plastic Waste Free World Conference & Expo is an international conference and exhibition for companies looking for new technologies, materials, and solutions to help realize their plastic waste targets and source the latest innovations driving the new circular economy. The event typically attracts major manufacturers, brand owners, retailers, materials experts, circular economy experts, government organizations, NGOs, the recycling industry, and the plastics sector to engage in discussions that will help reduce waste plastic in the environment. Conference tracks include: 1) Eliminating Waste Plastics, 2) Retail and Consumer Goods Packaging, and 3) Fashion and Textiles.

International Conference on Plastic Recycling and Waste Management July 21st - 22nd, Rome, Italy

International Conference on Plastic Recycling and Waste Management aims to bring together leading academic scientists, researchers and research scholars to exchange and share their experiences and research results on all aspects of Plastic Recycling and Waste Management. It also provides a premier interdisciplinary platform for researchers, practitioners and educators to present and discuss the most recent innovations, trends, and concerns as well as practical challenges encountered and solutions adopted in the fields of Plastic Recycling and Waste Management.

The Global Plastics Treaty: What You Need to Know

Originally hosted on March 16 by the Plastic Pollution Coalition, this webinar provided expert perspectives on the need and opportunity to negotiate a bold and binding global commitment to address plastic pollution and offered participants an overview of UNEA 5.2.

Microplastics: Prior CHPA environmental reports have included long lists of publications, meetings, and news reports on microplastics in the environment. This report briefly summarizes a fraction of recent work in an attempt to highlight the breadth of ongoing work. The presence of microplastics in environmental matrices have been well studied (e.g., water, soil, sediments, beaches, drinking water, etc.), were plentiful in this review period, and are not further discussed. Some recent findings:

  • Shao et al. (2022) reports on the physical and chemical characteristics, classification, spatial and temporal scale distributions, sources, transport, and environmental impacts of airborne microplastics in a literature review39.
  • Chen et al. (2022) found microplastics (> 20 μm and submicron size) in human lung tissues with most of those plastic particles found in lung tumors. Microfibers seemed to be embedded in lung tissues.
  • As the PFAS note on microplastics suggests, plastics can adsorb a variety of hydrophobic organic compounds and serve as a carrier of those chemicals, in this case introducing them into lung tissue (see above and citation 25). Note, removal in wastewater leads to higher levels of plastics in sludge which can become airborne when sludge is applied to land, dries out and winds spread dust.
  • NGO organizations like the Plastic Soup Foundation and the news media are spreading the news of plastics being found in human lung tissue40, 41.
  • Plastic particles have also been found in human blood42.
  • France became the first country to require microplastic filters on new washing machines starting in 202543.
  • Microplastics can adsorb chemicals from the environment (see PFAS above). However, this is not necessarily deleterious. Li et al. (2022) demonstrated that microplastics reduced the uptake and toxicity of a triazole fungicide in tests with zebrafish44. The chemistry of both the plastic and the contaminant are important in determining transfer from the plastic to an organism (or ‘protection’ from the contaminant).
    • Liu et al. (2022) evaluated the contribution of aged polystyrene microplastics to the total bioaccumulation of atorvastatin and amlodipine and assessed the environmental risks via experimental and model analysis. Aged particles decreased the bioaccumulation of pharmaceuticals (contributed for −2.9% and −1.2% for the total uptake of ATV, and −25.8% and −4.4% for AML) with greater reductions observed in fish (cold blooded) vs. birds (warm blooded).

Clearly, the presence of nonbiodegradable, non-natural materials, including plastic particles, in the environment is not positive. While there are some human studies suggesting effects of the plastics on various tissues and some studies have similarly shown potential adverse effects in the environment, these studies are relatively rare. Further, while plastics can serve as transport vectors for chemicals, adverse effects associated with this transport has not been demonstrated. Thus, so far, the microplastic issue appears to be more of a nuisance issue than an eminent environmental or human health risk. That said, researchers continue to study the issue and significant risks may arise for some plastic materials. The topic of microplastics in the environment is also being promoted by news agencies and NGOs and is a popular topic for scientific and regulatory/policy meetings.

Finally, during this review period the US EPA updated its 2017 expert working workshop report on Microplastic Research Needs. The report emphasizes that the 2017 priorities remain, that a significant amount of new information is available, and that it is appropriate to update the research needs going forward45.  



Exhibits ES-1 Priority Research Needs in Microplastics/Nanoplastics Research Topic

Priority Research Needs

Analytical Methods

  • Methods tailored to size range, plastic type, matrix, and research question.
  • Quality control measures to enable cross-study comparisons.
  • Methods to isolate, characterize, and measure nanoplastics.

Sources, Transport, and Fate

  • Primary data collection and modeling exercises to investigate sources of microplastics and nanoplastics and their movement throughout the environment.
  • Solutions to address the upstream sources of microplastics and nanoplastics.
  • Processes that influence movement of microplastics, such as flow, deposition, and degradation.

Environmental Assessments

  • v High-quality laboratory toxicity studies using environmentally relevant concentrations and conditions.
  • Exposure to and bioaccumulation of chemicals in tissues.
  • Characterization and impact assessment of microfibers.

Human Health Assessments

  • Development of reproducible methods to measure microplastics and nanoplastics.
  • Quantification of microplastics and nanoplastics in relevant matrices, such as drinking water, air, dust, and food.
  • Studies that quantify routes of exposure and relative risk to better characterize human health impacts.


1 Few environmental issues are associated with dietary supplements historically, and during this period.

2 Wilkinson, J.L., Boxall, A.B., Kolpin, D.W., Leung, K.M., Lai, R.W., Galbán-Malagón, C., Adell, A.D., Mondon, J., Metian, M., Marchant, R.A. and Bouzas-Monroy, A., 2022. Pharmaceutical pollution of the world’s rivers. Proceedings of the National Academy of Sciences, 119(8), p.e2113947119.

3 https://www.weforum.org/agenda/2022/02/pharmaceutical-pollution-health-drugs-rivers/

4 https://carb-x.org/carb-x-news/pharmaceuticals-in-rivers-threaten-world-health-study/

5 https://www.nbcnews.com/health/health-news/pharmaceuticals-lurking-u-s-drinking-water-flna1c9461352

6 https://www.bbc.com/news/science-environment-60380298

7 Maculewicz, J., Kowalska, D., Świacka, K., Toński, M., Stepnowski, P., Białk-Bielińska, A. and Dołżonek, J., 2022. Transformation products of pharmaceuticals in the environment: their fate,(eco) toxicity and bioaccumulation potential. Science of the Total Environment, 802, p.149916.

8 Mejías, C., Arenas, M., Martín, J., Santos, J.L., Aparicio, I. and Alonso, E., 2022. A Systematic Review on Distribution and Ecological Risk Assessment for Chiral Pharmaceuticals in Environmental Compartments. Reviews of Environmental Contamination and Toxicology, 260(1), pp.1-28.

9 Baker, B.B., Haimbaugh, A.S., Sperone, F.G., Johnson, D.M. and Baker, T.R., 2022. Persistent contaminants of emerging concern in a great lakes urban-dominant watershed. Journal of Great Lakes Research, 48(1), pp.171-182.

10 https://cosmeticsbusiness.com/news/article_page/Holland_and_Barrett_bans_chemical_sunscreen/199616

11 https://www.cosmeticsandtoiletries.com/regulations/regional/news/22105696/thailand-bans-coraldamaging-sunscreens

12 Wheate, N.J. and Ellis, A., 2022. A review of environmental contamination and potential health impacts on aquatic life from the active chemicals in sunscreen formulations. Australian Journal of Chemistry.

13 Towle, E.K., Donovan, E.C., Kelsey, H., Allen, M.E., Barkley, H., Blondeau, J., Brainard, R.E., Carew, A., Couch, C.S., Dillard, M.K. and Eakin, C.M., 2022. A National Status Report on United States Coral Reefs Based on 2012–2018 Data From National Oceanic and Atmospheric Administration’s National Coral Reef Monitoring Program. Frontiers in Marine Science, p.1999.

14 https://www.consumerreports.org/sunscreen/the-truth-about-reef-safe-sunscreen-a3578637894/

15 Downs, C.A., Bishop, E., Diaz-Cruz, M.S., Haghshenas, S.A., Stien, D., Rodrigues, A.M., Woodley, C.M., Sunyer-Caldú, A., Doust, S.N., Espero, W. and Ward, G., 2022. Oxybenzone contamination from sunscreen pollution and its ecological threat to Hanauma Bay, Oahu, Hawaii, USA. Chemosphere, 291, p.132880.

16 www.nps.gov/articles/000/idkt_sunscreen.htm

17 Yuan, S., Huang, J., Jiang, X., Huang, Y., Zhu, X. and Cai, Z., 2022. Environmental Fate and Toxicity of Sunscreen-Derived Inorganic Ultraviolet Filters in Aquatic Environments: A Review. Nanomaterials, 12(4), p.699.

18 Hong H, Adam V, Nowack, B. 2021. Form‐specific and probabilistic environmental risk assessment of 3 engineered nanomaterials (nano‐Ag, nano‐TiO2, and nano‐ZnO) in European freshwaters. Environmental Toxicology & Chemistry. 40(9): 2629 - 2639.

19 Panieri, E., Baralic, K., Djukic-Cosic, D., Buha Djordjevic, A. and Saso, L., 2022. PFAS Molecules: A Major Concern for the Human Health and the Environment. Toxics, 10(2), p.44.

20 Bednarz, V.N., Choyke, S., Marangoni, L.F.B., Otto, E.I., Béraud, E., Metian, M., Tolosa, I. and Ferrier-Pagès, C., 2022. Acute exposure to perfluorooctane sulfonate exacerbates heat-induced oxidative stress in a tropical coral species. Environmental Pollution, 302, p.119054.

21 Brase, R.A., Schwab, H.E., Li, L. and Spink, D.C., 2022. Elevated levels of per-and polyfluoroalkyl substances (PFAS) in freshwater benthic macroinvertebrates from the Hudson River Watershed. Chemosphere, 291, p.132830.

22 Ren, J., Point, A.D., Baygi, S.F., Fernando, S., Hopke, P.K., Holsen, T.M. and Crimmins, B.S., 2022. Bioaccumulation of polyfluoroalkyl substances in the Lake Huron aquatic food web. Science of the Total Environment, 819, p.152974.

23 Beale, D.J., Nilsson, S., Bose, U., Bourne, N., Stockwell, S., Broadbent, J.A., Gonzalez-Astudillo, V., Braun, C., Baddiley, B., Limpus, D. and Walsh, T., 2022. Bioaccumulation and impact of maternal PFAS offloading on egg biochemistry from wild-caught freshwater turtles (Emydura macquarii macquarii). Science of The Total Environment, p.153019.

24 Bangma, J., Guillette, T.C., Bommarito, P.A., Ng, C., Reiner, J.L., Lindstrom, A.B. and Strynar, M.J., 2022. Understanding the dynamics of physiological changes, protein expression, and PFAS in wildlife. Environment international, 159, p.107037.

25 Borthakur, A., Leonard, J., Koutnik, V.S., Ravi, S. and Mohanty, S.K., 2022. Inhalation risks of wind-blown dust from biosolid-applied agricultural lands: Are they enriched with microplastics and PFAS?. Current Opinion in Environmental Science & Health, 25, p.100309.

26 Savvaides, T., Koelmel, J.P., Zhou, Y., Lin, E.Z., Stelben, P., Aristizabal-Henao, J.J., Bowden, J.A. and Godri Pollitt, K.J., 2022. Prevalence and Implications of Per-and Polyfluoroalkyl Substances (PFAS) in Settled Dust. Current Environmental Health Reports, pp.1-13.

27 Griffin, E.K., Aristizabal-Henao, J., Timshina, A., Ditz, H.L., da Silva, B.F., Coker, E.S., Quiñones, K.Y.D., Aufmuth, J. and Bowden, J.A., 2022. Assessment of per-and polyfluoroalkyl substances (PFAS) in the Indian River Lagoon and Atlantic coast of Brevard County, FL reveals distinct spatial clusters. Chemosphere, p.134478.

28 Schroeder, T., Bond, D. and Foley, J., 2021. PFAS soil and groundwater contamination via industrial airborne emission and land deposition in SW Vermont and Eastern New York State, USA. Environmental Science: Processes & Impacts, 23(2), pp.291-301.

29 McMahon, P.B., Tokranov, A.K., Bexfield, L.M., Lindsey, B.D., Johnson, T.D., Lombard, M.A. and Watson, E., 2022. Perfluoroalkyl and Polyfluoroalkyl Substances in Groundwater Used as a Source of Drinking Water in the Eastern United States. Environmental Science & Technology, 56(4), pp.2279-2288.

30 Young, R.B., Pica, N.E., Sharifan, H., Chen, H., Roth, H.K., Blakney, G.T., Borch, T., Higgins, C.P., Kornuc, J.J., McKenna, A.M. and Blotevogel, J., 2022. PFAS Analysis with Ultrahigh Resolution 21T FT-ICR MS: Suspect and Nontargeted Screening with Unrivaled Mass Resolving Power and Accuracy. Environmental Science & Technology, 56(4), pp.2455-2465.

31 Merino, N., Qu, Y., Deeb, R.A., Hawley, E.L., Hoffmann, M.R. and Mahendra, S., 2016. Degradation and removal methods for perfluoroalkyl and polyfluoroalkyl substances in water. Environmental Engineering Science, 33(9), pp.615-649.

32 Woch, J., Małachowska, E., Korasiak, K., Lipkiewicz, A., Dubowik, M., Chrobak, J., Iłowska, J. and Przybysz, P., 2022. Barrier Dispersion-Based Coatings Containing Natural and Paraffin Waxes. Molecules, 27(3), p.930.

33 Zodrow, J., Vedagiri, U., Sorell, T., McIntosh, L., Larson, E., Hall, L., Dourson, M., Dell, L., Cox, D., Barfoot, K. and Anderson, J., PFAS Experts Symposium 2: PFAS Toxicology and Risk Assessment in 2021 and risk assessment in 2021—Contemporary issues in human and ecological risk assessment of PFAS. Remediation Journal.

34 https://www.epa.gov/newsreleases/epa-continues-take-actions-address-pfas-commerce

35 https://www.epa.gov/pfas/epa-actions-address-pfas

36 https://www.ecos.org/wp-content/uploads/2022/03/Standards-White-Paper_Updated_V3_2022_Final.pdf

37 https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=202120220AB1817

38 https://www.nrdc.org/stories/forever-chemicals-called-pfas-show-your-food-clothes-and-home

39 Shao, L., Li, Y., Jones, T., Santosh, M., Liu, P., Zhang, M., Xu, L., Li, W., Lu, J., Yang, C.X. and Zhang, D., 2022. Airborne microplastics: A review of current perspectives and environmental implications. Journal of Cleaner Production, p.131048.

40 https://www.plasticsoupfoundation.org/en/2021/10/what-is-in-the-air-around-us/

41 https://www.world-today-news.com/for-the-first-time-they-found-plastic-in-the-lungs-of-living-people-it-enters-with-dirty-air/

42 Leslie, H.A., Van Velzen, M.J., Brandsma, S.H., Vethaak, D., Garcia-Vallejo, J.J. and Lamoree, M.H., 2022. Discovery and quantification of plastic particle pollution in human blood. Environment International, p.107199.

43 https://blog.planetcare.org/france-microfibre-filters-washing-machines/

44 https://blog.planetcare.org/france-microfibre-filters-washing-machines/

45 Release of TFW Report on Priority Microplastics Research Needs: Update to the 2017 Microplastics Expert Workshop.