Prioritizing Pharmaceuticals for Environmental Monitoring in Greece: A Comprehensive Review of Consumption, Occurrence, and Ecological Risk

Pharmaceuticals are increasingly recognized as contaminants of emerging concern, yet monitoring strategies often do not reflect actual consumption patterns or ecological risk. Greece presents a particularly relevant case due to high pharmaceutical use and fragmented monitoring data. In the present study, 359 pharmaceuticals, metabolites, and transformation products were reviewed, as reported in monitoring studies in Greek wastewater, surface waters, and drinking water. Consumption data (from the Organization for Economic Co-operation and Development, OECD), environmental occurrence (from 55 studies), and ecotoxicity thresholds (i.e., from the NORMAN Database) were integrated to calculate risk quotients (RQs) and assess monitoring gaps. RQ values were derived for 241 compounds: 38 (16%) high-risk, 60 (25%) medium-risk, and 143 (59%) low-risk. High-risk substances included several NSAIDs, macrolide and fluoroquinolone antibiotics, synthetic hormones, contrast agents, and triclosan. Major under-monitoring was observed for widely consumed classes A and B, while antibiotics, NSAIDs, antidepressants, and analgesics were disproportionately targeted. Several metabolites showed higher RQs than their parent compounds but were rarely analyzed. These findings reveal significant mismatches between pharmaceutical use, environmental occurrence, and ecological risk in Greece. Results support adopting risk-based prioritization for environmental monitoring and align with ongoing updates to EU water policy.