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The report documents systematic pharmaceutical pollution in India, particularly in the bulk drug manufacturing hubs of Hyderabad and Visakhapatnam. It argues that the discharge of active pharmaceutical ingredients (APIs) into waterways contributes to the global threat of antimicrobial resistance (AMR) and causes severe local health and environmental degradation. The document highlights a failure of regulatory oversight and a lack of supply chain transparency, which allows multinational pharmaceutical companies to outsource production to polluting sites without accountability. It recommends integrating environmental standards into the Good Manufacturing Practice (GMP) framework and increasing transparency in supplier relationships.