Through an integrated approach, RIVM aims to create awareness on the relationship between the human health sector and the environmental sector. RIVM has mapped the relationships between medicinal product use and its discharge in the environment. To this end, RIVM has described in detail the processes that medicinal products go through, from development, market authorisation, production, buying and selling by pharmacies, prescription by physicians, use by patients, collection of medicine waste, until discharge and their fate in to the environment (the so-called medicinal product chain). RIVM identified potential levers in each phase of the medical product chain to reduce the amount of residues entering the environment. Which (combination) of levers results in an optimal balance between environment and human health and proves to be feasible, is yet to be investigated.
RIVM divided the suggested potential levers into two categories: information exchange within the medicinal product chain, and financial feedback mechanisms. For example, information on environmental toxicity could be incorporated in the development process of new medicinal products. (Drinking)water companies, in turn, could use information on properties of compounds when optimising their treatment facilities. Information on environmental fate and impact could be taken into account by health care workers and patients in their choice for specific medicinal products. A possible financial feedback mechanism is to account for the cost for removal of medicinal product residues in the beginning of the chain. Financial incentives could also be used to stimulate the return of unused or out-of-date medicinal products to the pharmacy.