Milieuafwegingen in de geneesmiddelvoorziening (Dutch only, English synopsis)
RIVM Report 2016-0207
The RIVM tries to identify opportunities to reduce the impact of pharmaceutical residues on the environment. We interviewed representatives of professionals from the medicinal product chain, such as policy makers, manufacturers, assessors, health care providers, pharmacists and water managers. These interviews focused on the substitution of certain drugs by treatments that are less harmful to the environment. In practice no combinations were found yet that qualify for this.
All professionals interviewed were willing to consider substituting treatments, but at the same time emphasized that the patient's interest is of first importance. The patient's treatment must stay qualitatively the same, which means the substitute must at least be equally effective and safe. In practice, for many pharmaceuticals this proves not yet possible. Moreover, the environmental benefits must be substantiated. For many pharmaceuticals environmental data are lacking. There is a need for a framework to compare effectivity, safety and environmental effects of pharmaceuticals.
The importance attributed to the environment in relation to the health care sector varies between the professionals. To address this importance, it is paramount that professionals within this sector become aware of this. Knowledge exchange can be an important means to increase awareness, both in the medicinal product chain and in the society.
Pharmaceutical residues end up in surface water via the sewer system, among other things because sewage treatment plants are unable to remove all residues. These residues may have harmful effects on organisms in the aquatic environment, such as behavioral changes, tissue damage and reproductive effects. The drinking water quality is not affected, but this may become a problem in the future.
This study is performed on behalf of the Ministry of Infrastructure and Environment and is part of the chain approach 'Medicijnresten uit Water' (Pharmaceutical residues out of Water).