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RIVM has knowledge how to save costs and how to avoid risks in regard to the whole pharmaceutical product chain, from prevention of discharge of pharmaceuticals in the environment to purification of drinking water.
The pharmaceutical industry, together with university researchers, develops new pharmaceuticals. This is driven by factors such as market and societal demand, financial considerations and legislation. The pharmaceutical industry also produces the pharmaceuticals.
Examples of potential measures:
European and national medicine agencies assess efficacy and safety of pharmaceuticals and decide whether pharmaceuticals can be registered and allowed on the market. After registration, the national registration authority determines whether a pharmaceutical can be sold by prescription only or over-the-counter. In the Netherlands, a third step constitutes the decision whether the product will be reimbursed by health care insurers. Examples of potential measures:
Pharmacists consult with doctors and hospitals in their area, which pharmaceuticals should be prescribed preferably, when there is a choice between different alternatives. Besides this, the purchase of pharmaceuticals is affected by pricing policies of drug manufacturers and reimbursement policies of insurance companies. Examples of potential measures:
The choice which pharmaceutical is used by a patient may be influenced by the physician, pharmacist and health care insurer. Prescription behaviour of a physician is, amongst others, influenced by guidelines, experience with a pharmaceutical and patients’ expectations. The pharmacy dispenses the pharmaceutical to the patient, along with the appropriate user-information. Health insures can influence pharmaceutical use with their reimbursement policy. Examples of potential measures:
Patients with unused and/or expired pharmaceuticals may choose to dispose of them by throwing them in the garbage.
Examples of potential measures:
Pharmaceutical residues may be excreted into the toilet with the patient’s urine or faeces. Furthermore, patients might dispose of unused and/or expired pharmaceuticals through the toilet or the sink. Examples of potential measures:
In many countries, pharmacists are not required legally to take back unused and/or expired pharmaceuticals, but many pharmacies do provide their patients this service. In The Netherlands collection and treatment of minor chemical waste is the responsibility of a municipality. Examples of potential measures to reduce the amount of pharmaceuticals in the environment are:
Municipalities are responsible for the collection and processingc of household waste; they usually outsource this task to a waste company. Household waste can be processed in two ways: it can be incinerated or landfilled. In the Netherlands, only the first option is used. Household waste is incinerated at lower temperatures than chemical waste.
Wastewater is transported through the sewer system to a sewage treatment plant. These plants have not been designed for the removal of pharmaceutical residues. In the Netherlands, an average reduction of up to 65% of the concentration of pharmaceutical residues is achieved. However, some pharmaceuticals are not removed at all. To improve removal of the remaining residues, additional purification steps may be required. After the treatment process, the purified wastewater is discharged onto surface waters. The sludge is either incinerated, landfilled or applied in agriculture. In the Netherlands, the latter two routes are not relevant.
Examples of potential measures:
In many European countries municipal waste is being landfilled. This is not the case in The Netherlands.
In the Netherlands, all household waste is incinerated. Most of the sewage sludge is also incinerated.
In many countries, sewage sludge can be applied in agriculture as a fertilizer. It may also be landfilled. Both options are not relevant in the Netherlands, because of specific legislation.
The treated wastewater is discharged onto surface waters. Although this wastewater is purified, it still contains pharmaceutical residues. Via surface waters, these residues enter other environmental compartments such as groundwater and soil.
Pharmaceutical waste is classified as minor chemical waste in the Netherlands. This means it needs to be collected separately from general household waste and incinerated at higher temperatures.
The drinking water company is responsible for the delivery of high quality drinking water. This drinking water originates from either surface water or groundwater. To remove pharmaceutical residues from surface or groundwater, drinking water companies have to purify the surface water or groundwater. A potential measure: