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National Institute for Public Health and the Environment, Ministry of Health, Welfare and Sport

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Pharmaceutical product chain

Pharmaceuticals in the environment

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.

Researcher at the pharmaceutical industry Assessment of medication Pharmacy Doctor or specialist prescribes medication Disposal of medication in household waste Person in the toilet Pharmacy takes back unused medication Garbage truck Sewage installation Waste mountain Waste incineration plant Tractor working the land Person at a clean river Incineration plant for minor chemical waste Clean and fresh water from the tab
A: Development and production of pharmaceutical products

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:

  • Pharmaceuticals with favourable environmental properties could be prioritised in pharmaceutical development.
  • Pharmaceutical industry could provide environmental data of their products publicly.
  • Market demand could be influenced by creating citizen awareness.
B: Admission to the market

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:

  • Environmental consequences and the availability of environment-friendly alternatives could be taken into account when deciding on market allowance and over-the-counter availability.
  • Information on environmental effects could be included in package leaflets and green labels on packages.
C: Purchase and sale of pharmaceuticals by pharmacies

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:

  • Consequences of pharmaceutical use for the environment could be included in the training of pharmacists and doctors.
  • Insurers could be obliged to take into account not only price but also environmental aspects in their decision whether or not to reimburse certain pharmaceuticals.
D: Prescription and use of pharmaceuticals

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 could make changes in their lifestyle or diet.
  • Physician professional organisations could include environmental aspects in guideline development.
  • The amount of pharmaceuticals issued to the patient could be optimized.
  • Pharmacists could include information about environmental aspects and appropriate manners of disposal in the user information they provide to the patient.
E: Disposal of pharmaceuticals in household waste

Patients with unused and/or expired pharmaceuticals may choose to dispose of them by throwing them in the garbage.

Examples of potential measures:

  • Patients could take unused and/or expired pharmaceuticals to a collection point for minor chemical waste or bring it back to the pharmacy.
  • Guidelines or legislation for disposal of unused and/or expired medication could be developed.
F: Discharge of pharmaceutical residues through the sewer system

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:

  • Patients could be educated why disposal through the toilet or sink is not the preferred way of disposal of unused and/or expired medicinal products.
  • Patients could take unused and/or expired pharmaceuticals to a collection point for minor chemical waste or bring it back to the pharmacy.
  • Patients could use special toilets or urine bags for separate collection of urine after use of pharmaceuticals with known environmental effects.
G: Collection of unused pharmaceuticals

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:

  • Financial barriers for the collection of unused and/or expired pharmaceuticals by pharmacies could be eliminated.
  • Pharmacists and researchers could examine the possibilities to reissue returned unused pharmaceuticals.
  • Municipalities organise a good take-back system for minor chemical waste.
H: Collection and processing household waste

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.

I: Purification of wastewater

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:

  • Wastewater treatment plants could include additional treatment steps, and more advanced purification techniques could be developed.
  • In order to prevent leakages and overflow, the type and maintenance of the sewage system could be optimized.
  • Hospitals could purify their waste water on-site.
J: Household waste is landfilled

In many European countries municipal waste is being landfilled. This is not the case in The Netherlands.

K: Household waste and sewage sludge is incinerated

In the Netherlands, all household waste is incinerated. Most of the sewage sludge is also incinerated.

L: Sewage sludge is landfilled or applied in agriculture

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.

M: Purified wastewater is discharged onto surface waters

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.

N: (Minor) chemical waste is incinerated

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.

O: Drinking water companies deliver drinking water

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:

  • Drinking water companies could keep investing in purification methods.



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