Pharmaceuticals and the environment

How medicinal substances end up in the environment

Medicinal substances can end up in the environment at all stages of the medicine’s life cycle. They reach the environment from a wide range of sources, such as wastewater from industry, hospitals and households, medicines that have been disposed of improperly and emissions from the medication of production animals. Medicinal substances are increasingly ending up in the environment as population growth and ageing increase the consumption of medicines and the amount of pharmaceutical residues.

In Finland, direct emissions from industrial production of medicines only cause a small proportion of the pharmaceutical residues that burden the environment. In Western countries, most of the environmental residues of medicines are caused by proper use of pharmaceuticals for human use. After taking the medicine, the medicinal substances or their metabolites are discharged into wastewater in urine and faeces. In addition, medicinal substances in pain relieving gels applied to the skin are flushed off the skin with the washing water and into the drain. Wastewater treatment plants cannot filter all pharmaceutical residues or render them harmless, which means that pharmaceutical residues end up in sewage sludge or in bodies of water untreated.

Environmental harm/risk of pharmaceuticals

The adverse effects of pharmaceuticals in the environment are diverse. Pharmaceutical residues have been found to cause e.g. reproductive and behavioural disorders in fish. In addition to aquatic organisms, pharmaceutical residues can also cause adverse effects in soil organisms. For example, antibiotics can increase the number of bacteria resistant to antibiotics in the environment, which may have an effect on the increase in antibiotic resistance. Antibiotic resistance has been found to be one of the largest global health threats. The total environmental load caused by pharmaceuticals cannot yet be fully assessed, as not all adverse effects caused by pharmaceutical residues in the ecosystem are yet known.

Legislation

The environmental criteria for pharmaceuticals are taken into account at different stages of the life cycle of a medicine by means of national decrees and regulations as well as international guidelines. In the EU, environmental risk assessments of pharmaceuticals for human use have been carried out for new pharmaceuticals since 2006. The environmental risk assessment of pharmaceuticals is carried out in accordance with the guidelines prepared by the European Medicines Agency (EMA) in 2006, an updated version of which will be published in 2024.

According to the guidelines, the use of medicinal substances for human use cannot be prohibited on the basis of environmental risks, but the assessment helps predict the risk of environmental emissions. However, for most of the pharmaceuticals authorised before 2006 there is no environmental risk assessment information, as no risk assessment is required for the renewal of the marketing authorisation. For veterinary medicines, environmental risk assessment is part of the benefit-risk assessment based on which marketing authorisation is granted. Environmental risk assessment has been carried out for all veterinary medicines authorised in Finland.

In 2019, the EU published a strategic communication on pharmaceutical residues in the environment. The Commission communication sets out measures to prevent the harmful effects of medicinal substances on the environment throughout the life cycle of the pharmaceutical. These include improving the environmental risk assessment of pharmaceuticals, reducing pharmaceutical losses and improving the efficiency of wastewater treatment.

Reducing pharmaceutical and packaging waste

Pharmaceutical waste cannot be completely prevented, but waste reduction can be promoted through appropriate use of medicines. It is good to purchase medicines in suitable batches according to the actual need for use. For example, when starting pharmacotherapy, a small starter package can be selected and a larger package only as the pharmacotherapy is established. It is important to use prescription medicines in accordance with the physician’s instructions. The dosage of over-the-counter medicines should be checked on the medicine package or package leaflet.

Handling pharmaceutical and packaging waste

In Finland, pharmaceutical waste is classified as hazardous waste, as it is harmful to humans, animals and the environment. Pharmaceutical waste management involves cooperation between the municipality, pharmacies and waste treatment plants. Pharmacies serve as collection points for pharmaceutical waste, where the consumer is entitled to leave pharmaceutical waste generated in households free of charge.

One of the most important environmental actions of a medicine user is taking unused and expired medicines to a pharmacy. In Finland, the appropriate disposal of medicines is working well, as most of the population brings pharmaceutical waste to the pharmacy for disposal. However, unused medicines are not always identified as pharmaceutical waste, which is why some of the population disposes of pharmaceutical waste incorrectly in household waste or down the drain. Residues left in pharmaceutical packaging such as bottles, or residues of cream-like medicines and inhalation powders, are also pharmaceutical waste. They must also be taken to a pharmacy’s pharmaceutical waste collection point.