Nordic Life Science 1
ENVIRONMENT // CWPHARMA 66 The annual global warm
ing potential of implementing enhanced technologies in all wastewater treatment plants of more than 50,000 connected persons was estimated to be 370,000 t CO2eq (Äystö and Stapf, 2020), which is approximately 0.6% of the total greenhouse gas emissions from the Baltic States (Crippa et al. 2021). A ccording to our studies in the CWPharma project, the Baltic Sea environment pharmaceutical burden could be reduced also by simply increasing the sewer network coverage. In all the countries in the Baltic Sea region, the vast majority of domestic wastewater is treated. However, there are still some countries, such as Russia, where the fraction of treated domestic wastewater is still as low as 67 percent (UNICEF and WHO, 2019). We all know that untreated wastewater released into the environment raises hygienic concerns, but it also increases API load into the environment. Our estimation is that if all wastewater generated within the Baltic Sea region was treated using a conventional activated sludge process, the loads of certain APIs, such as ibuprofen, could be decreased drastically (Äystö and Stapf, 2020). Making environmentally wise prescriptions easier Due to their undisputable benefits, APIs cannot be banned in the same way as some industrial chemicals or pesticides. However, there are attempts to decrease the use of environmentally problematic substances, without compromising patient safety or the quality of care. In Sweden an environmental classification of pharmaceutical substances (www.janusinfo.se and www.fass.se) has been in place for nearly 20 years helping doctors and pharmacist to make environmentally wise choices whenever possible. A similar system is in place also in Norway and has recently been implemented in Finland. Environmental classification could optimally result in pharmaceuticals with high environmental burden being replaced with less problematic ones. Reducing the consumption of environmentally risky pharmaceuticals would directly reduce their load into the environment. Moreover, it could relieve the pressure for enhanced wastewater treatment. Another economically reasonable way of reducing pharmaceutical load into the environment is to reduce the amount of unused pharmaceuticals. This would also help to cut the price tag of waste management. Unused pharmaceuticals unnecessarily increase API load into the environment during their production and waste management. Furthermore, society pays reimbursement costs also for the medicines that will not be used. Waste management and separate collection practices for unused pharmaceuticals vary within the Baltic Sea region. In countries such as Finland and Sweden, separate collection works well (Louhisalmi et al., 2020; Mehtonen et al., 2020), but there are also countries like Russia and Poland where separate collection functions poorly or does not exist at all. Work on many fronts The effects of pharmaceuticals in the environment are acknowledged widely, and actions towards better emission management are already taking place. Recent developments in this area include two important directive proposals by the European Commission. Firstly, a group of APIs have been proposed as priority substances in the Water Framework Directive. This would bring along legally binding environmental quality standards (“safe concentrations”) for surface waters, and in some cases for groundwater as well. This change would speed up actions to reduce API emissions into the environment, as exceeding the environmental quality standards would mandate countries to act. Secondly, there is the proposal for the updated Urban Wastewater Treatment Directive. This update would require the implementation of further wastewater treatment steps to eliminate micropollutant emissions (APIs included), along with increased micropollutant monitoring schemes. B NLS etter understanding of the environmental risks related to pharmaceutical residues has spurred a growing interest in green pharmacy, which can already be seen in university curriculums. This new generation of professionals will attempt to combine environmental friendliness and API design. The currently ongoing and proposed actions will decrease the environmental load of APIs in the future. Meanwhile, we can all do our best to treat our pharmaceutical waste properly and avoid unnecessary medication. ENVIRONMENT // COMMENTARY