New thesis shows the way to reduce pharmaceuticals in the environment

Modern pharmacy is a key factor behind healthcare’s increasingly advanced abilities to treat diseases and save lives. At the same time, the high potency of pharmaceuticals means that they, even in small concentrations, can cause far more widespread effects than those designed for. Every year, tons of pharmaceutical residues reach the Swedish environment, where they risk causing far-reaching effects on entire ecosystems, and in a new thesis at Uppsala University, Johanna Villén highlights how healthcare employees can contribute to an improvement.

“There are countless examples of the negative consequences of drugs in the environment. In India and Pakistan, the use of the vulture-toxic drug diclofenac in livestock has led to a 95 percent decline in the vulture population. This has, in turn, contributed to an increase in feral dogs, resulting in the wider spread of rabies. Other studies show how fish experience behavioral changes and impaired reproductive abilities. Obviously, we must set a new direction, and in my research, I study the role of healthcare and the measures and tools required to take that first step,” says Johanna Villén, PhD student at the Department of Pharmacy.

In one study, a number of experts assess the decision support that Janusinfo and FASS provide in the aspect of drugs and the environment. Many describe both platforms – especially Janusinfo – as useful and transparent. At the same time, apparent limitations are identified, including unclear regulations and insufficient environmental data regarding available drugs. A shortcoming that might be explained by the industry not being required to publish the environmental impact expected from new drugs.

“I have also studied how general practitioners and pharmacy staff view their role in implementing environmental perspectives when prescribing and consuming drugs. Their respons confirm a widespread ambition to contribute to increased sustainability, but also point out several perceived obstacles. Doctors must take into account medical needs, user-friendliness, costs and a number of other factors. Pharmacies aim to guide their customers via advice and encouragement to correctly dispose of unused drugs, and common among these groups is that they see their influence as limited.”

The conclusion that Johanna Villén presents is that joint efforts at parallel levels are key to achieving lasting change. Legislation and governance are required at global and national levels to ensure sustainable choices. Regulatory authorities must provide updated decision support with transparent criteria. Infrastructures for wastewater treatment need to be developed and in healthcare and pharmaceutical education, the environmental perspective should be given a more prominent place.

“Swedish Master of Science in Pharmacy programmes are gradually improving, but there is still great potential to do even better. At Uppsala University, we now offer the course Drugs in the Environment, which has in short time become one of our Faculty's most sought-after courses. Here we truly experience the great commitment that surrounds the challenge we encounter, and the fact that many participants, after completing the course, emphasize that the content should be mandatory in every pharmaceutical education gives hope for the future.”

Text: Magnus Alsne, photo: Mikael Wallerstedt