Uppsala leads international efforts to tackle pharmaceutical pollution

Modern pharmacy is central to healthcare’s growing ability to cure disease and save lives. Yet this success brings risks: when drugs leave the body or are disposed of incorrectly, they can reach the environment and cause effects other than those intended. Addressing this complex challenge requires global collaboration, and several cross-border initiatives are now emerging from the Faculty of Pharmacy.

“In both local studies and international surveys, conclusions are unambiguous. Many of today’s drugs are so potent that even low concentrations can affect entire ecosystems. Therefore, Uppsala's almost unique breadth of expertise in human and veterinary medicines – including two universities, the Swedish Medical Products Agency and the Swedish Veterinary Agency – gives us both the resources and responsibility to take a frontline position,” says Björn Wettermark, Professor of Pharmacoepidemiology.

A collaboration that is already yielding results is Bridging Waters, where Uppsala University and the University of the Highlands and Islands are jointly focusing on the Scottish Highlands and the Swedish island of Gotland: two environments that are periodically exposed to intensive tourism and pressure on both healthcare and sewage systems. Today, new recommendations for sustainable prescribing and use of drugs are being finalised – while at the same time, the next collaboration is being rolled out with the aim of reducing pharmaceutical substances in the Baltic Sea.

“The Baltic Sea region is a sensitive marine environment that faces multiple challenges with potential impacts on biodiversity. Knowledge needs are great, not least regarding how residues of the thousands of prescribed drugs affect local ecosystems. Therefore, we are now bringing together eight universities and authorities in four Baltic Sea countries to chart the course towards sustainable development,” says Marmar Nekoro, PhD student at the Department of Pharmacy.

In the project Reducing Pharmaceutical Pollution in the Baltic Sea Region, the network will jointly conduct surveys and analyses of implemented interventions. The results will be translated into recommendations and communicated to regulatory authorities and policy-making bodies. Along the way, the parties hope to establish branches in all Baltic Sea countries and lay the foundation for a collaboration that will last far beyond the two years of initial funding from the Swedish Institute.

“This is an urgent issue that affects everyone. Globally, drugs in the environment are climbing the UN and WHO agendas for a sustainable planet. In Europe, the EU's new directive for wastewater treatment plants places great emphasis on drug residues. At a national level, we recently lectured to 600 doctors about the role of healthcare in limiting the number of pharmaceuticals in the environment which was met with great interest – ​​and the more we address this subject, the more people will listen,” says Björn Wettermark.

In Uppsala, the bridge between research and regulatory bodies is also being strengthened. In collaboration with the Swedish Medical Products Agency's relatively newly established unit focusing on veterinary drugs in use, Marmar Nekoro is conducting a study with the aim of increasing our understanding of how prescribing antiparasitic drugs for pets can can affect the environment and add to the development of resistance.

“The Swedish University of Agricultural Sciences also participate in this work, and that we in Uppsala have access to both breadth and cutting-edge expertise along the entire One Health perspective gives us the conditions we need. And that an increasing number of European countries are creating education and initiatives to raise the issue on political and regulatory agendas shows that a positive change is indeed within reach,” states Marmar Nekoro.

text: Magnus Alsne, photo: Mikael Wallerstedt a o