Johanna Villén: Pharmaceuticals in the environment - perspectives on drug utilisation and mitigation strategies

Abstract

The environmental impact of pharmaceuticals has emerged as a critical concern. As global pharmaceutical consumption steadily increases, the environmental issues linked to their production, use, and disposal are becoming ever more pressing. This thesis aimed to study drug utilisation in relation to environmental risk and to explore the role and responsibility of healthcare professionals in reducing the environmental impact of pharmaceuticals. The focus was on promoting environmentally informed pharmaceutical use, emphasising use-oriented measures and the roles of various healthcare stakeholders. Four interconnected studies were conducted: an analysis of analgesic sales in the region surrounding Lake Mälaren to investigate use patterns of substances with environmental concern (Paper I); interviews with key decision makers representing Swedish national and regional authorities, the pharmaceutical industry, research institutes, and academia to evaluate the content, use, and impact of two Swedish environmental knowledge support systems for pharmaceuticals (Paper II); a national questionnaire to general practitioners exploring attitudes towards integrating environmental aspects into prescribing decisions (Paper III); and focus group discussions and individual interviews with community pharmacy staff on their role in reducing the environmental impact of pharmaceuticals (Paper IV).

The findings reveal that awareness of pharmaceuticals as an environmental problem exists within healthcare, however, important prerequisites for integrating environmental aspects into practice are still lacking. Access to reliable environmental risk data for many active pharmaceutical ingredients remains limited, decision-making criteria are often unclear, and there is little concrete guidance on how to incorporate environmental considerations into everyday clinical routines.

Healthcare professionals are essential in promoting environmentally informed pharmaceutical use. Physicians and pharmacists both consider themselves to have a role and responsibility in promoting more environmentally informed use of pharmaceuticals. Their contributions include preventing pharmaceutical waste and supporting pharmaceutical stewardship. However, there is a need for education and institutional support in enabling them to take action.

Findings show that addressing pharmaceutical pollution requires action beyond the efforts of individual healthcare professionals. Strong governance and clear direction, both at the national and international levels, are essential to enable change. Environmental considerations should be systematically integrated into established decision-making structures, such as treatment guidelines, so that sustainable choices become the default rather than the exception.

By combining analyses of pharmaceutical sales data with insights into healthcare professionals’ attitudes, drug utilisation studies can generate the evidence base needed to support the systematic and broadly accepted inclusion of environmental considerations in healthcare.