The presence of medicine residues in Northwest European water bodies is a growing concern, worsened by an ageing population and climate change. Medicine residues are an increasingly important source of water pollution across Europe. After use, parts of the medicines leave the body unchanged or as metabolites (partially broken down). These leftovers can ultimately enter waste water and surface waters. Exposure to these residues is linked to abnormalities in aquatic life, the development of antibiotic resistance, and potentially even threats to human health.

Currently, there’s a lack of collaboration between the water and healthcare sectors in the Northwest European region, resulting in strategies not aligned to effectively reduce medicine residues. This first pillar, in a series of three, aims to develop and implement a transnational strategy (to be operationalized through four regional action plans) to sustainably reduce medicine residues in the water bodies of Northwest Europe. 

A framework to identify high priority medicines

We aim to develop a framework to identify a top tier list of high priority medicines for monitoring and mitigation actions. Among the thousands of medicinal products authorized across Europe, some substances have been identified as pollutants of concern. These have been included in either the EU Water Framework Directive’s Priority Watchlist or in the EU Watch List for monitoring in surface waters. However, other medicines not included on these lists, might still pose a risk to water quality. This is because of their frequent use or high toxicity to the environment. Due to a lack of data, it’s currently difficult to determine which medicines are most important to monitor and how to efficiently reduce their emissions into water. By creating a framework to identify high-priority medicines, we can focus our efforts where it matters most. 

A toolkit for the pharmacy sector

Our findings will be implemented into a toolkit with mitigation strategies tailored for the pharmacy sector. The toolkit will be supported by anonymously aggregated medicine dispensing data and citizen surveys. This will help estimate actual medicine use by patients and clarify the volume of unused dispensed medicines.

At source water purification

All the input gathered at this point will contribute to our next step. In this activity, we will map the current approaches to water quality assessment and monitoring across the different regions. We identify the best available source-based water purification techniques, since purifying water close to the source of pollution can help reduce or prevent medicine residues from entering water bodies

Strategies and action plans

The report developed in this activity will serve as a basis for recommending effective and sustainable technological mitigation strategies. The report is directed at regional authorities to reduce water pollution at the source, for example in healthcare institutions. Pharmaceutical pollution affects health- and environmental sectors through reduced quality of life and increased societal costs. Because of this, our recommendations will be supported by a report presenting a framework for the health-economic assessment of pharmacy-oriented mitigation strategies

Prof. dr. Eelko Hak

Prof. dr. Eelko Hak is a professor of pharmacoepidemiology from the University of Groningen, he leads Pillar 1 and has been leading pharmacy-related environmental research since 2019.