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The Baltic Sea region’s waste management for unused medicines must be improved

Press release 2020-09-03 at 8:00
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In Finland, about two thirds of residents return their unused medicines to pharmacies, which are the designated collection points for household medicine waste. © Katja Lötjönen / Association of Finnish pharmacies

Of the measures to reduce emissions of active pharmaceutical ingredients (APIs), improving the take-back and treatment of pharmaceutical waste is considered low-hanging fruit. However, comparable information about the collection, take-back, and treatment practices in the various Baltic Sea countries has not been available. That has now changed.

CWPharma, a project funded by the EU’s Interreg Baltic Sea Region Programme, has evaluated national-level practices for take-back and disposal of unused medicines and other pharmaceutical waste, for better understanding of the overall API situation in the region. The project investigated pharmaceutical waste from households, hospitals and other health-care institutions, the pharmaceutical industry, veterinary practices, and farms.

‘We have evaluated current practices in Denmark, Estonia, Finland, Germany, Latvia, Lithuania, Poland, Russia, and Sweden, with the aim of improving national practices and thus reducing pharmaceutical-related emissions to the Baltic Sea,’ explains Senior Expert Jukka Mehtonen, with the Finnish Environment Institute, the leading partner in the project.

Improper disposal of medicines is all too common

The return of unused medicines to collection points varies greatly between Baltic Sea countries. The proportion of citizens who return their unused pharmaceuticals to designated collection points ranges from 10% to 70% depending on the country. Anywhere from 16% to 80% of survey respondents included their unused medicines in mixed household waste and 3–30% flushed them down the drain (Table 1 presents some of the figures). The most commonly cited reason for households’ inappropriate disposal of medicines is a lack of information on their environmental impacts and about environmentally sound disposal methods.

In some countries, dedicated collection of unused pharmaceuticals from households still lacks systematic organisation, or it may even be non-existent as is the case in Russia. Also, some national collection schemes function poorly. Latvia, Lithuania, and Poland are examples. In Germany, mixed household waste is often incinerated (though usually at temperatures not considered as high temperature incineration), so people are instructed to dispose of their unused pharmaceuticals with mixed household waste if incineration is performed. Otherwise, disposing of these pharmaceuticals via mobile collection vehicles or at recycling centres is recommended in Germany.

It is clear, that the implementation of take-back for unused medicines is highly heterogeneous, both in the Baltic Sea region and across EU member states in general.

 

Table 1: A summary of how citizens dispose of unused pharmaceuticals in some of the countries studied
 
Country and year of assessment Percentage of respondents who return unused pharmaceuticals to pharmacies or hazardous‑waste collection points Percentage of respondents who flush unused pharmaceuticals down the drain Percentage of respondents who dispose of unused pharmaceuticals with mixed household waste
Finland, 2009–2010 60–80% 3 % 16 %
Latvia, 2012 & 2014 6–10% 5–12 % 41–62 %
Lithuania, 2013 10–13% no information 50–64 %
Poland, 2015 5–8% 24–33 % 57–60 %
Sweden, 2011 & 2012 69–75% ≈ 17 %* ≈ 17 %*
Russia, 2013 no information 15 % 80 %

Comparable information is not available from some Baltic Sea countries.
* In Sweden ≈ 17 % of the respondents flushed medicinal waste down the drain or disposed of unused pharmaceuticals with mixed household waste. 

Information on unused veterinary medicines is less readily available than similar details for human-use ones and take-back is usually organised better for the latter than for veterinary pharmaceuticals. Veterinary pharmaceutical waste in the Baltic Sea region is currently either collected by veterinarians with other types of veterinary waste, returned to local collection points (pharmacies etc.) by farmers themselves or under contract with a waste operator, or disposed of directly as municipal waste.

How can API emissions be reduced?

The CWPharma project identified 21 solid practices for take-back and disposal of pharmaceutical waste and for promoting rational use of pharmaceuticals in the Baltic Sea region. Their national implementation elsewhere in the region does require careful consideration on account of differences in national legislation – for example, between Russia and those Baltic Sea countries in the EU. Nonetheless, the report provides a valuable starting point. The good practices it identifies answer the call for an EU strategic approach aimed at efficient risk reduction.

One of the main recommendations is that citizens be able to take all unused medicines – both prescription pharmaceuticals and over-the-counter ones – to a designated collection point such as the site where it was purchased (often pharmacy) or a hazardous-waste collection point. This should enable the unused medicines to be disposed of properly. The procedure is simple to remember and makes things easy enough for citizens. The same approach should be used for companion animals’ medicines.

For pharmaceutical waste generated in hospitals, the most efficient procedure is for hospitals to collect their own waste and send it directly to waste-treatment facilities. Hospitals in the Baltic Sea region already employ this practice. However, other health-care institutions, such as private clinics, retirement homes, and facilities providing assisted-living services or institutional care, should also have centralised collection in place for their pharmaceutical waste.

The report recommends giving farmers the option of returning unused veterinary medicines in conjunction with a veterinarian´s regular visits and giving veterinarians the permission to charge collection and waste management costs. Additionally, when the amount of unused veterinary medicines is large, the farmer should be responsible for organising delivery for appropriate handling just as pharmacies and hospitals do. While small amount of unused medicines should be returnable with unused household medicines, in the same way and to the same collection points.

The report also recommends information campaigns on the environmental effects of pharmaceutical emissions and how unused medicines can be handled appropriately, targeting citizens but also medical doctors, veterinarians, and farmers. These professionals play a key role in helping implement many of the good practices identified by the CWPharma project.

In general, high-temperature incineration, at around 1100–1300 °C, is the recommended method for treating unused medicines and other pharmaceutical waste, unless a lower temperature provably transforms the active ingredients into non-hazardous substances irreversibly.

In addition, the CWPharma project recommends that pharmacy staff and veterinarians instruct customers in the safe use and disposal of medical products when they provide pharmaceuticals.

What are the project’s next steps?

This autumn, the CWPharma project will issue its guidance on practices for improving dissemination of environmental information for pharmaceuticals and environment‑permit procedures for pharmaceutical plants. Furthermore, the project will provide guidelines on advanced wastewater treatment options designed for reducing API emissions and publish an overall plan for policy actions to reduce these emissions in the Baltic Sea region.

 

CWPharma in a nutshell

  • The project ran from October 2017 to November 2020.
  • The consortium consists of 15 organisations, from seven countries in the Baltic region: Denmark, Estonia, Finland, Germany, Latvia, Poland, and Sweden. Its work is co-ordinated by the Finnish Environment Institute (SYKE).
  • CWPharma is financed by the EU’s Interreg Baltic Sea Region Programme for 2014–2020. The project is supported by the EU Strategy for the Baltic Sea Region under the ‘Hazards’ policy area as an integral part of the flagship Pharmaceuticals in the Environment (PIE) effort, a Baltic Sea regional co-operation platform.
  • Project Web site: www.cwpharma.fi

 

More information:

Senior Expert Jukka Mehtonen, Finnish Environment Institute, tel. +358 295 251 421, e-mail: jukka.mehtonen@ymparisto.fi

Project Leader, Leading Researcher Noora Perkola, Finnish Environment Institute, tel. +358 295 251 507, e-mail: noora.perkola@ymparisto.fi

Link to the project report:
Good practices for take-back and disposal of unused pharmaceuticals in the Baltic Sea region. Clear Waters from Pharmaceuticals (CWPharma) Activity 4.1 Report
Reports of the Finnish Environment Institute 34/2020

More information about pharmaceuticals in the Baltic Sea environment at

  • http://www.swedishepa.se/Hazards/Pharmaceuticals
  • https://helcom.fi/action-areas/industrial-municipal-releases/pharmaceuticals/