Pharmacies need to be better at answering questions about how drugs affect the environment, and also include environmental considerations in the counseling. The entire pharmacy industry has to work harder with environmental issues. This is an entire area where we need to take a clear position, influence and take responsibility for such an important player as the pharmacy is.
Canadian Pharmacy Stance Towards Environmental Protection
The fact that environmental issues have become hotter in general is also noted in pharmacies. More and more customers ask questions about how different drugs affect the environment, for example, if they can buy a “green drug”. But today, pharmacists have no prerequisites for giving good answers. It seems that customers completely have a point. Today, pharmacies do not have access to information to provide answers. And that is completely unreasonable.
Canadian Pharmacy Online has decided to focus more on environmental issues. Among other things, you now have statistics about the medicines that the pharmacy collects each year. Last year, it was about 1200 tonnes of drugs collected instead of being thrown into the garbage. This is part of their philosophy that environmental aspects should be a natural part of the advice on medicines to customers.
It is about the pharmacy to inform its customers about the adverse effects on the environment of the analgesic substance diclofenac. It may seem like a small thing, but one has to start somewhere, and the pharmacy is promising more measures to improve the pharmacist’s environmental work.
Can Drugs Be More Environmentally Friendly?
Drugs affect different processes in our body, usually because they more or less specifically bind to different proteins, such as receptors or enzymes. Many of these proteins are also found in other species, especially other vertebrates that are relatively closely related to us, such as fish. When exposed to sufficiently high levels of drug, there is a risk that these species will also be affected. Some drugs, such as antibiotics and fungicides, are intended to affect microorganisms in our body. The use of such drugs can lead to resistance development in microorganisms in our own body or environment, thus reducing our ability to effectively treat severe infections now and in the future.
Drugs are chemically most often stable substances. For example, they should be durable during transport and storage, avoid breaking down of the sore environment in the stomach or at the first passage through the liver for the purpose of reaching its or its primary target organ in a sufficiently high concentration. Resistance to rapid decomposition is thus often a positive and desirable characteristic of a drug, while it is a negative property from an environmental point of view. Hard-biodegradable substances may have easier to pass purification plants and they can survive for a long time in the environment (i.e. they are persistent). This allows them to spread over larger areas and there is a greater risk that they can accumulate in a sufficiently high concentration to produce environmental effects.
How Drugs Affect Environment
Nearly 100% of certain medicines are eliminated in our treatment plants, while others cannot be removed at all. The system for treating many people’s sewage in joint treatment plants means that the levels of medicinal products in watercourses downstream of some treatment plants can be sufficient high to affect, for example, fish.
Fish and other aquatic organisms inhale water through the gills. These organs are designed to effectively facilitate the flow of molecules (e.g., oxygen) between blood and surrounding water. There is therefore the risk that other molecules, such as drugs, will also be included. Water-borne organisms therefore run a much greater risk of exposure to drug residues than animals who drink only water.
Some drugs may accumulate in aquatic organisms to concentrations far beyond those found in the water. Generally, fat-soluble substances accumulate to a greater extent than water-soluble substances, so from an environmental point of view, the latter are preferred. However, some substances accumulate much more than could be expected based solely on their fat solubility. One such example is levonorgestrel, a gestagen that is found in several common contraceptives. Probably this is due to the fact that there are special binding proteins in the blood of the fish that capture the drug and prevent it from disappearing into the water again.
Medicinal products not completely broken down into the body are excreted via urine and faces and end up in our treatment plants, Figure 1. This is the quantitatively largest source of environmental exposure of human medicinal products used in health care. In the treatment plants, the drugs can go three fates to meet. Either they break down or they end up in the purified outgoing wastewater (surface water), or in the sludge. Part of the sludge is spread on arable land. There is a debate about the pros and cons of returning nutrients from sludge to the cycle. One of the arguments against spreading is that the sludge contains many chemicals, including drugs. For veterinary medicine, the pathways of distribution are more complex, and some veterinary medicines are spread mainly to agricultural land.