Reducing pharmaceutical emissions to Baltic Sea

Noora Perkola,
Leading Researcher,
Finnish Environment Institute (SYKE),

Pharmaceutical residues are a risk to the environment and the need to manage their emissions is evident. At the same time, ageing population and medicalisation increase the consumption and consequently the emissions of pharmaceuticals. The European Union has recognized the situation in its Pharmaceutical Strategy and the Strategic Approach to Pharmaceuticals in the Environment.

The active ingredients of pharmaceuticals are a wide and complex group of substances. Decreasing their emissions requires a combination of different measures. As pharmaceuticals are vital to human health, their prescriptions are rarely, if ever, driven by environmental aspects. Unlike many other chemicals, we cannot ban the use of pharmaceuticals based on their toxicity to the environment – in contrary, toxicity is what makes many pharmaceuticals like antibiotics and cytostatic drugs effective. However, we can affect the spreading of pharmaceuticals in the environment.

Since 2017 we – researchers in 15 organizations from seven countries around the Baltic Sea – have worked together to identify the most problematic pharmaceutical compounds and the best ways to decrease their emissions to the environment. Our common project CWPharma was funded by the EU´s Interreg Baltic Sea Region Programme.

Before our project, pharmaceutical residues had been detected in wastewaters and surface waters in the Baltic Sea region, an opioid codeine even in fish. Still, there were many data gaps. For example, no data was available on some highly consumed pharmaceuticals and veterinary medicines. In CWPharma, we filled in many of the data gaps by compiling consumption data and analysing up to 75 pharmaceuticals in six case study areas. Twelve were identified as risk substances as their environmental concentrations in the environment exceeded what is considered safe. The most efficient ways to decrease their emissions are improvements in wastewater treatment and waste management, and more prudent use of pharmaceuticals.

One of the most effective ways to decrease the emissions is enhancing wastewater treatment. From human consumption, pharmaceutical residues end up to sewers and wastewater treatment plants. The same plants also collect sewage from emission hot spots like hospitals and other healthcare facilities. Typical wastewater treatment works well for some pharmaceuticals, but others are not removed sufficiently to avoid risks to the environment. For instance, the emissions of environmentally problematic painkiller diclofenac could be decreased by up to 71%, if ozonation or activated carbon were applied in every large and medium size wastewater treatment plant. It is noteworthy that while advanced treatment processes increase the costs and greenhouse gas emissions of wastewater management, the very same techniques remove numerous other contaminants in addition to pharmaceuticals.

On the other hand, as conventional wastewater treatment can remove certain pharmaceuticals, their emissions could be decreased by expanding the sewage network coverage and implementing the requirements of the EU’s Urban Wastewater Treatment Plant Directive. In the Baltic Sea catchment area, expanding the sewage network would be an especially effective measure in countries like Russia and Ukraine where its coverage is still low.

Minimizing pharmaceutical waste and proper treatment of the waste are considered low-hanging fruits in decreasing emissions. Handling of pharmaceutical waste differs greatly in the Baltic Sea coastal countries, and some countries still lack proper collection and disposal practices. One of the main reasons for improper disposal of medicine waste is simply the lack of knowledge. Some people flush medicines down the toilet as they do not know how pharmaceutical waste should be disposed of. Even less they know about the consequences of improper disposal. To avoid pharmaceutical waste ending up in the environment, not only better practices but also information campaigns are needed.

An environmentally and economically beneficial development would be decreasing the consumption of pharmaceuticals as it directly decreases the emissions. It is obvious that illnesses must be treated. But some of the environmentally troublesome pharmaceuticals can be replaced with pharmacologically similar but less problematic ones, and unnecessary medication can and should be avoided. With these two changes the emissions of certain pharmaceuticals could be decreased as much as with improved wastewater treatment.

End-of-pipe measures like advanced wastewater treatment are sometimes criticised, but in this case, they are highly justified. However, end-of-pipe measures alone cannot solve this problem. Pharmaceutical emissions must be managed throughout the pharmaceutical lifecycle, from design and production to waste management.

Information about efficient actions targeting various stages of the pharmaceutical lifecycle can be found on the project website (

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