Upload
others
View
3
Download
0
Embed Size (px)
Citation preview
Pharmaceuticals, Health and Environment
ISDE, Geneva 18.5.2009Ingrid Eckerman
Swedish Doctors for the Environment www.dnsy.se/lfm
Pharmaceuticals are chemicals …
• Biologically active• Non-degradable• Long life• Often toxic
Pharmaceuticals …
• Used in increasing amounts, increasing sorts of substances
• Sewage plants not made for them • Continuous release• Restrictions on use not plausible• Not possible to prohibit
Joakim Larsson 2008
Examples: effectsFish, frogs, mussels:• Reproductive disturbances• Sex disturbances• Development disturbances• Behavior disturbancesBirds:• Behavior disturbances• Kidneys affectedButterflies:• Blocking of the cholesterol synthesis
in the larvae
Examples: tested products
• Etinyloestradiol• SSRI• Simvastatin• Diclofenac• Klotrimazol
Sewage plants in India• Several broad spectrum antibiotics
found in concentrations toxic to bacteriae and plants
• Ciprofloxacin 30 milligram per liter • Enterococcae in the sewage plants
resistant to all known antibiotics
Larsson J, de Pedro C, Paxby N. Journal for Hazardous Materials 2007;Vol 148 (3):751-755
Oseltamivir does not break down in sewage plants
The active substance is still in water where birds with influesa viruses are living.
Läkemedelsvärlden 3.10.2007
Medicines in the water plants of Stockholm, 2 april, 2007 (ng/l)
Generic name
Norsborg incoming
Lovön incoming
Görväln incoming
Norsborg outgoing
Lovön outgoing
Görväln outgoing
Atenolol 1.0 0.5 1.5 <0.3 0.3 <0.3
Citalopram <0.3 1.4 0.5 <0.3 <0.3 0.3
Diklofenak 0.6 0.8 1.1 <0.1 <0.1 0.7
Ibuprofen <0.2 0.4 1.2 0.5 0.3 1.3
Metoprolol 1.1 1.5 2.5 0.3 0.5 0.4
Naproxen 1.4 1.4 2.0 0.7 0.2 1.3
Trimetoprim 0.4 <0.3 0.4 <0.3 <0.3 <0.3
Medicines in liver of perche caught in central Stockholm
Inner station Intermediate station
Outer station
Citalopram 0.1 µg/kg <0.1 µg/kg <0.1 µg/kg
Propoxyfen 0.25 µg/kg 0.16 µg/kg <0.1 µg/kg
Number of medicines found in drinking water
Place of sample Number of detected pharmaceuticals
Perth 14Singapore 8Paris 7Peking 6Edinburgh 4Hamburg, Johannesburg 3Bryssel, Helsingborg, HongKong, Copenhagen, Lyon, Sofia
2
Dubai, Düsseldorf, Hoorn (NL) 1Manchester, New York, Shipol 0
Miljö och hållbarhet
Examples on low degradable pharmaceuticals (t1/2 , days)
> 365 days amitriptylin ifosfamidbarbitursyrederivat kodeinbezafibrat metyldopacyklofosfamid metronidazoldextropropoxifen naproxenerytromycin sulfametoxazolfluorokinoloner tetracyklin
Medicines reach the human being
• Via consumption of fish, crustaceous animals or other aquatic organisms (bio-ackumulation, medicine residuals)
• Via drinking water (medicine residuals, metabolites)
Potential effects
• Sub-therapeutical exposure to mixtures under long periods, in all phases of life
• Synergy effects in mixtures (1+1=3)
• Changes in genes• Resistance to antibiotics• Hormone effects• Allergic reactions
Potential effects• The effects of life long exposure to very low
doses of pharmaceuticals on human receptor mechanisms are not known.
• There are no scientifical methods to evaluate a possible ocurrence of such effects.
Swedish sewage plants
Less than half of the pharmaceuticals are degraded more than 50%.
Exemple easily purificated: IbuprofenExemple difficult to purificate: Diclofenac,
Tramadol
Läkemedelsprojektet – Stockholm Vatten AB
We will be more humans on the earth We will eat more medicinesBut ...we will not have more water on the earth!
2005 = 2030 =
1997- 1998
• ”Medicines and the Environment. What Do We Know Today? A Brief State of the Art Analysis”
• Sent the report to all pharmaceutical companies that sold medicines in Sweden, to authorities and to our professional organisations
• Prepared presentation at ISDE GA in Arezzo • Tried in vain to interest LIF,
the pharmaceutical industry’s organisation
1999
• Demanded environmental classification in Fass (the directory on medicines)
• Presented the report to the environment director of SLL (Stockholm county council), dr Åke Wennmalm
2002 - 2004
• Lobbying to get environmental effects of pharmaceuticals included in the EU laws about medicines.
• The government ordered the Medical Products Agency (LMV) to make a report.
• The LMV said “compulsory classification is not possible”.
2003 Environmental classification
of pharmaceuticalsA Swedish initiative
2004
• Worked in EU to reduce the environmental effects by pharmaceuticals
• Environmental classification of medicines• Analyses of residuals in water from
medicines
2004-2006
• Two big full day seminars on ”Pharmaceuticals, environment and health”
• Writh concerning the LMV report
• Brought up the question at HCWH
2007
• Pharmaceuticals NOT included in REACH
• HCWH published a fact sheet
2008
• Two seminars for the parliament, together with the Green party
• Swedish Medical Association decided to work with environment and health. Pharmaceuticals and climate changes were chosen.
EU 2008
Pharma package:1. Access to reliable information 2. Safety monitoring of medicines
(pharmacovigilance). Environment NOT included
3. Fake medicines
Sweden 2007 -• Spreading of the classification system• Support by the Swedish government• Germany and Netherlands have joined • The commission is attended• Working groups• Pharmaceutical Forum (includes the Standing
Committee of European Doctors CPME)• EMEA (European Medicines Agency)• EEA (European Environment Agency)• DG Environment (Directorate General)
What needs to be done?
• Pharmaceuticals included in REACH?
• Environmental monitoring included in pharmacovigilance
• Environmental classification compulsory
• Professional organizations' working for good choices
Life habits and the inheritance are the base
Non-pharmaceutical treatments is the next step
Medicines must sometimes be used as a complement
TO PREVENT ILLNESS AND TREAT DISEASES
Folkhälsoenheten i Nacka 2005
WHAT CAN DOCTORS DO?Not prescribe medicines that are not needed• Concider other alternatives• Not slide on indications• Reconcider regularlyNot prescribe medicines that will not be taken• Concordance with the patient• Start packagesChoose the best preparation• Janusinfo, Kloka listan, Fass …• Ask the company consultant!Lobby for more environment friendly medicines• Ask the company consultant!
Folkhälsoenheten i Nacka 2005
Environmental demands• Do you buy active substances from other
producers?• Do you make environmental demands upon the
contractors?- which demands?- how do you control?
• Do you make environmental demands upon the subcontractors?- which demands?- how do you control?