co-funded by EU LIFE Programme

Active and obsolete pharmaceuticals in the Baltic Sea regionMikhail Durkin, Coalition Clean Baltic Secretariat, Sweden

Действующие и устаревшие фармакопрепараты в Балтийском регионеМихаил Дуркин, Секретариат Колалиции Чистой Балтики, Швеция

• CCB: was established in 1990

• CCB: a network of grass-root environmental NGOs

• CCB: cooperation of Environmental Citizens Organisations (ECO)

• CCB: 19 member organizations and through them – over 800 000 individual members

• CCB: works in the entire Baltic Sea catchment area, through organisations in Belarus, Denmark, Estonia, Finland, Germany, Latvia, Lithuania, Poland, Russia, Sweden and Ukraine

• CCB: lobby at EU and HELCOM level, coordinated actions and field work, awareness raising and capacity building

Network of grass-root environmental NGOs

co-funded by EU LIFE Programme

Network covering the whole catchmentRussiaFriends of the Baltic, St. PetersburgGreen World, St. PetersburgGUIDE Environmental Group, Kaliningrad

FinlandFinnish Association for Nature ConservationFinnish Society for Nature and Environment

Sweden Swedish Society for Nature ConservationWWF-Sweden

Denmark Danish Society for Nature Conservation

GermanyBund für Umwelt und NaturschutzDeutschland / Friends of the Earth Germany

EstoniaEstonian Green Movement

Latvia Environmental Protection Club of Latvia, VAKLatvian Green Movement

LithuaniaLithuanian Fund for NatureLithuanian Green Movement

PolandGreen Federation, GAJA, SzczecinPolish Ecological Club, PKE

BelarusEcohomeIPO Ecoproject

Ukraine The Western Centre of the Ukrainian Branchof the World Laboratory, Lviv, Ukraine

co-funded by EU LIFE Programme

Water Protection in Agriculture

River Basin and Wastewater Management

Fisheries and Aquaculture

Network working across sectors

Hazardous Substances and Marine Litter

Biodiversity and Nature Conservation

Sustainable Development in Coastal and Marine Areas

Harmful Installations and Maritime Transport

co-funded by EU LIFE Programme

Why bother? Background and Rationale• Poor state of the Baltic with regards to

chemical pollution status– Gap between HELCOM and EU

• Focus on pharmaceuticals at EU level– EU WFD Watch List

• Need to address the issue at HELCOM– Strategy for hazardous substances (1998)

• Cessation target within 25 years– List of substances of specific concern (2007)– List of Priority Hazardous Substances (2010) +

substances of possible concern– HELCOM Moscow Ministerial (2010)

• Gather expertise and knowledge– HELCOM Copenhagen Ministerial (2013)

• State-of-play report• Input to EU• Decide on measures

co-funded by EU LIFE Programme

Pharmaceuticals in the BSR, state-of-play (2016)

co-funded by EU LIFE Programme

www.no-pills.eu

• Human consumption and use in the countries

• Pathways to the environment

• Concentrations in WWTP influent and effluent as well as sewage sludge, and in river water

• An estimate of the magnitude of inputs to the Baltic Sea

• Information about the handling of pharmaceutical waste in countries

Pharmaceuticals in the BSR: what do we know?

• ca. 2200 tAPI /yr enter annually through WWTPs• main loads: cardiovascular, central nervous system and anti-inflammatories and

analgesics (diclofenac, ibuprofen and paracetamol most frequent)• main source - excretion by human and animals and incorrect disposal• vast observations (45000 source/path and 4600 sea/coastal samples)• data from 7 out of 9 coastal states• traced effects in biota (blue mussels accumulate most)• developed take-back but unknown efficiency?

co-funded by EU LIFE Programme

www.no-pills.eu

Waste water treatment

co-funded by EU LIFE Programme

www.no-pills.eu

Is it safe to use sludge?• 26,500 kg/yr of 52

pharmaceuticals are retained to in WWTP sludge.

• Of 52 the amounts of 6 pharmaceuticals in the sludge exceeded 1,000 kg/yr

• amount of priority pharmaceuticals retained in sludge was estimated to be 22,500 kg/yr (85% of all)

Is there treatment available?• Lack of wide-spread advanced

WWTP technology applied across the region – only pilot plants (e.g. 2 in Sweden)

Waste management and take-back• Voluntary vs. obligatory• Lacking data on efficiency

• Estonia– 89,190 kg collected

• Finland– 185,000 kg returned– 33,000 kg disposed to waste– 28,000 kg disposed to sewers

• Sweden– 1,500,000 kg covered by take-back– 800,000 kg returned– 250,000 kg to waste– 50,000 kg by pharmacies– 250,000 kg wholsale waste– 100,000 kg hospitals co-funded by EU

LIFE Programme

www.no-pills.eu

Proposal for the Baltic Priority List

co-funded by EU LIFE Programme

www.no-pills.eu

• anti-inflammatory and analgesic

• codeine, diclofenac, ibuprofen, irbesartan, ketoprofen, naxoproxen, paracetamol, and tramadol;

• antimicrobial• ciprofloxacin,

clarithromycin, fluconazole, sulfamethoxazole;

• cardiovascular agents • atenolol, eprosartan,

furosemide, metoprolol, sotalol;

• antiepileptic • carbamazepine

Swedish watch list (MPA, 2015), 17 substances in addition to EU WFD ”Watch List”

Name Justification by Swedish MPA

Ciprofloxacin Persistent and demonstrated resistance development in the environment

Citalopram Has been detected in fish and drinking water. PBT- properties. Relatively large usage.

Fluconazol Has been detected in drinking water, surface water and sludge.

Ibuprofen Large usage and has been detected in surface waterCarbamazepin Has been detected in drinking water and surface water.Cetoconazol Has been detected in sludgeLevonorgestrel PBT- propertiesLosartan Large usageMetoprolol Large usage and has been detected in drinking water, surface water and sludge.

Metotrexat Unknown environmental effects and presence. A chemotherapy that is used by the households.

Naproxen Has been detected in drinking water and surface water. Increased usage as it is often used as a replacer for diclofenac

Oxazepam Has been detected in fish, surface water and drinking water. Toxic at environmental relevant concentration.

Sertralin Has been detected in surface water, fish and sludge.Sulfametoxazol Has been detected in surface water, fish and sludge.Tramadol Has been detected in surface water and drinking water.Trimetroprim Large usage. Has been detected in drinking water, surface water and sludge

Zolpidem Has been detected in drinking water, surface water and sludge

Measures available and applicable

co-funded by EU LIFE Programme

www.no-pills.eu

• Measures to reduce the inputs should address all stages of the product lifecycle from manufacturing to consumption to waste management.

• Technical solutions can be applied in WWTPs, mainly as tertiary treatment methods.

• Oxidation, adsorption and filtration methods could also be used for the pre-treatment of hospital and production site wastewater prior to discharging to the sewer.

• Take-back of unused medicines by pharmacies should be applied in countries where such systems are not yet in place, in order to reduce the disposal of unused medicines via solid waste or sewer.

• Eco-labelling of pharmaceutical products can help doctors, pharmacists and consumers to consider environmental perspectives when choosing medication.

• Decreasing the total consumption of pharmaceuticals

Pharmaceuticals: what we still need to know?

co-funded by EU LIFE Programme

www.no-pills.eu

• Better and consistent consumption data

• Concentrations of pharmaceuticals in WWTPs influent and effluent as well as rivers

• Emissions of pharmaceuticals to environment

• Occurrence and fate of metabolites

• Concentrations in sewage sludge and soil

• Consumption, sources, pathways and loads of veterinary pharmaceuticals to soils and the aquatic environment

Thank you for your attention!

Östra Ågatan 53, SE-753 22 Uppsala,

Sweden+46 73-977 07 93;

mikhail.durkin@ccb.sewww.ccb.se

co-funded by EU LIFE Programme