Pharmaceuticals and Environment: a web-based decision support for considering environmental aspects of medicines in use

Helena Ramström,Marlene Ågerstrand,Marie-Louise Ovesjö,Siv Martini,Gerd Lärfars,Johanna Borgendahl

doi:10.1007/s00228-020-02885-1

Abstract

PurposeThe database Pharmaceuticals and Environment is a non-commercial, freely available web-based decision support presenting compiled environmental information for pharmaceutical substances. It was developed by Region Stockholm and launched in 2016 at janusinfo.se. The purpose of this paper is to present the database, report on its current use, and reflect on lessons learned from developing and managing the database.MethodsA standard operating procedure describes the work and content of the database, e.g., how information is retrieved, processed, and presented. Google Analytics was used for metrics. Issues related to the database have been discussed and handled by a reference group. The experiences from this work are presented.ResultsThe database contains environmental hazard and risk information, primarily gathered from regulatory authorities and pharmaceutical companies. There are also assessments comparing substances within some groups of pharmaceuticals. The database is used by the Swedish Drug and Therapeutics Committees to include environmental aspects when recommending pharmaceuticals for health care providers. Page views show that users primarily look for information on commonly used substances, e.g., diclofenac and paracetamol/acetaminophen. Major problems for the development of the database are lack of data, lack of transparency, and discrepancies in the available environmental information.ConclusionIn the absence of an adequate decision support produced by the regulatory authorities, we find the database Pharmaceuticals and Environment to be useful for Swedish Drug and Therapeutics Committees and health care providers, and it is our belief that the information can be valuable also in other settings.

Highlights

The use of pharmaceuticals is likely to continue to increase due to a growing aging population with chronic diseases, and access to new pharmaceuticals [1,2,3]
The purpose of this paper is to present the database Pharmaceuticals and Environment, report on its current use, and reflect on lessons learned from developing and managing a database intended as decision support
Having the information presented per product was not suitable for the needs of Region Stockholm, and the initial work with information presented per active pharmaceutical ingredients (APIs) was continued by Region Stockholm

Summary

Introduction

The use of pharmaceuticals is likely to continue to increase due to a growing aging population with chronic diseases, and access to new pharmaceuticals [1,2,3]. This is positive in terms of improved health for the treated individuals but at the same time poses an increased risk to the environment. The massive decline in vulture populations in the Indian subcontinent in the 1990s was caused by diclofenac poisoning [7], and behavioral changes in fish have been shown in studies with oxazepam and citalopram [8, 9]. High levels of pharmaceuticals in the effluent from the manufacturing process can cause local environmental problems [12]

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