Why bother? Background and Rationale. Pharmaceuticals in the BSR: what do we know? Proposal for the Baltic Priority List. Measures available and applicable. Pharmaceuticals: what we still need to know?

1. co-funded by EU
LIFE Programme
Active and obsolete pharmaceuticals in the Baltic Sea region
Mikhail Durkin, Coalition Clean Baltic Secretariat, Sweden
Действующие и устаревшие фармакопрепараты в Балтийском регионе
Михаил Дуркин, Секретариат Колалиции Чистой Балтики, Швеция

2. • 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

3. Network covering the whole catchment
Russia
Friends of the Baltic,
St. Petersburg
Green World, St.
Petersburg
GUIDE Environmental
Group, Kaliningrad
Finland
Finnish Association for
Nature Conservation
Finnish Society for
Nature and
Environment
Sweden
Swedish Society for
Nature Conservation
WWF-Sweden
Denmark
Danish Society for
Nature Conservation
Germany
Bund für Umwelt und
Naturschutz
Deutschland / Friends
of the Earth Germany
Estonia
Estonian Green Movement
Latvia
Environmental Protection
Club of Latvia, VAK
Latvian Green Movement
Lithuania
Lithuanian Fund for Nature
Lithuanian Green Movement
Poland
Green Federation, GAJA,
Szczecin
Polish Ecological Club, PKE
Belarus
Ecohome
IPO Ecoproject
Ukraine
The Western Centre of the
Ukrainian Branch
of the World Laboratory, Lviv,
Ukraine
co-funded by EU
LIFE Programme

4. 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

5. 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

6. 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

7. 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

8. 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)

9. 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

10. 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

11. 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 water
Carbamazepin Has been detected in drinking water and surface water.
Cetoconazol Has been detected in sludge
Levonorgestrel PBT- properties
Losartan Large usage
Metoprolol 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

12. 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

13. 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

14. Thank you for your attention!
Östra Ågatan 53, SE-753
22 Uppsala, Sweden
+46 73-977 07 93;
mikhail.durkin@ccb.se
www.ccb.se
co-funded by EU
LIFE Programme