Background: Pharmaceuticals play an important role in the treatment and prevention of disease in both humans and animals. However, the high and increasing use of pharmaceuticals, in combination with their persistence, bioaccumulating properties, and potential toxicity for water-living organisms, has led to pharmaceutical residues becoming an increasing environmental problem worldwide.
Objectives: The aim of this study was to investigate sales of analgesic pharmaceuticals drugs, in relation to environmental hazard in the geographic region surrounding the Swedish Lake Mälaren, Sweden’s largest drinking water source.
Methods: This was examined with an observational cross-sectional study, using sales data on pharmaceuticals from the Swedish E-health Agency which includes all pharmaceuticals for human and veterinary use, i.e. through prescriptions (Rx), OTC, or to hospitals and other health facilities. The total sales of analgesic drugs (NSAIDs, paracetamol and other non-opioid analgesics and opioids) for both human and animal use in the region were analyzed for the years 2016 to 2020 in relation to the inherent environmental hazard for each active pharmaceutical ingredient (API). Classification on environmental hazard of the API was collected from the database Pharmaceuticals and Environment at Janusinfo.se.
Results: We found that a total of 454 tons of analgesics were sold during these five years. Paracetamol, ibuprofen and acetylsalicylic acid were the most sold APIs and were all classified as low hazard compounds. Diclofenac, the only pharmaceutical classified as high hazard, was the fifth most sold API with a total of 2321 kg. Veterinary use was small compared to human use, only contributing with a total of 1023 kg. A majority of the sold volumes of analgesics were dispensed prescriptions for human use, in urban municipalities.
Conclusions: Visualization of drug sales for humans and animals in different settings can be used to identify the environmental burden of pharmaceuticals. Based on our study, we suggest additional measures to reduce the impact of pharmaceuticals on the environment should be directed to prescribing physicians in urban areas and campaigns targeted at the high over-the-counter sales of diclofenac.
