Abstract

The National Institute for Public Health and the Environment (RIVM) uses data on the consumption rates of prescribed pharmaceuticals to predict the quantities of these pharmaceuticals that may ultimately be emitted into surface waters. Water supply companies and local water boards can use this information to adjust their water quality monitoring programs in order to enable an early identification of possible priority substances. This information can also be used to choose cost-effective emission reduction measures or evaluate policy initiatives.
The consumption rates of these prescribed pharmaceuticals are provided by the Foundation for Pharmaceutical Statistics (SFK), which collects the relevant data from pharmacies in the Netherlands. The consumption rate data are transformed and expressed as amounts of active ingredients. This approach enables the quantities of potential pharmaceutical emissions into the surface water system to be calculated.
The consumption of pharmaceuticals in the Netherlands is increasing due to an expanding population and the proportional increase in the ageing population. This trend is particularly visible for pharmaceuticals used for heart and cardiovascular diseases and anti-diabetic drugs. In contrast, the consumption of some pharmaceuticals, such as ethinyl-estradiol, an active compound in anti-contraceptives, is expected to decrease due to demographic trends.
In the absence of emission reduction measures, the residues of pharmaceuticals pass through sewage water into surface waters. Measures at the source include the separate treatment of various types of wastewater, as is currently being tested in pilot projects by several hospitals in the Netherlands. The effectiveness of urine source separation in office buildings is also being tested. Such measures will most likely be most effective at the local level. On a larger scale, advanced sewage treatment technologies show a particularly great potential for reducing the emission of pharmaceuticals, both in the Netherlands and abroad. For the Dutch water supply companies, international measures are important: a significant amount of pharmaceuticals enters the Netherlands in the waters of the Rhine and Meuse rivers.