Pharmaceuticals and the environment

Pharmaceutical products are essential tools in modern medicine and are present in our daily lives. Many of us take medications as needed or on a regular basis, with consumption often increasing as we age. After being metabolised—or sometimes even in their original form—many pharmaceutical substances are excreted by the human body and enter wastewater systems through urine, feces, and even washing off from the skin after topical application. Improper disposal of unused medications via sinks and toilets further contributes to this issue.

Wastewater treatment plants are not capable of completely removing all pharmaceutical substances. As a result, treated water often still contains traces of pharmaceuticals, which are discharged into surface waters. These substances pose risks to aquatic life, including fish, algae, amphibians, and other organisms. For instance, the synthetic hormonal compound found in birth control pills (17α-ethinylestradiol) has been shown to impair the reproductive ability of fish and amphibians even at very low concentrations.

Further Information: Entry, occurrence, and effects of pharmaceuticals in the environment

In matters of healthcare, too, acting in an environmentally conscious way is important. Patients can help reduce the negative environmental impact of pharmaceuticals. Preventing illnesses, considering non-medication treatments, and using medications responsibly all contribute to environmental protection.

Medicines are valuable and often expensive products that should be used carefully. However, expired or unused medications can accumulate in households. To protect both human health and the environment, these should be disposed of properly. In Germany, disposal options for unused medications vary by region. In most cases, disposal via household waste or hazardous waste collection points is recommended. You can check the locally recommended disposal methods by entering your postal code at arzneimittelentsorgung.de

One rule applies everywhere: NEVER dispose of medications down the toilet or sink!

Further Information:

• Environmentally conscious use of medicinal products
• Environmentally conscious disposal of leftover drugs
• Informational video: Alte Arzneimittel – ein Fall für die Tonne (in German)

By integrating environmentally conscious approaches into their prescribing practices, physicians can actively contribute to reducing the entry of pharmaceuticals into the environment—without compromising patient health or restricting medical treatment choices.

One starting point is prevention and the strengthening of all body systems as well as the immune system. This primarily involves preventive measures such as vaccinations, exercise on prescription, invitations to check-ups and nutritional advice. If appropriate, non-medication treatments might also be considered. Naturally, avoiding overprescription and misprescription benefits both patients and the environment. This can be achieved through thorough medical diagnostics and treatment planning. Additionally, prescribing alternative application forms can help reduce the amount of active substances entering the environment. Choosing pharmaceuticals that degrade more effectively in wastewater treatment plants and the environment or have lower environmental toxicity is another effective strategy. Furthermore, prescribing smaller package sizes can help reduce the accumulation of unused medications that require disposal.

Pharmacies, as central points for dispensing medications and providing professional advice, play a crucial role in minimizing pharmaceutical pollution. To support pharmacies in informing patients about environmental aspects of pharmaceuticals, the UBA has developed informational materials, including multilingual resources, that can be downloaded or ordered free of charge. Pharmacists can also contribute by conducting medication reviews, collaborating with physicians, and educating on the proper disposal of unused medications.

To ensure that both current and future doctors and pharmacists can gain knowledge on the environmental aspects of pharmaceuticals, the German Environment Agency has created free and editable teaching materials. These resources enable educators in universities, vocational schools, and continuing education programs to integrate environmental aspects into their curricula with minimal additional effort.

Further Information:

• Prescribing drugs: Environmental aspects
• Informational materials on pharmaceuticals and the environment
• Teaching materials on pharmaceuticals in the environment

The "Scientific Background" section of this portal provides in-depth insights into the environmental impact of human pharmaceuticals. It examines trends in pharmaceutical consumption, identifies substances considered environmentally relevant, and explains in detail the various pathways through which these substances enter the environment. Findings of pharmaceuticals in water bodies, soil, and drinking water are also discussed.

Additionally, the toxicity of specific pharmaceuticals to environmental organisms is illustrated using specific examples. A key topic in this context is wastewater treatment technology, particularly the extent to which modern treatment plants with quaternary treatment can remove pharmaceuticals from wastewater. The legal framework for environmental risk assessments of pharmaceuticals is also explained. Finally, measures to reduce the entry of pharmaceutical substances into the environment —both within the drug authorization process and beyond—are presented.

Further Information:

• Entry and occurrence of human pharmaceuticals in the environment
• Environmental effects of pharmaceutical substances
• Environmental aspects in the drug authorisation process
• Concepts and mitigation strategies