Residues of pharmaceuticals in the environment can cause significant ecotoxicological issues but they also pose an imminent risk for human health e.g. by pollution of water resources used for food and drinking water production. Many active substances of pharmaceuticals for human use and their metabolites have been identified in the environment worldwide. To maintain water quality a variety of approaches during a pharmaceutical lifecycle are urgently needed, spanning actions from development, production over dispensing to end-of-pipe advanced wastewater treatments. In this paper, we report about a recently developed eco-directed pharmaceutical prescribing concept for Germany capable to trigger a significant beginning-of-the-pipe effect. The proposed system aims to balance therapeutical needs and environmental impacts by including ecotoxicological information and classification into pharmaceutical and medical decision making within the praxis of prescribing and dispensing medicines. We reviewed relevant existing eco-directed classification systems from Sweden, Finland, and Scotland. Based on these three different systems, we propose a practical environmental information, classification and dissemination system tailored to the German healthcare system, which combines positions from stakeholders including those responsible for regulation and health related data. Our results can be highly relevant to approaches aiming to establish similar systems in further countries. We identified the database ChemInfo hosted by the German Environment Agency as the central information system, for collecting environmental information from market authorisation processes. Our novel traffic light classification system is based on the hazard and risk outcomes of the environmental risk assessment and presents for the first time a European wide applicable environmental classification, capable of ranking pharmaceuticals within an indication group and identifying substances of concern to support decision making. The classification system will label all pharmaceuticals, recently added to the EU list of priority substances within the Water Framework Directive, in red. Finally, we identified eight dissemination systems through which this information and classification can be included into decision making.
Woitaske-Proske et al. (Mon,) studied this question.