Green and Sustainable Pharmacy Klaus Kümmerer · Maximilian Hempel Editors Green and Sustainable Pharmacy 123 Editors Prof. Dr. Klaus Kümmerer Maximilian Hempel Department of Environmental Deutsche Bundesstiftung Umwelt Health Sciences D-49090 Osnabrück University Medical Center Freiburg Germany [email protected] Breisacherstraße 115b 79106 Freiburg Germany [email protected] [email protected] ISBN 978-3-642-05198-2 e-ISBN 978-3-642-05199-9 DOI 10.1007/978-3-642-05199-9 Springer Heidelberg Dordrecht London New York Library of Congress Control Number: 2010924552 © Springer-Verlag Berlin Heidelberg 2010 This work is subject to copyright. All rights are reserved, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilm or in any other way, and storage in data banks. Duplication of this publication or parts thereof is permitted only under the provisions of the German Copyright Law of September 9, 1965, in its current version, and permission for use must always be obtained from Springer. Violations are liable to prosecution under the German Copyright Law. The use of general descriptive names, registered names, trademarks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. Cover Photo: Jim Barber - fotolia.com Cover design: deblik, Berlin Printed on acid-free paper Springer is part of Springer Science+Business Media (www.springer.com) Foreword Dear reader, Pharmaceuticals are an indispensable part of our modern times, allowing for a high quality of life and an increased life expectancy. The last few years have shown that pharmaceuticals leave an partly unchanged impact on the environment after their use. As they are barely incompletely eliminated by sewage treatment, they are still found in relevant concentrations in the aquatic environment and drinking water. Human-toxicologically seen, the concentrations give no reason for concern, how- ever, they are nevertheless a serious environmental problem. Furthermore, we know that the pharmaceutical production is connected with a high consumption of energy and resources and with the emergence of relatively large volumes of waste. All in all it appears that the production and use of pharmaceuticals can involve significant environmental impacts. Therefore it is only logical to pursue the question of how pharmacy and pharmaceutical industry can be more sustainable. Which sustainable strategies can prevent the entry of pharmaceutical residues in environment and drinking water? How can we reduce resource consumption and waste in their production process? Is the concept of “Sustainable Chemistry” trans- ferable to the pharmacy? How to reduce the entry of unused pharmaceuticals in the environment? What incentive options do we have to create a more sustainable pharmaceutical industry? In order to find answers, a holistic approach is needed, identifying the environ- mental relief potential along the entire life cycle of pharmaceuticals. The organizers of the “1st International Conference on Sustainable Pharmacy” attempted to discuss the aspects of the whole life cycle in one conference. The result is very impressive: this book summarizes the current debate on sus- tainable pharmacy. The authors are from the pharmaceutical industry, environmental and social research, from regulatory agencies and banks. I thank the organizers of the “1st International Conference on Sustainable Pharmacy”, the editors and authors for this readable work. Deutsche Bundesstiftung Umwelt (DBU) Fritz Brickwedde v Preface and Scope of the Book The presence of pharmaceuticals in the environment was first reported in the 1970s, but it wasn’t until the advent of better analytical instruments that the topic began to gain more and more interest among scientists. It has attracted increased interest among the general public since the 1990s, when people began to become concerned about the presence of pharmaceuticals in their drinking water. Since then, phar- maceuticals in the environment have continued to be a “hot bed” of interest, as demonstrated by the huge number of publications on the topic (for an overview see the book “Pharmaceuticals in the Environment. Sources, fate effects and Risk”, Springer Publisher). A broader view is now emerging covering the whole life-cycle of pharmaceuticals, the bodies responsible and people that decide on design, synthe- sis, manufacturing and use, as well as the introduction of pharmaceuticals into the environment: Green and sustainable pharmacy. This concept forms the background to this book. On the one hand, there are ongoing discussions about the different life stages of an active pharmaceutical ingredient and many publications on the subject have already appeared, research is in fact still in its infancy. On the other hand, the topic is complex, and activities focus on different scientific fields such as synthetic and medicinal chemistry, environmental hygiene, ethics, etc. Some issues are mainly being dealt with by industry (e.g. waste minimization), while others are part of a wide public discussion (genetically modified and patented organisms, the presence of pharmaceuticals in the environment). Some concerns have already lead to tech- nological attempts to eliminate pharmaceutical residues in municipal waste water. We therefore felt that there was an urgent need to bring together the different groups of people involved, in order to connect the various issues raised and combine the many lines of discussion pursued in order to create a platform from which to move things forward in the interest of a more sustainable future. These few thoughts may illustrate the challenges that green and sustainable phar- macy presents. This book endeavours to stimulate and encourage further discussion on green and sustainable pharmacy. Several issues have been addressed in contri- butions from different authors. Along the life cycle of a pharmaceutical this book contains five major parts: vii viii Preface and Scope of the Book • The first deals with general aspects such as pharmaceuticals in the environment, the links to green and sustainable chemistry, more general aspects of sustainable pharmacy and the possible role of pharmaceutical companies are addressed. • The second part discusses the development, synthesis and production of phar- maceuticals. Only a few selected topics are highlighted here. Because synthesis- related issues are already covered by other publications, the authors were asked to address this issue on a more general level. • The third part addresses the use and disposal of pharmaceuticals. The focus here is on the role of patients, doctors and pharmacists in contributing to green and sustainable pharmacy by proper use of the pharmaceuticals. An environmental classification system for pharmaceuticals as a valuable piece of information for doctors, pharmacists and patients is presented. We also take a look into the future: how will drug consumption develop? • A classical topic is addressed in the fourth part, i.e. emission management, for which knowledge of the role of different sources such as hospitals and the general public is indispensable. A synopsis of effluent management strategies, i.e. effluent treatment, training and education as well as benign by design is given. • In the fifth chapter, obstacles and incentives on the path to greener and more sustainable pharmacy are addressed. These span from legislative regulations and issues of patent life time to the possible role of banks and investors This book does not claim to cover all the aspects of green and sustainable phar- macy. Rather, it attempts to provide an overview of the present state of knowledge based on different examples, typical lines of thought and the outcome of discus- sions on major issues. Since green and sustainable pharmacy is still in its infancy, it attempts to identify lack of knowledge and stimulate more activities on the way to sustainable pharmacy rather than to resolve ongoing discussions. The book would not have been possible without the support received from our co-workers at the Applied Environmental Research Section of the Department of Environmental Health Sciences, University Medical Centre Freiburg, and the Deutsche Bundesstiftung Umwelt in Osnabrück, which gave us the time necessary to edit a book in such a new and demanding field. The idea for the book and its central theme arose at the 1st International Conference on Sustainable Pharmacy (http://www.dbu.de/ 550artikel27309_788.html) sponsored by the Deutsche Bundesstiftung Umwel, without which neither the conference nor the book would have been realised. Florian Keil and Hans-Christian Schaefer were both members of the team that planned and organized this conference on sustainable pharmacy. They contributed valuable discussions and raised important and interest- ing questions within the planning phase of the conference and the book. Thank you! Thank you also to all the authors who sacrificed their precious time to contribute to this book. Furthermore, we wish to thank all the participants of the conference for dedicating their time and knowledge, thus contributing to very open and productive discussions at the conference and fruitful contacts later on. Thanks to all of you for your contribution! Numerous discussions with colleagues, contributors to the book and other