Water Authorities Ask the CBG to Take Action on Environmentally Harmful Over-the-Counter Medicines

The regional water authorities (waterschappen) want to engage in discussions with the Dutch Medicines Evaluation Board (CBG) about how it can contribute to preventing pollution. As a first step, they are asking the CBG to assess whether diclofenac gels and creams should remain available over the counter.

Research conducted by the Dutch National Institute for Public Health and the Environment (RIVM) shows that 97–98 percent of the diclofenac found in surface water results from topical use on the skin. After use, part of the substance is washed into the sewer system through showering or washing and subsequently ends up in surface water. Because these products are available over the counter in drugstores and supermarkets, they are often used without guidance from a healthcare professional. Restricting their availability to prescription-only status could help prevent unnecessary environmental pollution.

A Shared Responsibility for Clean Water

In line with European agreements, the water authorities are working on source-oriented measures aimed at preventing harmful substances from entering water systems in the first place. According to the water authorities, this can only be achieved through collaboration with healthcare stakeholders, the pharmaceutical sector, and regulatory authorities.

“Everyone should be able to rely on high-quality and accessible healthcare. At the same time, we see that some self-care medicines can unintentionally have a major impact on water quality,” says Sander Mager, Vice-Chair of the Union of Water Authorities. “Once these substances enter the water system, they are difficult to remove. That is why we want to explore together with the CBG and healthcare stakeholders how environmental effects can be taken into account earlier in the chain.”

Call to Include Environmental Impact in the Assessment of Self-Care Medicines

In their letter to the CBG, the water authorities request a discussion on:

• how environmental information can be incorporated into the broader assessment of the distribution and use of certain self-care medicines;

• how users can be better informed about the potential environmental impact of their medicine use;

• how knowledge from the water sector can contribute to policies that protect both public health and water quality.

Diclofenac as an Example of a Broader Challenge

According to the water authorities, diclofenac is a clear example of a larger issue. Every year, pharmaceutical residues enter rivers, ditches, lakes, and groundwater. This is harmful to nature and may have consequences for the health of both humans and animals.

At more than half of the monitored locations in the Netherlands, diclofenac concentrations exceed levels considered safe for aquatic life. The substance is therefore already included on European watch lists and is expected to be designated as a priority substance under forthcoming regulations.

Working Together on Solutions

The water authorities want to engage with the CBG to jointly reduce the environmental burden caused by pharmaceuticals. By sharing practical data and research findings on water quality, they aim to contribute to measures that protect both the water system and public health, while leading to effective and proportionate solutions.

The water authorities are responsible for wastewater treatment and continuously work on improving the removal of pharmaceutical residues from water. This includes investigating new treatment technologies, such as advanced filtration systems and ozone treatment. In addition, they collaborate with hospitals, pharmacies, and pharmaceutical manufacturers to reduce the amount of pharmaceutical residues entering wastewater. They also seek to raise public awareness of the issue through information campaigns and education.

Photo: © Blikonderwater