The weight of forty elephants. Every year, 190 tons of medicine residues end up in Dutch canals, rivers and ditches. This is harmful to people and nature.
We use far too many medicines, says Erika Brattinga-Róth. She is an employee of Healthy Aging Network Northern Netherlands (HANN) and project leader ‘Medicine residues in water’. There will be a major conference on Thursday at the provincial government building in Assen on how to tackle this problem.
Urine and feces
Paracetamol, antibiotics, cholesterol lowering drugs, we swallow and put away a lot of pills, drinks and ointments. Leftovers enter the sewage water through our urine and feces or when showering. “And there are people who flush medicines that they no longer use down the sink and toilet,” says Brattinga. “That is of course very harmful.”
Now of course we have sewage treatment plants. “They remove 65 percent of the medicine residues from the sewage water before it goes to the surface water,” says Brattinga. “The rest won’t work, because those installations are not designed to handle so many medicine residues in the water. The technology itself is there to adapt these installations, but that costs a lot of money. It is very complicated to extract those last percentages.”
What are the consequences of all those medicine residues? “Fish suffer a lot from it,” says Brattinga. “They ingest residual hormones, which causes males to exhibit feminine behavior and reproduction to a halt. Predatory fish no longer chase their prey as fast, conversely the prey fish also become lethargic. The predatory fish also ingest the medicine residues of their prey, which worsens the problem.”
Resistant bacteria
Even worse is that the resistance of bacteria to antibiotics is increasing due to the pollution of surface water. “Because these antibiotics also enter the surface water, bacteria pass on that resistance to each other, as it were. The result is that you need increasingly stronger antibiotics to make patients better.”
Fortunately, drinking water companies in the Northern Netherlands appear to have few problems with medicine residues so far. Drenthe has a huge reservoir of bottom water and that is clean. However, the residents of Groningen must take into account that they obtain a large part of their water from the Drentsche Aa. Pollution lurks there, not only from medicine residues, but also from pesticides.
Since 2019, all kinds of organizations in the Northern Netherlands have been trying to do something about the problem: water boards, hospitals, health insurers, pharmacists, colleges and the university. “We now have 47 parties,” says Brattinga. You would not immediately expect an organization like Healthy Aging to play an important role in this, because it focuses on healthy aging. But according to Brattinga this is obvious.
Chronic diseases
“We take so many medications because we are getting older, but not in good health,” she says. “Remember: On average, women develop chronic diseases at the age of 41 , men a few years later. Then the taking of medication often starts. And then people often develop more diseases and conditions.”
Medicines usually have side effects and to counteract them you sometimes need other medicines. Prevention is better than cure, is therefore a wisdom that applies doubly here. “Take type 2 diabetes for example, which is really a lifestyle disease. And even once you have the disease, you can often avoid the need for medicines by eating healthy and exercising more. The same goes for high cholesterol.”
Take a walk
It actually starts with a headache: people easily take a paracetamol. “While that does not address the cause. For example, you have a fluid deficiency, which you can easily remedy by drinking more water. Or you need fresh air, then a walk outside will help. Or you often have stomach pain because your intestines are not working properly. Then eating more fruit and vegetables and whole-grain bread may help.”
Especially now that the Netherlands is aging, and there are more older people with all kinds of conditions, healthcare must change drastically, according to Brattinga. “We actually have health care: if you have something, you go to the doctor and he will prescribe you pills or a drink. We need to focus much more on how to stay healthy.”
“Remember,” Brattinga continues, “that that estimate of 190 tons of drug residues in surface water is based on what pharmacies dispense upon doctor’s prescription. We do not include what you can simply buy in the supermarket, so all that paracetamol, ibuprofen and so on.”
Major consumers
But shouldn’t the project’s initiators focus more on hospitals? These are large consumers of medicines. “We do that too,” says Brattinga. “But we have calculated that only 6 percent of the medicine residues come from hospitals. The lion’s share comes from ordinary residential areas.”
This does not alter the fact that hospitals in general are considered environmental polluters that should not be underestimated. While they prepare their own medicines in their own pharmacies, they can use filter systems to prevent leftovers from flushing into the sewer. It is also important to prevent waste when prescribing medicines to patients. Then they have to make fewer medicines and, above all, throw away less. “Those medicines are burned. That does cause CO2 emissions.”
Better intake system
Anyway, the efforts of ordinary citizens are essential to tackle this problem. However, it will not be easy to convince people that they should use medicines differently. “That is why we are working on this problem with so many different parties. Students from NHL Stenden, for example, are investigating how you can create a better collection system for excess medicines, so that people no longer flush them down the toilet. It would be nice if you could hand them in at the supermarket, but you need a good system for that.”
The call for a healthier lifestyle is particularly popular among well-educated people with a somewhat larger wallet and much less so among poor people, who are sick much more often. “That is correct and that is why we are happy that there are also projects at food banks to provide cooking lessons, for example. You see that people often leave a cauliflower or a bag of potatoes and opt for ready-made products.”
What can I do?
What can you do yourself to prevent contamination by medicine residues?
1. If you have any leftover medication, hand it in at the pharmacy.
2. Read the package leaflet and try to adhere as closely as possible to the way you should use the medicines.
3. Ask the pharmacist or doctor if you do not understand something or if you experience unexpected side effects.
4. Don’t get angry if the doctor doesn’t prescribe medication, but gives lifestyle advice. Medicines have side effects, exercising more and eating healthier will only make you healthier. If that advice does not help, you can still ask for medication.
5. Do not use painkillers such as paracetamol too quickly. You then treat the symptoms; it is better to ask yourself where the pain comes from.