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Use of pharmaceuticals is continuously increasing globally and their residues are recognized as a risk for theenvironment. The aim of this study was to investigate drug utilization patterns of analgesics in relation toenvironmental hazard in the region surrounding Sweden’s largest drinking water source, Lake Mälaren. This wasexamined using sales data on pharmaceuticals from the Swedish E-health Agency. The total sales of analgesics(non-steroidal anti-inflammatory drugs, paracetamol, other non-opioid analgesics, and opioids) for both humanand veterinary use in the region were analyzed for the years 2016 to 2020, in relation to the inherent environmental hazard for each active pharmaceutical ingredient (API). We found that a total of 454 tons of analgesicswere sold in the region during these 5 years. Classifications of environmental hazard were available for 16 out ofthe 45 studied APIs, accounting for 98.8% of the total mass in kilograms. Paracetamol, ibuprofen, and acetylsalicylic acid, which are all classified as low-hazard compounds, were the most commonly sold APIs. Diclofenac, the only pharmaceutical classified as high-hazard, was the fifth most commonly sold API, with a total soldmass of 2321 kg. The majority of the total sold mass of analgesics originated from dispensed prescriptions forhuman use in urban areas. Visualization of drug sales for humans and animals in different settings can be used toidentify the environmental burden of pharmaceuticals. Based on our study, we suggest that additional measuresto reduce the impacts of pharmaceuticals on the environment should primarily be directed to prescribing physicians in urban areas and campaigns targeted at the high over-the-counter sales of diclofenac. Moreover, it isimportant to address the fact that many pharmaceuticals currently have limited data on environmental hazard. 

Background: Pharmaceuticals treat and prevent diseases but can pose a risk to organisms, predominantly in aquatic environments. The use of pharmaceuticals is predicted to increase due to, among other factors, a growing and aging population and climate change. Therefore, it is important to develop mitigation strategies to prevent pharmaceutical residues from entering the environment. In Sweden, two public pharmaceutical web-based knowledge supports provide information on the environmental impact of pharmaceuticals.

Objective: To explore stakeholder perspectives, use and future opportunities related to two webbased knowledge supports publicizing environmental information on pharmaceuticals.

Methods: Stakeholders identified for their experience with the knowledge supports, pharmaceutical policy, and stakeholder collaboration were recruited using purposive and snowball sampling for semi-structured interviews. Interviews were conducted in person or via video calls. Respondents included twenty-one representatives from the pharmaceutical industry, regional and national authorities, academia, and an independent research institute. Interview transcripts were analyzed using content analysis.

Results: Respondents valued having environmental information on pharmaceuticals publicly accessible on two wellknown pharmaceutical knowledge supports. The knowledge supports have been used in Sweden and internationally. Perceived differences were recognized between the impact and perspectives of the two knowledge supports with a general preference for the Janusinfo knowledge support. The preference was especially identified regarding transparency and the use of the information in clinical practice. Barriers to impact were a lack of resources and decision-making criteria. Respondents believed that the impact and value of the knowledge supports could be improved with more authority involvement.

Conclusion: Public knowledge support providing environmental information on pharmaceuticals has been valuable across sectors, especially, among Drug and Therapeutics Committees. We believe the results from this study could be useful for other countries interested in implementing a similar system.

Aims: Prescribing pharmaceuticals is essential to improve health, but it also has substantial environmental impact. This study investigated the extent to which Swedish general practitioners (GPs) are willing to integrate environmental aspects into treatment decisions and their opinions on policies to reduce pharmaceutical pollution.

Methods: A questionnaire assessing environmental considerations in prescribing was developed and distributed to 1233 Swedish GPs and physicians in training (response rate: 22%) between September 2023 and June 2024. It included 3 patient cases to assess trade-offs between therapeutic effect and environmental impact of pharmaceuticals used for pain management, blood pressure reduction, and contraception. Questions about attitudes to policies to reduce the environmental impact of pharmaceuticals were also included. Data were analysed using descriptive and inferential statistics.

Results: Most respondents were willing to prescribe a less effective pharmaceutical if it was environmentally preferable, 77% for pain management and blood pressure reduction, and 50% for contraception. Environmental impact was ranked as the least important factor in prescribing decisions when compared to cost, regional treatment guidelines, dosage intervals, and user-friendliness. A total of 68% of respondents agreed that physicians should consider environmental aspects when prescribing, however only a few often searched for environmental information when prescribing. Policies directed towards other stakeholders, such as authorities and the pharmaceutical industry, received substantial support.

Conclusion: Swedish GPs are willing to consider environmental factors when prescribing. However, other factors are more often considered and GPs attribute higher responsibility to other actors. Improving access to environmental information about pharmaceuticals could support greener prescribing.

Background: Pharmaceutical pollution is an increasing environmental concern. As key actors in the healthcare chain, community pharmacies play an important role in managing pharmaceuticals from an environmental perspective. Although environmental initiatives exist at the corporate level in Sweden, it remains unclear how well these are known to, or implemented by, pharmacy staff. Objectives: To explore how community pharmacy staff in Sweden perceive their role in reducing pharmaceutical pollution, and identify the opportunities and challenges they face in promoting environmentally friendly use of pharmaceuticals. Methods: Focus group discussions and individual semi-structured interviews were conducted with pharmacy staff in Sweden between May 2024 and February 2025. All focus group discussions and interviews were audio recorded, transcribed, and analysed using inductive qualitative content analysis. Results: Four focus group discussions and five individual interviews were conducted. The analysis resulted in three main categories. First, while there was an awareness of environmental issues, participants expressed a lack of concrete guidance and requested more information, such as lists of environmentally harmful pharmaceuticals. Second, pharmaceutical waste, originating both from households and pharmacies, was highlighted as a major concern. Third, there appeared to be a sense of limited agency and a wish for support from, for example, regulatory authorities to address pharmaceutical pollution. Conclusion: Swedish pharmacy staff view themselves as potential contributors to reducing pharmaceutical pollution, but struggle to identify concrete actions. They are concerned about pharmaceutical waste and responsibility is often shifted to other stakeholders.