The database is located online in the Swedish Medicines Information portal, or FASS, a commonly used resource for both doctors and the general public for up-to-date pharmaceutical information.
“FASS is very well known among doctors in Sweden as a source for everything you want to know about a particular pharmaceutical, so it just felt natural to add an environmental component onto it,” says Matilda Persson, a spokesperson for the Swedish pharmaceutical industry group.
So far, the database lists about 1,100 substances, although only 60 percent have been environmentally reviewed. One-fourth of those have detailed data. By 2010, all pharmaceuticals marketed in Sweden are supposed to be assessed, excluding those unlikely to have an environmental impact, such as vitamins.
Although there are no statistics available on how many doctors have used the database, Persson says that it registers about 5 million visits per month and is regarded as the most important pharmaceuticals website in Sweden.
Lööf, a physician at Central Hospital in Västerås who specializes in internal medicine and gastroenterology, said he and many of his colleagues feel the database is useful but that it needs more hard data on drugs, especially older ones that don’t fall under EU legislation.
“Physicians do use the database, but it’s not yet common for them to use it for every prescription because it’s still lacking a lot of information on pharmaceuticals,” said Lööf, chairman of the Drug Therapeutic Committee at the Centre for Clinical Research in Västerås, which works with local physicians to provide drug therapy strategies.
He adds that drugs without environmental data are often classified first as high risk, but then changed to low risk once more information is obtained, which can be confusing to physicians and patients.
“The list changes from year to year and this is a problem,” Lööf said. Still, he believes that the database is a good start in managing pharmaceutical information.
There are no plans to extend the database to the rest of Europe. That could change as the European Environmental Agency, under the European Commission, recently recommended that all EU countries introduce a drug classification system.
“We don’t know whether the European Commission will accept this recommendation, but it is a very strong push on the Commission to adopt this system in all of the EU,” said Wennmalm. He believes that in a few years, a drug classification system might be introduced to all 27 EU countries, especially Germany, which has already expressed interest.
Christina Rudén, program manager of MistraPharma, a Swedish national research initiative that studies pharmaceuticals’ environmental effects, said because the European Union’s pharmaceutical legislation is fairly new, it may be easy to change. She said Swedish reviewers are likely to suggest an amendment that includes a classification system similar to JanusInfo.
“It’s quite impressive of Sweden to put this voluntary classification system in place since these pharmaceutical industries are so multi-national,” Ruden said. “There are some serious concerns internationally and particularly in the U.S. about why the industries should do this voluntary classification system, but at the end of the day the pharmaceutical industry agreed to do it, and I think that’s a very positive sign.”
Not all drugs can be green. Some might seep into waterways yet save people’s lives. And since the environmental threats of pharmaceuticals are not yet fully understood, some experts worry about passing laws without properly assessing the risk that they pose.
“It’s far worse if people in need of a treatment lose the treatment because of a poor risk assessment that overestimates something that’s a small risk to the environment,” said Frederick Bouder, a research associate at the King’s Centre for Risk Management at King’s College London who studied regulation of pharmaceuticals in the environment in the United States and Europe.