The levels of diazepam measured in Swedish waters are low and are not expected to pose any environmental risk, but diazepam is metabolized partly to oxazepam, which has been measured in concentrations posing a risk. This means that the use of diazepam may contribute to the environmental risk and the substance is therefore included in the Stockholm County Council's table of pharmaceuticals with risk for negative environmental impact according to the environmental programme 2017–2021. Oxazepam has been detected in treated wastewater, surface water and drinking water in Stockholm County in the last five years (2012–2016).
Diazepam is recommended in Wise list. Environmental classification of pharmaceuticals is taken into consideration, sometimes with other environmental aspects, when selecting pharmaceuticals for the Wise list. When comparable pharmaceuticals are equivalent to medical effects, safety and pharmaceutical efficacy, environmental impact and price are considered.
Concrete proposals on how to work to reduce emissions of environmentally harmful pharmaceuticals on the list have been developed in close cooperation with the Stockholm Drug and Therapeutics Committee's expert advice. The action proposals were developed from an environmental perspective. The patient's best always goes first and several pharmaceuticals on the list are also included in the Wise list. However, for such pharmaceuticals, there may be measures that could reduce the environmental impact.
Concrete proposal for diazepam
Environmental information for the substance is not available on Fass.se. It is voluntary for manufacturers to publish environmental impact information on Fass.se. In The Wise list substances with little or moderate environmental impact are recommended before substances that are completely missing or have incomplete environmental data if the substances are medically equivalent.
Author: Health and Medical Care Administration, Region Stockholm