2025-02-192024/25:SoU14 · p.7SoUHealth & social services

Medicines and environment

Environmental considerations in medicine prescribing and reclassification

What's at stake: Pharmaceutical residues in water and soil affect fish, microorganisms and ecosystems, and how the generics and prescription-status systems are designed affects both environmental protection and the conditions facing the pharmaceutical industry.

Case texts and AI reasoning are AI-translated from the Swedish originals; the Swedish text is authoritative.

What the vote decides

The question is whether parliament should require, through formal requests to the government, clearer environmental guidelines for prescribing, a reformed generics system, and stricter environmental requirements for the prescription status of over-the-counter medicines, or whether ongoing inquiries and regulatory work already under way are sufficient.

Yes Yes — the committee proposal

The committee notes that work is already under way on an environmental premium within the medicine benefit scheme and on environmental considerations in medicines legislation, including diclofenac discharges, and that the Treklöver Inquiry's proposal to weigh environmental harm when setting the prescription status of over-the-counter medicines is being processed within government. On this basis, the committee opposes the motions.

No No — the reservations

Reservation 14 (MP)

MP holds that the government should draw up clear guidelines for doctors to substitute medicines for more environmentally friendly alternatives, reform the generics system so that environmental impact is weighed alongside price, and proceed with all proposals to let environmental harm be grounds for reclassifying over-the-counter medicines as prescription-only, including diclofenac.

Summarised from the committee report. Party labels in the summary come from the report, not from the vote.

VSMPCLKDMSD
YesNoAbstainAbsent

What do the votes mean here?

Yes The committee proposal: rejecting the motions (keeping things as they are).

No Backing the counter-proposal: reservation 14 by MP.

Abstain The party marks a position of its own that is not one of the two final alternatives.

What each plan points to — and how the party voted

For each party: the vote its own election manifesto and party programme point to in this case, next to how the party actually voted. A plan can only point to Yes or No; a party can also abstain.

PlanVoteConfidenceEvidence
VNoYes 19/0/0/5departs from the planconfidence: mediumnot addressed
SNoYes 90/0/0/16departs from the planconfidence: mediumnot addressed
MPown reservationNoNo 0/13/0/5follows the planconfidence: highexplicit
CNoYes 21/0/0/3departs from the planconfidence: mediumnot addressed
LNoYes 12/0/0/4departs from the planconfidence: mediumnot addressed
KDNoYes 14/0/0/5departs from the planconfidence: mediumnot addressed
MYesYes 57/0/0/11follows the planconfidence: lownot addressed
SDYesYes 63/0/0/9follows the planconfidence: lownot addressed

Committee proposal

The Riksdag rejects the motions 2024/25:114 by Björn Tidland (SD) and 2024/25:3055 by Ulrika Westerlund et al. (MP) motions 58-61.

Original (Swedish)

Riksdagen avslår motionerna 2024/25:114 av Björn Tidland (SD) och 2024/25:3055 av Ulrika Westerlund m.fl. (MP) yrkandena 58-61.

Riksdag decision: The Riksdag rejected approximately 90 proposals about medicines and dental care. The proposals were submitted during the general motion period 2024 and deal with, among other things, prescribing of medicines, review of the pharmacy market and the cost ceiling for dental care. The Riksdag refers primarily to the fact that work is already underway in the areas covered by the proposals.

Counter-proposals

Plan vs actual vote

Every party, in chamber order: what its own plan pointed to, how it voted, and the reasoning behind both. Highlighted rows are where the two differ — but a vote that follows the plan is a result too, so the reasoning is there for every party.

VVänsterpartietNoYesdeparts from the plannot addressed

The plan requires ambitious environmental goals followed up with strict legislation and decisions at all levels characterized by genuine care for people and nature.

Plan documents: party programme · 2022 manifesto

Reasoning and quotes

The plan requires ambitious environmental goals followed up with strict legislation and decisions at all levels characterized by genuine care for people and nature. Taking environmental effects into account in the generic system, providing guidelines for substitution with more environmentally friendly drugs and letting environmental damage be the basis for prescription designation is such strict regulation. The plan also states that policy must make demands on producers, not rely on their own considerations.

Original (Swedish)

Planen kräver ambitiösa miljömål som följs upp med skarp lagstiftning och att besluten i alla led präglas av genuin omsorg om människor och natur. Att väga in miljöeffekter i generikasystemet, ge riktlinjer för utbyte mot miljövänligare läkemedel och låta miljöskadlighet ligga till grund för receptbeläggning är sådan skarp reglering. Planen slår också fast att politiken måste ställa krav på producenterna, inte förlita sig på deras egna avvägningar.

  • strict environmental legislationdecisive»miljömål som följs upp med skarp lagstiftning och praktiskt arbete.« (party programme ↗)“environmental goals followed up with strict legislation and practical work.”
  • environmental consideration in all decisions»ställning och präglas av genuin omsorg om människor och natur.« (party programme ↗)“position and characterized by genuine care for people and nature.”
  • demands on producers»Politiken kan och måste ställa krav på att industrin ställer om« (2022 manifesto ↗)“Policy can and must make demands on industry to transition”
  • protection of ecosystems»skapa goda villkor för rika ekosystem, bland annat genom att återställa« (party programme ↗)“create good conditions for rich ecosystems, partly by restoring”

The plan takes no explicit position on what the committee actually decided — often because the committee's reason was procedural. The stance is derived and fully cited, but it does not show the party broke a commitment.

SSocialdemokraternaNoYesdeparts from the plannot addressed

The plan requires that environmental consideration is built in from the start and that all environmental impact in the form of emissions is minimized, with legislation and economic policy instruments as the most important instruments.

Plan documents: party programme · 2022 manifesto

Reasoning and quotes

The plan requires that environmental consideration is built in from the start and that all environmental impact in the form of emissions is minimized, with legislation and economic policy instruments as the most important instruments. Guidelines for switching to more environmentally friendly medicines, a generic system that weighs in environmental effects and prescription practices based on environmental harmfulness are such policy instruments. Medicines' environmental impact is not explicitly mentioned in the plan.

Original (Swedish)

Planen kräver att miljöhänsyn byggs in redan från början och att all miljöpåverkan i form av utsläpp minimeras, med lagstiftning och ekonomiska styrmedel som de viktigaste instrumenten. Riktlinjer för utbyte mot miljövänligare läkemedel, ett generikasystem som väger in miljöeffekter och receptbeläggning grundad på miljöskadlighet är sådana styrmedel. Läkemedlens miljöpåverkan nämns inte uttryckligen i planen.

  • environmental consideration built in from the startdecisive»Hänsynen till miljöns krav ska byggas in i produktionsprocesserna redan från början.« (party programme ↗)“Environmental consideration must be built into production processes from the beginning.”
  • minimize emissions»miljöpåverkan i form av utsläpp och avfallsprodukter ska minimeras.« (party programme ↗)“environmental impact in the form of emissions and waste products must be minimized.”
  • instruments in environmental policy»forskningssatsningar, lagstiftning och olika ekonomiska styrmedel är de viktigaste« (party programme ↗)“research investments, legislation and various economic policy instruments are the most important”
  • state control of healthcare»Tillsynen av sjukvården ska växlas upp för att garantera kvaliteten.« (2022 manifesto ↗)“Supervision of healthcare shall be stepped up to guarantee quality.”

The plan takes no explicit position on what the committee actually decided — often because the committee's reason was procedural. The stance is derived and fully cited, but it does not show the party broke a commitment.

MPMiljöpartietNoNofollows the planexplicit

The party programme demands that emissions of polluting substances such as pharmaceutical residues are reduced and that strict demands are placed on producers to make products circular and phase out environmentally harmful substances.

Plan documents: party programme · 2022 manifesto

Reasoning and quotes

The party programme demands that emissions of polluting substances such as pharmaceutical residues are reduced and that strict demands are placed on producers to make products circular and phase out environmentally harmful substances. The plan also sees pharmaceutical consumption as a problem for both patient safety and the environment, and the election manifesto wants to phase out toxic substances immediately. Guidelines for switching to more environmentally friendly medicines, environmental considerations in the generic system and prescription restrictions on environmental grounds follow directly from this.

Original (Swedish)

Partiprogrammet kräver att utsläpp av miljöstörande ämnen som läkemedelsrester reduceras och att skarpa krav ställs på producenterna att kretsloppsanpassa produkter och fasa ut miljöskadliga ämnen. Planen ser också läkemedelskonsumtionen som ett problem för både patientsäkerheten och miljön, och valmanifestet vill fasa ut giftiga ämnen omgående. Riktlinjer för byte till miljövänligare läkemedel, miljöhänsyn i generikasystemet och receptbeläggning på miljögrunder följer direkt av detta.

  • reduce pharmaceutical residues in waterdecisive»Utsläpp av miljöstörande ämnen såsom kväve, fosfor, läkemedelsrester« (party programme ↗)“Emissions of polluting substances such as nitrogen, phosphorus, pharmaceutical residues”
  • strict demands on producers»producenterna att kretsloppsanpassa nya produkter« (party programme ↗)“producers to make new products circular”
  • medicines burden the environment»läkemedelskonsumtionen i dag är ett problem« (party programme ↗)“pharmaceutical consumption today is a problem”
  • phase out toxic substances»fasa ut giftiga ämnen omgående, speciellt från produkter för barn.« (2022 manifesto ↗)“phase out toxic substances immediately, especially from products for children.”
CCenterpartietNoYesdeparts from the plannot addressed

The party programme makes a toxin-free environment a fundamental right and warns of chemicals whose effects on humans and nature are harmful or unknown, and the election manifesto wants to save lakes and watercourses from toxins.

Plan documents: 2022 manifesto · party programme

Reasoning and quotes

The party programme makes a toxin-free environment a fundamental right and warns of chemicals whose effects on humans and nature are harmful or unknown, and the election manifesto wants to save lakes and watercourses from toxins. The plan's steering principle is that it shall be unprofitable to harm the environment, which supports that environmental effects are weighed in the generics system and in prescription charging. Pharmaceutical substances in the environment are however not explicitly mentioned.

Original (Swedish)

Partiprogrammet gör giftfri miljö till en fundamental rätt och varnar för kemikalier vars effekter på människa och natur är skadliga eller okända, och valmanifestet vill rädda sjöar och vattendrag från gifter. Planens styrmedelsprincip är att det ska vara olönsamt att agera miljöförstörande, vilket stöder att miljöeffekter vägs in i generikasystemet och vid receptbeläggning. Läkemedel i miljön nämns dock inte uttryckligen.

  • toxin-free waterdecisive»Rädda Sveriges sjöar, vattendrag och hav. Våra barn ska kunna bada utan att utsättas för gifter, nedskräpning eller algblomning.« (2022 manifesto ↗)“Save Sweden's lakes, watercourses and seas. Our children shall be able to swim without exposure to toxins, litter or algal blooms.”
  • toxin-free environment as a right»Tillgång till rent vatten, ren luft och giftfri miljö är en fundamental rätt för alla människor« (party programme ↗)“Access to clean water, clean air and a toxin-free environment is a fundamental right for all people”
  • environmental steering incentives»Det ska alltid vara lönsamt att vara miljövårdande och olönsamt att agera miljöförstörande.« (party programme ↗)“It shall always be profitable to act in an environmentally protective way and unprofitable to cause environmental harm.”
  • caution with chemicals»Dagligen används kemikalier och tekniker vars effekter på människan och naturen är skadliga eller okända.« (party programme ↗)“Chemicals and techniques whose effects on humans and nature are harmful or unknown are used daily.”

The plan takes no explicit position on what the committee actually decided — often because the committee's reason was procedural. The stance is derived and fully cited, but it does not show the party broke a commitment.

LLiberalernaNoYesdeparts from the plannot addressed

The election manifesto requires continued measures to prevent pollutants such as pharmaceuticals from spreading in our waters, and the party programme that waste policy prevent pharmaceutical residues from spreading in nature.

Plan documents: 2022 manifesto · party programme

Reasoning and quotes

The election manifesto requires continued measures to prevent pollutants such as pharmaceuticals from spreading in our waters, and the party programme that waste policy prevent pharmaceutical residues from spreading in nature. The counter-proposal's demands for guidelines for switching to more environmentally friendly pharmaceuticals, environmental considerations in the generic system and the possibility of prescribing environmentally harmful pharmaceuticals are steering tools for precisely this, in line with the precautionary principle and with environmental requirements being able to be set in public procurement. The plan does not mention the generic system, so the conclusion is derived.

Original (Swedish)

Valmanifestet kräver fortsatta insatser för att förhindra att föroreningar som läkemedel sprids i våra vatten, och partiprogrammet att avfallspolitiken förhindrar att läkemedelsrester sprids i naturen. Motförslagets krav på riktlinjer för byte till miljövänligare läkemedel, miljöhänsyn i generikasystemet och möjlighet att receptbelägga miljöskadliga läkemedel är styrmedel för just detta, i linje med försiktighetsprincipen och med att miljökrav ska kunna ställas i offentlig upphandling. Planen nämner inte generikasystemet, så slutsatsen är härledd.

  • stop pharmaceuticals in watersdecisive»Samtidigt behövs fortsatta insatser för att förhindra att skräp och föroreningar, som plast och läkemedel, sprids i våra vatten.« (2022 manifesto ↗)“At the same time continued measures are needed to prevent litter and pollution, such as plastic and pharmaceuticals, from spreading in our waters.”
  • prevent pharmaceutical residues in nature»Avfallspolitiken måste förebygga och förhindra att tungmetaller, läkemedelsrester och andra« (party programme ↗)“Waste policy must prevent and stop heavy metals, pharmaceutical residues and other [pollutants]”
  • precautionary principle»Kemikalielagstiftningen ska utgå från försiktighetsprincipen.« (party programme ↗)“Chemical legislation shall be based on the precautionary principle.”
  • environmental requirements as steering tool»offentlig upphandling ska tydliga miljö-, klimat- och hälsoskyddskrav kunna ställas och långsiktigt« (party programme ↗)“in public procurement clear environmental, climate and health protection requirements can be set and long-term [maintained]”

The plan takes no explicit position on what the committee actually decided — often because the committee's reason was procedural. The stance is derived and fully cited, but it does not show the party broke a commitment.

KDKristdemokraternaNoYesdeparts from the plannot addressed

The party programme makes the substitution principle an important tool, requires that action be grounded in the precautionary principle and that environmental considerations be integrated into all policy areas.

Plan documents: party programme

Reasoning and quotes

The party programme makes the substitution principle an important tool, requires that action be grounded in the precautionary principle and that environmental considerations be integrated into all policy areas. Guidelines for switching to less environmentally harmful medicines, environmental considerations in the generics system and prescription owing to environmental harmfulness are applications of exactly this. The requirement for cost-effectiveness in the jointly financed care qualifies but does not break the conclusion.

Original (Swedish)

Partiprogrammet gör substitutionsprincipen till ett viktigt verktyg, kräver att agerandet grundas på försiktighetsprincipen och att miljöhänsyn integreras i alla politikområden. Riktlinjer för byte till mindre miljöskadliga läkemedel, miljöhänsyn i generikasystemet och receptbeläggning på grund av miljöskadlighet är tillämpningar av just detta. Kravet på kostnadseffektivitet i den solidariskt finansierade vården kvalificerar men bryter inte slutsatsen.

  • the substitution principledecisive»innebär att mindre farliga ämnen så långt möjligt ska« (party programme ↗)“means that less harmful substances as far as possible shall”
  • the precautionary principle»agerandet grundas på försiktighetsprincipen« (party programme ↗)“action is grounded in the precautionary principle”
  • environmental considerations in all decisions»Hållbar utveckling förutsätter att ekologi, ekonomi och sociala hänsyn integreras.« (party programme ↗)“Sustainable development requires that ecology, economy and social considerations are integrated.”
  • cost-effective medicines supply»Den solidariskt finansierade hälso- och sjukvården ska vara ändamålsenlig och kostnadseffektiv, säker för patienterna och baserad på kunskap och beprövad erfarenhet« (party programme ↗)“The jointly financed health and medical care shall be appropriate and cost-effective, safe for patients and based on knowledge and proven experience”

The plan takes no explicit position on what the committee actually decided — often because the committee's reason was procedural. The stance is derived and fully cited, but it does not show the party broke a commitment.

MModeraternaYesYesfollows the plannot addressed

The plan wants to tackle hazardous substances in water but chooses the technology path: research on and expansion of advanced water treatment.

Plan documents: 2022 manifesto · party programme

Reasoning and quotes

The plan wants to tackle hazardous substances in water but chooses the technology path: research on and expansion of advanced water treatment. It simultaneously rejects small-scale bans directed at individuals and demands that environmental policy be effective rather than symbolic, while patients should have good access to medicines. Directing doctors' prescribing and controlling medicines based on environmental damage is therefore outside the plan's line.

Original (Swedish)

Planen vill komma åt farliga ämnen i vatten men väljer teknikvägen: forskning om och utbyggnad av avancerad vattenrening. Den avvisar samtidigt småskaliga förbud riktade mot enskilda och kräver att miljöpolitiken är effektiv snarare än symbolisk, samtidigt som patienter ska ha god tillgång till läkemedel. Att styra läkares förskrivning och receptbelägga läkemedel utifrån miljöskadlighet ligger därför utanför planens linje.

  • water treatment as an instrumentdecisive»Satsa på forskning om vattenrening samt utbyggnad av avancerad vattenrening« (2022 manifesto ↗)“Invest in water treatment research and expansion of advanced water treatment”
  • no small-scale bans»Där miljöbovar betalar för sig, men du kan unna dig en plastpåse när du veckohandlar.« (2022 manifesto ↗)“Where environmental villains pay for themselves, but you can treat yourself to a plastic bag when you shop.”
  • effective, not symbolic environmental policy»Klimatpolitiken får aldrig reduceras till dyrbar symbolpolitik« (party programme ↗)“Climate policy shall never be reduced to expensive symbolic politics”
  • access to care and medicines»Alla har rätt till likvärdig vård« (2022 manifesto ↗)“Everyone has the right to equivalent care”
SDSverigedemokraternaYesYesfollows the plannot addressed

The plan requires that environmental policy seeks the measures that give the most environmental benefit per krona and is based on facts rather than feelings, and it wants to stop symbolic politics that places new burdens on operations.

Plan documents: 2022 manifesto

Reasoning and quotes

The plan requires that environmental policy seeks the measures that give the most environmental benefit per krona and is based on facts rather than feelings, and it wants to stop symbolic politics that places new burdens on operations. The counter-proposal's requirements on environment-guided medication substitution, environmental criteria in the generic system and prescription restrictions on environmental grounds are such measures with unclear effect and cost to healthcare. The plan is however concerned about toxins in the aquatic environment, which partly points in another direction.

Original (Swedish)

Planen kräver att miljöpolitiken söker de åtgärder som ger mest miljö per krona och baseras på fakta snarare än känslor, och den vill stoppa symbolpolitik som lägger nya bördor på verksamheter. Motförslagets krav på miljöstyrda utbyten av läkemedel, miljökriterier i generikasystemet och receptbeläggning på miljögrunder är sådana åtgärder med oklar effekt och kostnad för vården. Planen oroas dock av gifter i vattenmiljön, vilket delvis pekar åt andra hållet.

  • most environmental benefit per kronadecisive»Sträva efter miljöeffektivitet och hitta de åtgärder som ger mest miljö per krona« (2022 manifesto ↗)“Strive for environmental efficiency and find the measures that give the most environmental benefit per krona.”
  • fact-based environmental policy»Miljöpolitiken måste alltid stämmas av mot nya rön i forskningen och baseras på fakta framför känslor.« (2022 manifesto ↗)“Environmental policy must always be adjusted against new findings in research and be based on facts rather than feelings.”
  • stop symbolic politics»Stoppa symbolpolitik som går ut över möjligheten att bedriva industri och näring« (2022 manifesto ↗)“Stop symbolic politics that goes against the possibility of conducting industry and business.”
  • toxins in the aquatic environment»Situationen vad gäller övergödning och gifter i Östersjön är allvarligt.« (2022 manifesto ↗)“The situation regarding eutrophication and toxins in the Baltic Sea is serious.”

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Sources and documents

Documents under consideration

Source: The Swedish Parliament