Site MapMedicine Waste Reduction
There are many reasons why prescription and over-the-counter medicines become unwanted – some reasons are avoidable and some are not. Many people stop taking drugs due to side-effects, lack of efficacy, or quicker recovery than anticipated. Over-the-counter medicines sometimes expire before we completely use them. But we also are buying more drugs, per-person, than ever before in this country.
The reality is we will always have some waste medicines. But let’s consider how we can reduce the amount of drugs that become waste.
Washington Citizens for Resource Conservation is developing practical medicine waste prevention and ecotoxicity reduction strategies. We have been working on both long term and immediate strategies and present the more immediate strategies on this page for the public/consumers, healthcare practitioners, payers (insurers), and pharmaceutical manufacturers.
A myriad of factors go into determining patient treatment and pharmaceutical prescribing. The concepts presented here are not meant to discount any other highly important considerations such as financial accessibility, adherence/compliance, and differences in drug efficacies. The following strategies are ideas for places to start working on reducing unwanted pharmaceutical waste.
Waste Prevention Strategies
Public/Consumers
- Buy smaller Quantities. Try to buy the amount you will use and no more. If it’s a new treatment for you, try it out first by buying the smallest quantity available. And remember, a giant container of over-the-counter drugs or vitamins may seem more cost-effective, but it's not if they expire and the product doesn’t get used.
- Education. Check out these resources for more information. Also, talk to your peers and doctors to help get them thinking about this issue.
- Review your medicines. Check in periodically with your doctor or pharmacist so they know ALL the different drugs you take. This step can help prevent waste and also provide you with better care so you aren't accidentally taking incompatible or redundant medicines.
- Reuse? Not an option for household medicines. Read about why not. Reuse may be a possibility for medicines that have not left the institutional setting, depending on local governing laws. Before making any donations to collections going to other countries or disaster relief efforts, you should look into the specific situation and be informed on the problem of pharmaceutical dumping onto marginalized communities. Read the World Health Organization's Guidelines for Drug Donations.
Healthcare Practitioners
- Education. Learning about the issue is a good place to start. There are several relevant articles for further reading. Even better- talk to your colleagues about it. We will send you copies of Pharmaceutical Pollution Prevention: A Guide for Healthcare Professionals if you contact us, or you can download it yourself here. Also, Teleosis Institute offers an online course titled Green Health Care.
- Disease prevention. When overall health is improved, fewer drugs are needed for treatment. Many healthcare professionals are making great efforts to focus on disease prevention. Preventing pharmaceutical pollution is just another good reason to emphasize disease prevention.
- Drug ecotoxicity. Not all drugs are created equal. And that’s a good thing because they obviously do very different things in our bodies. But they also have varying degrees of ecotoxicity. Many drugs have been given ecotoxicity ratings by the Stockholm County Council in Sweden. A catalog of the rated drugs can be found at janusinfo.se. Utilizing the catalog can add more information to a healthcare practitioner’s decision-making process when choosing drugs. For example, if there are two drugs that are otherwise equally effective, utilizing the Swedish drug rating system to choose the treatment could help reduce the environmental impact.
- Do not prescribe more medication than can be used. Medicine becomes waste more commonly when a patient starts a new treatment, either for acute problems or new treatment for chronic problems. Some classes of drugs are more likely to become waste. CNS Agents, nutritional products, and psychotherapeutic agents are the pharmaceuticals that most commonly end up as household waste. (This is based on findings from a medicine take-back study in California that did not accept controlled substances.) Read about the Teleosis Institute study to learn more about which drug classes are commonly ending up as waste.
- Samples. Only take samples if you feel sure you will provide them to patients. Whenever possible, ask for vouchers rather than samples. If the vouchers don’t get used in time, they become paper to recycle, but unused samples become drug waste that must be disposed of properly as business waste.
- Review patients' medications. Review and regularly assess the patient’s total consumption of medication. This allows you to check for medication redundancy and incompatibility. When patients are seeing multiple doctors or changing their treatment, it's easy for them to accidentally take duplicate or harmfully-interacting drugs.
- Proper waste disposal. Properly dispose of waste pharmaceuticals from your business. Contact your state’s ecology department for more information. Read here for advice to tell your patients about proper disposal of their unwanted medicines.
Payers (Insurance Providers, Medicare/Medicaid)
- Starter packs. Promote free starter packs of a small quantity of drugs for new treatment. This can save money by reducing waste. It could also be used to encourage generic purchasing over brand name drugs.
- Support current waste reduction efforts. WCRC and others are working to hold a multi-stakeholder summit to address household pharmaceutical waste reduction. To get involved, contact us at eva@wastenotwashington.org.
Pharmaceutical Manufacturers
- Vouchers. Offer vouchers instead of samples for your products. This can save money and prevents waste from unused samples.
- Drug ecotoxicity. Consider ecotoxicity as part of the equation during drug development and manufacture. In particular, investigate potential endocrine disruption, as well as, chronic exposure to a multitude of pharmaceuticals and other compounds found in the environment.
- Support current waste reduction efforts. WCRC and others are working to hold a multi-stakeholder summit to address household pharmaceutical waste reduction. To get involved, contact us at eva@wastenotwashington.org.
Resources
Information on Teleosis Institute, now a part of Practice Greenhealth, can be found at www.teleosis.org. The Teleosis Institute is devoted to developing effective, sustainable health care provided by professionals who serve as environmental health stewards. Teleosis Institute offers an online course titled Green Health Care.
Stockholm County Council's database of drugs rated for their ecotoxicity potential. Go to http://www.janusinfo.se/imcms/servlet/GetDoc?meta_id=7238. While not all drugs are rated yet, there are many in the database and more continue to be added. The drugs are given a PBT rating (persistent, bioaccumulative, and toxic).
There are many organizations coordinating drug donations for redistribution. If you have unexpired drugs from an institutional setting that you would like to donate, be sure to investigate the situation first. To understand why, read this article on the problem of drug dumping.
Relevant Articles
Daughton CG, Ruhoy IS. The afterlife of drugs and the role of pharmEcovigilance. Drug Safety. 2008; 31(12): 1069-82.
Nathan A, Goodyer L, Lovejoy A and Rashid A. ‘Brown bag’ medication reviews as a means of optimizing patients’ use of medication and of identifying potential clinical problems. Family Practice. 1999; 16: 278-282.
Jesson J, Pocock R, and Wilson K. Reducing medicines waste in the community. Primary Health Care Research and Development. 2005; 6: 117-124.
Jones M. New Life for Old Pills. AARP. September & October 2006; p 56.