Healthcare Without Harm (HCWH) published a video informing doctors and clinicians on the issue of pharmaceutical pollution in the environment, and ways in which this can be avoided. The video was made by the SaferPharma focus group within HCWH – which focuses on up-stream solutions, preventative measures, and sustainable prescribing options to reduce pharmaceutical pollution.
Click here to watch the video (also below), and read more about HCWH.
Pharmaceutical prescribing is the most common medical intervention in modern healthcare, and pharmaceutical usage in daily life is increasing across the globe. This is as a result of growing and aging populations, new technological advances, and pharmaceutical availability. As a result, these compounds (parent drugs, and human metabolites), enter waste streams in large quantities – which are most frequently treated at municipal wastewater treatment plants (WWTPs). However, WWTPs were not designed to remove small organic pollutants (like pharmaceuticals), and are unable to be completely eliminate these compounds from wastewater. As a result these compound enter surface water, and the wider environment, when final effluent is discharged from the treatment plant.
Doctors are well positioned to address this reduce unnecessary pharmaceutical emissions and waste by adopting simple prescription practices, educating patients, and supporting change in procurement and prescription practices.
Practical actions include:
- Prescribing smaller starter packs for new medicines, and refills only as needed
- Prescribing preventative measurers and non-medicinal therapies where possible
- Prescribing pharmaceuticals, and especially antibiotics, only when needed
- using rapid point of care diagnostics in primary and second to support clinical decision making
- Advising on alternative ways to prevent infections (such as vaccination)
- Educating patients on pharmaceutical pollution
- Recommending ways to reduce pollution and emissions by changing buying and disposal behaviour
- Raising awareness on prescription and over-the-counter medicine stockpiling, and safe disposal and return schemes at pharmacies
There is no one solution going forward, and cross-sector collaboration with a combination of up-stream approaches is needed. Green formulary development (prioritising pharmaceuticals based on environmental impact), public awareness, educating clinicians/healthcare practitioners, promoting appropriate prescribing, stewardship activities, and social prescribing, – these all have an important part to play in reducing pharmaceutical pollution in the environment.