Researchers at Glasgow Caledonian University, with support from NHS Highland, carried out a policy fellowship to investigate environmentally informed pharmaceutical prescribing in Scotland, as one of the solutions to reduce pharmaceutical pollution in the environment. The policy brief was published by the Centre of Expertise for Waters (CREW), and explores use of environmental criteria to inform the prescribing of pharmaceuticals – and assesses what evidence-based policy options are needed to enable the adoption of a national framework.
You can find the full policy brief here: https://www.crew.ac.uk/publication/environmentally-informed-pharmaceutical-prescribing-scotland
Pharmaceutical prescribing is the most common medical intervention in healthcare – but this activity has an environmental impact through increasing carbon emissions (e.g., medicine development, procurement, transportation), presence in surface water, and contribution to the development of antimicrobial resistance (AMR) in clinical and environmental settings.
An “eco-directed” pharmaceutical prescribing framework would contribute to new sustainability targets of the healthcare sector, whilst also promoting improved medicine stewardship in line with the Realistic Medicines agenda. “Eco-directed” prescribing proposes:
- Reducing pharmaceutical consumption as appropriate through rational prescribing practices
- Prescribing medicines which had less environmental impact based on environmental information (e.g., biodegradability, bioaccumulation potential, ecotoxicity, excretion profile)
This project investigated key policies in the environment, healthcare, and water sectors that are related to pharmaceutical prescribing and pharmaceutical pollution. And the OHBP steering group participated in a series of stakeholder workshops and knowledge exchange activities to inform on the policy assessment, to rank criteria and identify barriers in the relevant policies.
Pharmaceutical pollution and the need to address this are recognised in key healthcare and environmental policies. However, barriers to the integration of environmental criteria in medicine appraisal, environmental monitoring of pharmaceutical substances, awareness of stakeholders, and coordination between key expert groups need to be resolved.
This work proposes a policy framework to integrate eco-directed prescribing as a joint programme within the healthcare and environmental sectors, including:
- Organisation of a coordinative mechanisms between key stakeholders
- Systematic integration of environmental criteria in formulary development supported by expert evaluation of environmental risks of pharmaceuticals
- Improving knowledge of healthcare workers and the public on the environmental impact of medicines.