Just published is a comprehensive examination of sustainability and the use of pharmaceuticals in health care. Read the summary at Expert Review of Clinical Pharmacology, 2011, 4(2):211-232; doi: 10.1586/ecp.11.6;
“Green Pharmacy & PharmEcovigilance: Prescribing and the Planet,” by Daughton CG and Ruhoy IS
The article is Open Access and can therefore be freely downloaded as an Acrobat PDF or accessed in HTML from these URLs: http://www.expert-reviews.com/doi/abs/10.1586/ecp.11.6 or http://www.expert-reviews.com/doi/pdf/10.1586/ecp.11.6
One of the overarching objectives in our work on pharmaceuticals as environmental contaminants has been to forge clearer linkages between environmental integrity and human health, and to foster awareness, dialog, and debate within the healthcare communities regarding the intimate connections between the environment and the practice of medicine.
Our major message is that a more sustainable system of health care can evolve simply by focusing on redesign of any of numerous aspects of the delivery of health care that serve to reduce and optimize the overall use of medications.
The paper posits that any of the numerous actions, behaviors, and customs involved with the prescribing and dispensing of drugs can be altered to: (1) reduce the incidence of leftover medications (and thereby lessen the need for disposal – which is usually done by flushing to sewers or discarding in trash) and (2) reduce the quantities of unmetabolized residues excreted or washed into sewers. The second point is one that is almost always discounted as not feasible, but one that we maintain offers the greatest potential for minimizing the environmental burden of pharmaceutical ingredients.
Unfortunately, these are really not issues that have historically concerned most healthcare practitioners. But by using a systems-level approach, we believe a cogent and compelling argument can be advanced.
By taking actions to protect the environment, a broad spectrum of extremely important collateral benefits for health care can naturally emerge. These benefits involve systems-wide improvements in:
(i) the quality of health care (e.g., improved therapeutic outcomes),
(ii) reducing healthcare costs (from lessened usage of medications), and
(iii) reducing drug diversion and unintended poisonings (because of fewer leftovers); the latter is a major problem in the US and a great concern to the White House ONDCP.
In the final analysis, we believe that the prudent prescribing and dispensing of drugs, coupled with an enlightened understanding between consumers and physicians with respect to medication utility and use, would minimize the incidence of leftover medications – thereby largely solving the current problems surrounding drug disposal and diversion.
Also, by reduced and prudent usage (coupled with the selection of those drugs with favorable pharmacokinetics), the entry of residues (via excretion and bathing) from the intended use of medications could also be reduced.
In essence, by attempting to protect the environment from exposure to medication residues, we believe that a rare win-win can be achieved — for consumers (patients), healthcare professionals, health insurers, and the pharmaceutical industry.
Christian Daughton, Ph.D.
Chief, Environmental Chemistry Branch (on detail) Environmental Sciences Division National Exposure Research Laboratory U.S. Environmental Protection Agency
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