Interventions to Reduce the Environmental Impact of Medicines: A UK perspective✰

Polypharmacy and deprescribing: challenging the old and embracing the new

“…Safety has been defined in terms of reported adverse drug withdrawal events (ADWEs), return of medical condition(s), hospital admission and/or all-cause mortality [ 11 , 26 ]. The absence of change in health status following deprescribing, can be perceived as positive, because it could mean less treatment burden, lower medication costs and low carbon footprint prescribing [ 27 ]. However, research is needed to identify the safety concerns of deprescribing and large randomized controlled trials are needed to understand the prevalence and severity of ADWEs from deprescribing and the best strategies to reduce their risk [ 26 ].…”

Reusing medicines to mitigate their environmental impact

“…Similarly important in this time of climate crisis, but perhaps less readily quantifiable than the cost implications, is the environmental impact of pharmaceutical waste. In the UK, 10% of people dispose of unwanted medicines down household drains 7 and 41% throw them out with general waste, which goes primarily to landfill 8 . It is postulated that both routes contribute to environmental contamination and there is evidence to support this; medicines have been found in surface waters such as lakes and rivers, but also in groundwater, soil, manure and even drinking water, as conventional waste water treatment systems are not designed to fully remove drug residue from water supplies 8 .…”

Climate Change and the Professional Obligation to Socialize Physicians and Trainees into an Environmentally Sustainable Medical Culture

“…For example, in 2018, 25% of the UK population was prescribed a psychotropic medication [ 23 ], yet a follow-up review estimated that at least 10% of total prescriptions were unnecessary (e.g., prescriptions were not clinically indicated, there were more effective non-pharmacological alternatives, prescriptions were redundant) [ 24 ]. The rationale of polypharmacy in psychiatry is multifaceted and has historically been difficult to address [ 25 ]; however, given the sheer number of psychotropics prescribed and the large carbon footprint generated by producing them, efforts to reevaluate psychiatrists’ current prescribing practices could significantly minimize this waste and the carbon footprint it generates [ 26 ].…”

“…There are multiple reasons why physicians have historically contributed so substantially to climate change. Perhaps the biggest is that many providers are still unaware of the significant environmental impacts of their practice [ 26 ]. In a sample of over 400 international members of the American Thoracic Society, 80% identified that climate change was relevant to patient care, yet nearly half reported lacking knowledge about how to address climate change with their patients, and only 30% were aware of what their hospitals were doing to address their carbon footprints [ 33 ].…”