R13 -Environmental impacts of medicine

How does healthcare contribute to environmental damage?

Healthcare contributes through:

• Greenhouse gas (GHG) emissions.

• Energy use for heating, cooling and electricity.

• Transport of medicines, staff and patients.

• Pollution of air and waterways.

• Pharmaceutical and plastic waste.

What are the main stages in the life cycle of a medicine?

The six main stages are:

1. Active pharmaceutical ingredient (API) production and formulation.

2. Device production.

3. Packaging.

4. Distribution and transport.

5. Patient use.

6. Disposal or reuse.

How does the production of medicines negatively affect the environment?

• Extraction of raw materials uses scarce natural resources.

• Manufacturing requires energy and water.

• Pharmaceutical factories can cause local pollution.

• Components manufactured in different countries require transportation.

• Production may also raise concerns about workers' rights.

What is pharmaceutical pollution, and how does it enter the environment?

Pharmaceutical pollution occurs when medicines or their active ingredients contaminate the environment.

Sources include:

• Excretion of medicines by humans and animals.

• Wastewater from pharmaceutical manufacturing.

• Incorrect disposal of unused medicines.

• Veterinary medicines entering soil and waterways.

What evidence shows that pharmaceutical pollution is a global problem?

• Approximately 40% of the world's rivers may contain harmful levels of pharmaceutical pollution.

• Antibiotics were detected at 65% of 711 river sites tested worldwide.

• Pharmaceutical pollution was found in rivers across all 10 national parks in England.

Why is pharmaceutical packaging environmentally harmful?

• Much of it is single-use.

• Complex plastics are difficult to recycle.

• Recycling facilities may not be available locally.

• Globally, less than 10% of plastics are recycled.

How does transporting medicines contribute to environmental damage?

• Global supply chains involve travelling thousands of miles.

• Refrigerated transport (cold chains) requires extra energy.

• Heavy or bulky products increase transport requirements.

• Frequent local deliveries increase carbon emissions.

How does medicine wastage affect the environment and healthcare system?

Medicine wastage has three main impacts:

• Environmental: Unnecessary production, transport, pollution and disposal.

• Financial: Wasted medicine costs, staff time and disposal costs.

• Social: Wasted patient and healthcare professional time.

What percentage of the NHS carbon footprint comes from medicines and prescribing?

Medicines and prescribing contribute approximately 17% of the NHS Carbon Footprint Plus, according to the lecture's chart.

Inhalers and anaesthetic gases contribute a further approximately 3%.

What are the NHS net zero targets?

The NHS aims to achieve:

• 2040: Net zero for emissions it directly controls (NHS Carbon Footprint).

• 2045: Net zero for all emissions, including its supply chain (NHS Carbon Footprint Plus).

Why do anaesthetic gases have a significant environmental impact?

Anaesthetic gases are greenhouse gases that can trap large amounts of heat in the atmosphere.

Examples include:

• Desflurane.

• Nitrous oxide.

• Isoflurane.

• Sevoflurane.

Desflurane has a particularly high global warming potential, which led to its decommissioning by NHS England in 2024.

What is the environmental problem associated with nitrous oxide (N₂O)?

Nitrous oxide is used for pain relief, childbirth and anaesthesia.

The lecture reports that:

• It accounts for approximately 75% of the UK's anaesthetic gas carbon footprint.

• Up to 99% was wasted through leakage from piped systems in the project described.

Solutions include reducing leaks, reviewing usage and switching to cylinders where appropriate.

Why do different inhaler devices have different carbon footprints?

• Metered-dose inhalers (MDIs): Contain propellants that are greenhouse gases.

• Breath-actuated inhalers (BAIs): Also use greenhouse gas propellants.

• Dry powder inhalers (DPIs): Do not contain propellants, so generally have lower direct emissions.

Lower-GWP propellants can also reduce emissions.

Inhaler selection must still consider clinical suitability and patient preference.

What is a carbon footprint?

A carbon footprint is the total greenhouse gas emissions produced by an individual, product, organisation or activity.

It measures their contribution to climate change and is usually expressed in kilograms of carbon dioxide equivalent (kg CO₂e).

How is a carbon footprint calculated?

Carbon footprint (kg CO}

={Activity or resource use}x{Emission factor}

An emission factor estimates the amount of greenhouse gases produced by an activity.

• Carbon footprints are often estimates based on resource use or financial expenditure.

What is Global Warming Potential (GWP)?

GWP measures how much heat a greenhouse gas traps in the atmosphere over 100 years compared with the same mass of CO₂.

• CO₂ has a GWP of 1.

• A gas with a higher GWP has a greater warming effect per unit mass.

What are examples of greenhouse gases and their Global Warming Potentials?

The lecture provides these approximate examples:

Greenhouse gas	GWP
Carbon dioxide (CO₂)	1
Methane	28
Nitrous oxide	273–310
Desflurane	2,540–2,590

The slides use slightly different figures from different sources. The important concept is that desflurane has a much higher GWP than CO₂.

What are the limitations of carbon footprinting?

Carbon footprinting focuses mainly on greenhouse gas emissions.

It does not fully consider:

• Water consumption.

• Resource depletion.

• Pharmaceutical pollution.

• Plastic waste.

• Other environmental and social impacts.

This is known as carbon tunnel vision.

What is a Life Cycle Assessment (LCA), and why is it important?

• A Life Cycle Assessment evaluates the environmental impacts of a product throughout its entire life cycle.

• It considers production, packaging, transport, use and disposal.

• An LCA provides a more complete assessment than carbon footprinting alone because it considers multiple environmental impacts.

How can pharmaceutical manufacturing become more environmentally sustainable?

• Use green chemistry principles.

• Reduce energy and water consumption.

• Minimise waste and pollution during manufacturing.

• Reduce unnecessary packaging.

• Increase recycled materials.

• Improve supply-chain sustainability.

How can medicine transport become more sustainable?

• Reduce unnecessary delivery journeys.

• Combine deliveries and optimise routes.

• Use electric vehicles or bicycles where suitable.

• Reduce packaging weight and volume.

• Improve cold-chain efficiency.

How should unused medicines be disposed of, and what are the environmental challenges?

Unused medicines should be returned to a pharmacy for safe disposal rather than placed in household waste or flushed down drains.

Challenges include:

• Incineration contributing to air pollution.

• Landfill posing a pollution risk.

• Difficulties separating different types of waste.

• Limited recycling options for medicine packaging and devices

How can pharmacists help reduce the environmental impact of medicines?

Pharmacists can:

• Carry out structured medication reviews.

• Reduce overprescribing.

• Deprescribe unnecessary medicines when clinically appropriate.

• Prevent overordering and wastage.

• Encourage appropriate lower-carbon medicines.

• Educate patients about safe medicine disposal.

These actions support medicines optimisation and NHS sustainability goals.

What is the role of the Association of British Pharmaceutical Industries (ABPI) in environmental sustainability?

The ABPI supports pharmaceutical companies in meeting NHS net zero goals.

Its commitments include:

• Conserving water.

• Reducing manufacturing and packaging waste.

• Increasing recycling.

• Using green chemistry.

• Reducing the environmental impact of medicine production.

However, participation is largely voluntary, and greenwashing remains a concern.

What is PAS 2090, and why is it important for pharmaceutical sustainability?

PAS 2090 is an international standard for conducting product-level Life Cycle Assessments of pharmaceuticals.

It provides a consistent, science-based framework for measuring and comparing the environmental impacts of medicines.

It supports progress towards net zero but is not currently a regulatory requirement, according to the lecture.

summary

Key concept	What to remember
NHS net zero targets	2040 (directly controlled emissions), 2045 (all emissions)
Medicines and prescribing	17% of NHS Carbon Footprint Plus
Carbon footprint	Total GHG emissions, measured in CO₂e
GWP	Heat trapped relative to CO₂ over 100 years
LCA	Environmental assessment across a product's life cycle
MDIs vs DPIs	MDIs contain GHG propellants; DPIs do not
Desflurane	High-GWP anaesthetic decommissioned in 2024
Pharmaceutical pollution	Can arise from manufacturing, use and disposal
PAS 2090	Standardised pharmaceutical life cycle assessments
Pharmacists' role	Medicines optimisation, reducing waste and sustainable prescribing