Small-scale hospital deprescribing could lead to a carbon dioxide drop equivalent to 4000 car trips of 100km a year, says Dr Aili Langford.
The environmental impact of desprescribing, even on a small scale, in hospitals is not to be underestimated, says an expert.
If healthcare were a country, it would be the fifth largest emitter in the world, behind China, United States, India and Russia. Reducing medical waste might start us on the road to recovery, say experts.
Speaking at session one of the Advanced Pharmacy Australia’s webinar series on deprescribing and reducing medical waste, NHMRC emerging leadership fellow Dr Aili Langford said there were many ways to reduce overprescribing in a hospital setting.
“Perhaps it’s using the patient’s own drugs during their inpatient hospital stay, rather than dispensing new packages,” she said.
“I know there’s probably some local policy level considerations regarding that.
“Providing smaller supplies of new medications or starter packs when someone is initiating a medication while they may still be titrating doses or determining the appropriateness, efficacy or safety of the medication … this can mitigate waste from poor tolerability.
“And then finally … regular medication review with appropriate deprescribing.”
The environmental impact of deprescribing were not often considered, said Dr Langford.
“A recent study looked at the potential of deprescribing in terms of greenhouse gas emissions,” said Dr Langford.
“They did a modelling study where they estimated a 5% reduction in drug consumption in quite a small hospital setting. In a 200-bed hospital, it could lead to a reduction of over 100 tonnes of greenhouse gas emissions per year.
“While this may seem relatively small scale, it speaks to the potential large-scale impacts, if deprescribing is done and done well and done appropriately in our local settings, how that could have quite substantial flow-on effects.
“Just to contextualise that previous statistic, that reduction is equivalent to around 4000 car trips of 100km.”
Dr Langford called on pharmaceutical companies to share more information about the environmental impacts of their medications.
Currently, healthcare represents 7% of the total carbon dioxide emissions in Australia, with pharmaceuticals contributing to 19% of the sector’s emissions, said Dr Langford.
Associate Professor Hayley Blackburn from the University of Montana, said this impact was particularly significant in higher income countries.
“Healthcare’s carbon footprint is immense, particularly in higher income countries like the US and Australia,” she said.
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“We know that if we took healthcare and we made healthcare a country, we would be the fifth largest emitter in the world, behind China, United States, India and Russia.
“We know of that [healthcare] footprint, pharmaceuticals make up anywhere between 20-25% … in high income countries.
“It’s much lower in lower income countries, it’s about 10-12% globally when we think about the overall percentage of carbon in healthcare systems.”
Professor slackburn said that there were many sources of pharmaceutical waste that could be targeted.
“If [medication] goes out the door and the patient does not use [it], then typically that’s going to be flushed, trashed or brought back into a take back program, where it’s ultimately incinerated.
“In an inpatient setting, that waste is going to be disposed according to hospital policy, and so it may either end up in wastewater or it may end up in an incinerator.
“We would like to think that wastewater treatment would remove those drugs or incineration would come without any adverse effects.
“But we know, unfortunately, incineration does come with the greenhouse gas emissions associated with transporting those items, as well as the pollutants that come from the incineration process for those products.
“And if we go into wastewater treatment facilities, we know that the efficiencies of removal of those drugs in wastewater is actually relatively low.”
Professor Blackburn said improved methods to track medication across the system and reduction in unnecessarily large package sizes could help reduce waste.
Hospital policies – like needing to throw out drugs that have been labelled for one patient but not touched – can sometimes add to wastage where practice quite easily could easily reduce it, she added.
Founding member of AdPha’s climate and health specialty practice group Grace Wong said that deprescribing was a benefit to all.
“Deprescribing is a “win-win” action – reduction in medication misadventure risk and financial cost for patients, and reduction in environmental impact of the manufacture, use and disposal of medicines,” she said.