Green Prescriptions

• The Importance of Proper Disposal
• Reducing Harm from What Passes through Patients
• 10 Green Prescription Habits

The Importance of Proper Disposal

This very rough model suggests that, although inappropriate disposal of unused medicines is a low percentage of the overall problem, it is a very significant contributor to environmental contamination.

If 20% of drugs were unused, and 50% of what was taken passed unmetabolised, unused drug take-back would eliminate as much as one third of the source of environmental contamination with pharmaceuticals.

GPs and pharmacists can do a lot to improve drug take-back rates, by reminding patients to return unused drugs and providing a place for them to do so. In the UK, pharmacists are reimbursed for drugs they collect, while recently in Ireland there was a two-month Dispose of Unused Medicines Properly (DUMP) campaign to raise awareness of take-back schemes there.

Reducing Harm from What Passes through Patients

A 100% effective take-back scheme would leave only the drugs which pass through the body either unaltered or as active metabolytes of the original compound. The potential for harm of this further proportion can be reduced by choosing, when all other considerations are equal, the least environmentally hazardous drug suitable for treating the patient's condition.

As part of their objective to reduce pharmaceutical residues in water to 2005 levels by 2011, Stockholm County Council has been classifying medicines according to their potential impact on the environment: Environmentally Classified Pharmaceuticals.

Swedish doctors are being advised and trained to use the environmental hazard classification in their prescription practices.

10 Green Prescription Habits

The Stockholm County Council gives doctors the following prescribing advice:

1. Follow "Kloka Listan," Stockholm County Council's "Wise List" of recommended drugs for common diseases. Always take cost effectiveness and environmental impact into account when comparing medications that are equally safe and suitable for the purpose.
2. Prescribe starter packs.
3. Prescribe refill packs if available.
4. Encourage patients to return unused medications to the pharmacy.
5. Inform patients of the importance of also returning used estrogen patches to the pharmacy and avoiding flushing them down the toilet, since most of the estrogen remains in the patch after use.
6. After being used inhalers can still contain active substance. Ask the patients to read the enclosed instruction carefully and to bring these inhalators to the pharmacy.
7. Do not prescribe more medications than can be used; if in doubt, repeating the prescription is preferable.
8. Review and regularly reassess the patient's total consumption of medication in order to reduce waste.
9. Learn more about which ones of "your" drugs have the largest environmental impact. Can they be replaced?
10. Please contact the representatives of the pharmaceutical manafacturers, if you do not find a certain substance in the table.