Considerations for Environmentally Conscious Pharmacy Students

Many health care workers struggle to understand the connection between health care and the environment, even though these entities affect each other in a reciprocal manner. Environmental conditions, such as severe weather, contaminated water supplies, and air pollution, affect health by causing injuries and fatalities, exacerbating respiratory and cardiovascular diseases, and spreading infectious diseases, such as cholera and cryptosporidiosis.¹ In turn, health care can also affect the environment in cases of improper disposal of pharmaceutical waste, manufacturing and supply chain issues, and pollution from health care systems.

Recent research confirms the presence of pharmaceuticals in locations that extend beyond its intended use by patients or in the health care setting. For example, a 2014 Environmental Protection Agency water study measured municipal wastewater effluent from 50 health care facilities serving 46 million people and detected hydrochlorothiazide in every sample. Valsartan was found at the highest concentration, and lisinopril was found at concentrations that could produce 1 dose annually.² Moreover, in 2014, 7.9% of the total national carbon footprint was attributable to health care.³

As more data emerge showing how closely health care and the environment are intertwined, the roles of pharmacists and pharmacy students continue to be explored and defined. Although the climate crisis can feel overwhelming, it can be comforting to remember that no effort, regardless of size, goes to waste.

Tackling environmental issues can feel particularly paralyzing for students, given the numerous responsibilities that accompany school. For new graduates, stepping into new roles as pharmacists while striving to protect the environment can be intimidating and isolating. However, making environmental health a part of standard practice within the pharmacy can begin with just a few action steps.

GOING GREEN DURING PHARMACY SCHOOL

Equip yourself with knowledge

Attending conferences can help support exposure to knowledge and ideas on how to make an impact. For example, the annual CleanMed Conference provides attendees with the opportunity to network and learn from experts about sustainable health care and environmental protection.⁴

Share your mission

Student-led initiatives that invite discussion about the intersections of health care and the environment are an important step to identifying gaps in education. Asking peers and professionals both within and outside pharmacy about their ideas, ways to collaborate, and strategies to implement sustainability into practice can foster growth and make change approachable.

For example, the Planetary Health Report Card initiative is implemented by medical students to encourage medical schools to incorporate sustainable health care education while measuring each medical school’s “green” score. Advocating for environmental factors to be taken into consideration during the clinical decision-making process is critical because of the many links between patients’ health and the environment.

Growing sustainable leaders

Joining student organizations and professional organizations can help maintain motivation in sustainability efforts and support the free exchange of ideas.

For example, the Sustainable Pharmacy Project, originating from Virginia Commonwealth University School of Pharmacy, provides opportunities for pharmacy students to connect, collaborate, and hold events that inspire future pharmacists to lead efforts to reduce pharmaceutical waste. Additionally, Rx For Climate is a web-based organization focused on empowering pharmacists to make sustainable decisions and enforce the idea that pharmacists have an important role in the fight against climate change.

STAYING GREEN POST PHARMACY SCHOOL

Promote sustainable prescribing

As practicing pharmacists, opportunities to promote sustainability are numerous and diverse, and educating other health care practitioners has always been central to the pharmacist’s role. Although this has traditionally been limited to education on optimal therapeutic use of medications, it is not unrealistic to extend this scope to include guidance on therapy that considers environmental impact as well.

For example, anesthetic gases used during surgery exhibit a profound greenhouse effect, yet there are less impactful alternatives available that do not compromise patient safety. In a 2019 study, pharmacists were found to be key in implementing these alternatives and reducing their use at the University of Wisconsin, resulting in a 64% per-case reduction in carbon dioxide equivalent emissions.⁵

Furthermore, pharmacists are aware that dry powder inhalers are the environmentally friendly choice among inhaler options because of metered dose inhalers’ higher carbon footprint.⁶ As medication experts, pharmacists can make suggestions like this regarding the safer choice of a medication for the environment as well as for the patient while also helping to write protocols and educate other clinicians on how to make these environmentally conscious choices and balance patient needs.

There are also databases available like Janusinfo, which categorizes the environmental hazards of different medications, allowing pharmacists to compare the environmental risks involved with prescribing a given medication. In this way, just as cost, availability, and patient preference may shape prescribing patterns, environmental harm should be among the factors that guide medication utilization.⁷

Pharmacists are also well positioned to support sustainability on a systems level. Because they are heavily involved in the selection, procurement, distribution, and utilization of medications in hospitals and other settings, they can work to reduce the impact on environmental systems by making environmental sustainability a consideration during these processes to support patient health.

Empower your patients

Pharmacists can promote their institutions’ medication disposal services and play an active role in reducing improper medication disposal. In a 2016 study, the most common method of household disposal of unused medications among 18,008 participants globally was the garbage.⁸ Proper disposal of medications is a simple and effective method that minimizes harm to ecological systems.

Pharmacists should continue to instruct patients on how to utilize medication disposal programs rather than flushing or pouring medications down the drain. Equipping patients with knowledge of these services empowers them to take an active role in keeping their environments safe and healthy.⁹

Look further upstream

There is also room for pharmacists to promote sustainability even further upstream within the pharmaceutical industry and drug development. A growing area of interest in pharmaceutics is utilizing green chemistry principles for new drug synthesis and implementing “benign-by-design” drug manufacturing (ie, medications that biodegrade into benign components rather than environmentally harmful pollutants) to lessen the impact of medications that reach the environment.¹⁰

Opportunities for pharmacy students and pharmacists to positively affect the environment are endless. From attending environmentally centered conferences as a student pharmacist to creating benign-by-design medications as a pharmacist, no effort is too small. Through collective action, students can make a difference.¹¹

There is still a lot that remains unknown about the symbiotic relationship between pharmacy and the environment, but 1 truth remains: Health care providers play a pivotal role in affecting the climate crisis, whether through action or inaction.

To find a pharmacy offering medication disposal services near you, visit https://safe.pharmacy/drug-disposal/ and provide your zip code.

To hear more about the ways in which environmental conditions affect patient health, visit https://www.pharmacytimes.com/view/webcast-the-impact-of-environmental-conditions-on-patient-health.

REFERENCES

1. Climate effects on health. CDC. March 2, 2021. Accessed September 1, 2021. https://www.cdc.gov/climateandhealth/effects/default.htm
2. Kostich M, Batt A, Lazorchak J. Pharmaceuticals in municipal wastewater Problem statement Active pharmaceutical ingredients (APIs) What are risks to humans and aquatic life? Challenges: well over 1000 APIs approved by FDA for use in the S. 2014.
3. Pichler P-P, Jaccard IS, Weisz U, Weisz H. International comparison of health care carbon footprints. Environ Res Lett. 2019;14(6):064004. doi:10.1088/1748-9326/ab19e1
4. About CleanMed. CleanMed. https://cleanmed.org/about-cleanmed/
5. Zuegge KL, Bunsen SK, Volz LM, et al. Provider education and vaporizer labeling lead to reduced anesthetic agent purchasing with cost savings and reduced greenhouse gas emissions. Anesth Analg. 2019;128(6):e97-e99. doi:10.1213/ANE.0000000000003771
6. Panigone S, Sandri F, Ferri R, Volpato A, Nudo E, Nicolini G. Environmental impact of inhalers for respiratory diseases: decreasing the carbon footprint while preserving patient-tailored treatment. BMJ Open Respir Res. 2020;7(1):e000571. doi:10.1136/bmjresp-2020-000571
7. Pharmaceuticals and environment. Janusinfo. Accessed August 23, 2021. https://www.janusinfo.se/beslutsstod/lakemedelochmiljo/pharmaceuticalsandenvironment.4.7b57ecc216251fae47487d9a.html#query/warfarin
8. Paut Kusturica M, Tomas A, Sabo A. Disposal of unused drugs: knowledge and behavior among people around the world. Rev Environ Contam Toxicol. 2017;240:71-104. doi:10.1007/398_2016_3
9. Collecting and dispensing of unwanted medicines. United States Environmental Protection Agency. March 23, 2015. Accessed September 1, 2021. https://www.epa.gov/hwgenerators/collecting-and-disposing-unwanted-medicines
10. Tucker JL, Faul MM. Industrial research: drug companies must adopt green chemistry. Nature. 2016;534(7605):27-29. doi:10.1038/534027a
11. Gahbauer A, Gruenberg K, Forrester C, et al. Climate care is health care: a call for collaborative pharmacy action. JACCP. 2021;4(5):631-638. doi:10.1002/jac5.1412
12. Chung JW, Bang OY, Ahn K, et al. Air pollution is associated with ischemic stroke via cardiogenic embolism. Stroke. 2017;48(1):17-23. doi:10.1161/STROKEAHA.116.015428