Considerations for environmentally conscious pharmacy students

Many healthcare workers struggle to understand the connection between healthcare and the environment, even though these entities influence each other. Environmental conditions, such as extreme weather conditions, contaminated water supplies and air pollution, affect health by causing injuries and deaths, exacerbating respiratory and cardiovascular diseases, and spreading infectious diseases, such as cholera and cryptosporidiosis.1 In turn, healthcare can also affect the environment through inappropriate pharmaceutical waste disposal, manufacturing and supply chain issues, and pollution from healthcare systems.

Recent research confirms the presence of pharmaceuticals in places that extend beyond their intended use by patients or in healthcare. For example, a 2014 water study by the Environmental Protection Agency measured municipal wastewater effluent from 50 healthcare facilities serving 46 million people and detected hydrochlorothiazide in each sample. Valsartan was found at the highest concentration and lisinopril was found at concentrations up to 1 dose per year.2 Additionally, in 2014, 7.9% of the total national carbon footprint was attributable to healthcare.3

As more and more data emerges showing how closely linked healthcare and the environment are, the roles of pharmacists and pharmacy students continue to be explored and defined. While the climate crisis may seem overwhelming, it can be heartwarming to remember that no effort, no matter how small, is in vain.

Tackling environmental issues can seem particularly crippling for students, given the many responsibilities that come with school. For new graduates, taking on new roles as pharmacists while striving to protect the environment can be intimidating and isolating. However, making environmental health a part of standard pharmacy practice can begin with a few action steps.

GO GREEN DURING PHARMACY SCHOOL

Equip yourself with knowledge

Attending conferences can help foster exposure to knowledge and ideas about how to make an impact. For example, the annual CleanMed conference offers attendees the opportunity to network and learn from experts on sustainable healthcare and environmental protection.4

Share your mission

Student-led initiatives that invite discussion on the intersections of healthcare and the environment are an important step in identifying gaps in education. Asking peers and professionals inside and outside pharmacy about their ideas, ways of working together, and strategies for putting sustainability into practice can foster growth and make change accessible.

For example, the Planetary Health Report Card initiative is implemented by medical students to encourage medical schools to incorporate training in sustainable health care while measuring the “green” score of each medical school. Advocating for environmental factors to be considered in the clinical decision-making process is essential because of the many links between patient health and the environment.

Growing sustainable leaders

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

For example, the Sustainable Pharmacy Project, which grew out of the Virginia Commonwealth University School of Pharmacy, gives pharmacy students the opportunity to connect, collaborate, and organize events that inspire future pharmacists to lead efforts to reduce waste. pharmaceuticals. In addition, Rx For Climate is a web-based organization that aims to empower pharmacists to make sustainable decisions and to uphold the idea that pharmacists have an important role in the fight against climate change.

STAY GREEN POST PHARMACY SCHOOL

Promote sustainable prescribing

As practicing pharmacists, the opportunities to promote sustainability are many and diverse, and the education of other health care practitioners has always been central to the role of the pharmacist. While this has traditionally been limited to education on the optimal therapeutic use of drugs, it is not unrealistic to expand this scope to include therapy advice that also takes environmental impact into account.

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

Additionally, pharmacists are aware that dry powder inhalers are the green choice among inhaler options due to the higher carbon footprint of metered dose inhalers.6 As drug experts, pharmacists can make suggestions like this regarding making a drug choice safer for the environment as well as for the patient while helping to write protocols and educate other clinicians. on how to make these eco-friendly choices and balance patient needs.

There are also databases available like Janusinfo, which categorizes the environmental risks of different drugs, allowing pharmacists to compare the environmental risks of prescribing a given drug. In this way, just as cost, availability, and patient preferences can shape prescribing patterns, environmental damage should be among the factors guiding drug use.7

Pharmacists are also well positioned to support sustainability at the systems level. Because they are heavily involved in the selection, procurement, distribution and use of drugs 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 the health of patients.

Empower your patients

Pharmacists can promote their facility’s drug disposal services and play an active role in reducing inappropriate drug disposal. In a 2016 study, the most common method of disposing of unused medicines by households among 18,008 participants worldwide was in the trash.8 The proper disposal of drugs is a simple and effective method that minimizes damage to ecological systems.

Pharmacists should continue to teach patients how to use medication disposal programs rather than dumping or dumping medications in the sewer. Giving patients knowledge about these services enables them to take an active role in maintaining the safety and health of their environment.9

Look further upstream

Pharmacists also have the opportunity to promote sustainability even further upstream within the pharmaceutical industry and drug development. An area of ​​growing interest in pharmacy is the use of green chemistry principles for the synthesis of new drugs and the implementation of the manufacture of “harmless by design” drugs (that is, drugs that biodegrade into benign components rather than pollutants harmful to the environment) the environment.ten

The opportunities for pharmacy students and pharmacists to positively impact the environment are endless. From attending environmentally focused conferences as a pharmacy student, to creating benign drugs by design 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 one truth remains: Healthcare providers play a central role in the impact of the climate crisis, whether through action or inaction.

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

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

THE REFERENCES

  1. Effects of climate 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 (API) What are the risks to humans and aquatic life? Challenges: Over 1000 APIs approved by the FDA for use in S. 2014.
  3. Pichler PP, Jaccard IS, Weisz U, Weisz H. International comparison of healthcare carbon footprints. About 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 purchases of anesthetic agents with cost savings and reduced greenhouse gas emissions. Anal Anesthetic. 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: reducing the carbon footprint while preserving personalized treatment. BMJ Open Respir Res. 2020; 7 (1): e000571. doi: 10.1136 / bmjresp-2020-000571
  7. Pharmaceuticals and the 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 of people around the world. Rev Environ Contam Toxicol. 2017; 240: 71-104. doi: 10.1007 / 398_2016_3
  9. Collection and distribution of unwanted drugs. 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: pharmaceutical 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 pharmaceutical 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


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