Drug wastage across the NHS is a massive and costly problem that has a profound impact on environmental contamination and disposal practice.

We have discussed the problem previously on the Clinical Waste Discussion Forum. Unwanted and unused medicines stockpiled then disposed into black bag waste or into the toilet without any consideration of their subsequent impact.

But it goes further, much further, than that. What about non-prescription or over-the-counter medicines, since they too can be heavily polluting but are completely off the radar probably for no better reason than a realisation that it is an almost insurmountable and diffuse problem.

It is wrong to focus only on unwanted medicines. What too about those medicines that are wanted, and which are taken by patients in the right dosage, at the right time, and for the right duration of treatment. Reading the various guides and disposal programs aimed at reducing wastage and environmental impact one would imagine that this vastly greater amount causes no problem. But pop a tablet and it’s NOT gone – it goes straight through and is excreted in urine to enter a Victorian wastewater treatment system that cannot remove pharmaceutical residues before discharge as ‘clean’ water.

So the problem runs deep. Too many patients given medicines that are not always required, prescriptions not needed, and all that pee! Avoiding medicines wastage, and providing a disposal route for unwanted medicines is important, but will barely scratch the surface of this complex problem.

Over-prescribing is a huge problem though GPs and others are reluctant to admit and take responsibility for this. Repeat prescriptions are seen as a massive problem, and NHS Isle of Wight are taking action to persuade patients not to ask for these unless absolutely necessary. It is far too easy to sign a repeat prescription without the necessary checks and controls that might better be used to control medicines waste. Indeed, ineffective or unsafe prescribing is the nub of this problem though it is far easier, and politically less troublesome, to place the blame on patients to curb their audacity in asking for these!

Isle of Wight have briefed the press to claim that the problem of repeat prescriptions is:

• patients not believing the medicine is necessary
• possible side effects
• fitting taking or using medicines into daily routines
• choosing between medicines if patients feel they are taking too many, and
• cutting down or stopping taking medicines they have been taking for a long time

Posters are to be put up in GP surgeries and a national website http://www.medicinewaste.com/ has been created to press home the message.

But nowhere is there any suggestion that at last GPs will tighten prescribing practices to issue prescriptions only when clinically required. Worse, the lax issue of repeat prescriptions issued without any of the required checks and controls is simply not mentioned.

Perhaps it will cost more money as there will be a need to see more patients more often. There may be limited capacity in many GP practices though the cynical might expect that time could magically be found if GPs were to receive another funding uplift.

Too many medicines mean high costs and an adverse environmental impact. Placing the blame on patients instead of prescribers may fool some to believe that the PCTs and others are managing the problem, but does not have much chance of success and even less likelihood of making any tangible difference while GPs continue to ignore their responsibility to safe and effective prescribing.