The environmental impact of pharmaceutical waste is rightly a matter of concern, even if some individuals within the Environment Agency are using those concerns as an excuse or tool to mould the pattern of clinical waste management in a way that satisfies their own simple ideologies.
The processes is flawed, not least since it ignores the vast quantities of pharmaceuticals entering the environment by other routes.Though some of those contaminants are being actively managed, others are conveniently ignored, largely as ‘not our responsibility’. Inevitably therefore, this highly selective and scientifically flawed approach, that with closer and more rigorous investigation might be considered as dishonest and possibly corrupt, overstates the case and deliberately places artificial barriers to the processing of clinical wastes using non-burn or ATT technologies.
One of the more effective ways to reduce pharmaceutical wastes in the environment including those excreted in urine, and those entering via disposal to the toilet or into black bag waste, is to reduce prescribing and educate GPs and patients alike. There is no need for antibiotic prescription for the vast majority of coughs and colds, but many GPs still dish them out with little concern. As well as creating antibiotic resistance problems and wasting money, this increases that percentage being discarded as unused prescriptions etc. Patients too can do their bit, by changing their expectations of a prescription for every ill, and taking back unused medicines – including non-POMs – to the pharmacy for more appropriate disposal. In their turn, PCTs, Local Authorities and central government must fund pharmacy take-back schemes so that independent pharmacies are not left to bear the disposal costs, and develop community collection or take-back schemes to actively promote safe disposal.
Having GPs rationalise their prescribing habits has been the subject of great attention over many years, and for lots of reasons. Much improvement has been achieved, but there is still much to do. So it is unfortunate that GPs and their representatives, are seeking to oppose publication of practice level prescribing data, claiming that this could lead to unfair pressure on GPs’ prescribing decisions, the GPC has warned. But that is, of course, one of the main reasons for doing so.
Publication will ensure that it is possible to identify GP practices with poor, costly and wasteful prescribing practices. Since that must surely impact directly and indirectly on the environment, though disposal of unwanted and unnecessary medicines, or as excretion of the administered dose, DEFRA should be joining the affray and pushing for more thorough review of these data, with robust intervention when over-prescribing is identified as well as some positive action to promote more effective collection and disposal.
But don’t hold your breath.