By Frithjof Laubinger, Environmental Economist, OECD Environment Directorate
Pharmaceuticals are widely considered as essential for maintaining human and animal health, but many of us do not consider their impact beyond treating infections and disease. In fact, residues from medicine can become an environmental concern when they enter the environment. This can happen in a myriad of ways – not just from improperly discarded unused or expired medicine, but also after they are consumed and excreted. While it is hard to address the latter, the former is more straightforward.
Flushing antibiotics down the toilet or pouring unused liquid medicine into the sink leads to leakage into freshwater systems. Alarmingly, most conventional wastewater treatment plants are not designed to remove these pharmaceutical residues. Medicines thrown away amongst residual household waste can also enter the environment when this waste is landfilled.
Household medicines remain unused for various reasons. An early recovery, therapy changes, non-adherence, or prescription and purchasing errors can lead to medicines remaining unused. Studies in the United States estimated that up to 42% of prescription drugs remain unused and six out of ten patients reported having leftover opioids after the completion of their treatment. In France, an estimated 17 300 tonnes of pharmaceuticals became waste in 2019, approximately 260g per capita.
Meanwhile, pharmaceutical consumption is rising, driven by an ageing and growing population, a rise of chronic health conditions and changes in clinical practice. Over the past two decades, per-capita consumption of lipid-modifying agents (such as cholesterol-lowering statins) has increased by a factor of nearly four and per-capita consumption of anti-diabetic and anti-depressants has doubled in OECD countries.
Improper disposal of unused or expired medicine is widespread and results not only in wasted healthcare resources but poses significant risks for environmental contamination. Ecotoxicological studies show worrying effects of pharmaceuticals on ecosystem health. Observed impacts on wildlife include traces of oral contraceptives causing the feminisation and reproductive failure of fish and amphibians, as well as residues of psychiatric drugs altering fish behaviour.
There are also serious risks to human health including accidental poisoning or intentional misuse if unused medicines are not stored and disposed of safely. As well, leaked antibiotics can contribute to the development of antimicrobial resistant bacteria, rendering treatment ineffective and posing a serious risk to public health.
Our recently published OECD report, “Management of Pharmaceutical Household Waste” provides three key recommendations to limit environmental impacts from unused or expired medicine.
1. Avoid medicine waste when possible
Shorter prescription cycles and prescribing smaller amounts, as well as adjusting packaging sizes help to minimise the amount medicines left over after recovery or in case of therapy changes. For instance, France recently passed a law to allow community pharmacies to hand out prescription medicine, including antibiotics, per individual units.
Redistribution could also help to avoid some medicine wastage. While these initiatives are still relatively niche and face hurdles regarding quality assurance and counterfeits, some initiatives exist. In the Netherlands, Pharmaswap provides a platform for pharmacies to trade unopened, close-to-expiry stocks of medicine.
2. Improve collection and treatment of unavoidable waste
Fully eliminating medicine waste is unrealistic. Some patients may recover more rapidly than foreseen, change their treatment or not adhere to prescribed treatments. Ensuring proper collection and disposal of this unavoidable medicine waste is thus important.
Various countries have separate collection systems in place, which can prevent leakage into the environment via sewage waters or landfills and to avoid misuse. In particular, take-back schemes organised as part of an extended producer responsibility (EPR) approach have shown to be effective, while also implementing the polluter pays principle (e.g. in France, Sweden, Portugal or Spain). Ideally, drug take-back should be made available to consumers all year-round at convenient collection points, and free of charge to minimise transaction costs compared to other disposal routes.
3. Raise awareness
Awareness among the public about proper disposal routes remains limited in many countries. In the Netherlands, 17.5% were unaware that liquid medicines should not be flushed and 35% of Canadians did not know about proper disposal of unwanted medication. In a US survey, 45% of the respondents did not recall receiving information on proper disposal practices.
Well-focused communication campaigns are thus essential. Several EPR schemes require a share of the scheme’s budget to be spent on communication and outreach. In addition, doctors and pharmacists play a key role in informing the public about the appropriate disposal of their unused medicines. Information leaflets handed out with products is one way to inform patients and consumers.
On 10 May 2022, OECD experts presented the key findings and guidance on the environmentally sound management of pharmaceutical household waste. Find more information and watch the event replay.
(OECD, 2022), Management of Pharmaceutical Household Waste: Limiting Environmental Impacts of Unused or Expired Medicine, OECD Publishing, Paris.
(OECD, 2019), Pharmaceutical Residues in Freshwater: Hazards and Policy Responses, OECD Studies on Water, OECD Publishing, Paris.