Pharmaceuticals
Making up 20% of the NHS carbon footprint pharmaceuticals come in a close second. When it comes to their financial impact we can see the amount that we spend on medicine each year is consistently rising. In 2018, The King's Funds estimated the total NHS spending on medicines in England grew from £13 billion in 2010/11 to £17.4 billion in 2016/17 – an average growth of around 5% a year.
To understand best how we can reduce the carbon footprint from pharmaceuticals, we need to understand what we procure and what has the biggest impact. In 2014 the SDU did just that, identifying a priority list of items that made up over 60% of the contribution of the cost, quantity of active pharmaceutical ingredient (API) and GHG estimate (Table 1). They noted that as LCA data on the carbon footprint of all medications is not available some estimation on the carbon factor, based on industry estimates, took place.
However they note that even if the GHG estimated impact were halved for the top 20 all would remain in the top 50, indicating that the cost and weight of API make up a significant element of the carbon footprint estimate.
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Table 1: The top 20 priority list identified for further investigation in light of their cost, quantity of API and GHG estimate (SUD 2014).
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BNF Chemical Name:
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Adalimumab
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Amoxicillin
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Atorvastatin
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Beclometasone Dipropionate
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Budesonide
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Co-Codamol (Codeine Phos/Paracetamol)
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Co-Dydramol (Dihydrocodeine/Paracet)
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Enteral Nutrition
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Etanercept
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Fluticasone Propionate (Inh)
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Gabapentin
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Ibuprofen
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Metformin Hydrochloride
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Naproxen
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Paracetamol
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Salbutamol
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Simvastatin
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Sodium Valproate
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Sulfasalazine
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Tiotropium
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It is not just the type of medication we need to take into account. The drugs delivery can also have a significant on the carbon footprint as we see with metered dose inhalers (MDIs). Think about a bottle of IV paracetamol vs an oral dose. The discarded packaging from a bottle of IV paracetamol and the space it takes up in transport are greater than that of a packet of tablets. It is also likely that due to the fact that IV medications require sterilisation that the manufacture is also more carbon intensive. We are currently working on a global project looking to quantify this.
A study conducted by the U.S. Geological Survey in 1999 and 2000 found measurable amounts of one or more medications in 80% of the water samples drawn from a network of 139 streams in 30 states.
It is important that we look beyond the carbon footprint to other ecological issues that can be caused by the medications we use. There is a reason why it is essential that we incinerate pharmaceutical waste. If we throw it in domestic waste or worse still pour excess drugs down the sink, it is highly likely that it will find its way into the water supply. The WHO state that the amount of pharmaceuticals that have been measured in surface and treated water are well below that, that can cause harm to humans.
However harm to aquatic life has and is being documented. Did you know that excess oestrogens in the water from contraceptive pills has lead to the feminizing of male fish, with intersex fish being found polluting parts of the Pontomac River (Harvard, 2011).
The Impact of IV Anaesthetic Drugs
Thanks to the brilliant work performed by Jodi Sherman, Matthew Eckelman and their team in the US we now are able to compare the carbon footprints of many of the IV drugs we use in anaesthesia. Using chemical engineering methods and process design, available in patents and other public literature, they have been able to generate a cradle to grave life cycle inventory (LCI) of 20 commonly used IV anaesthetic drugs. It is important to note that the chart below compares the CO2e (kg) of mass equivalents of the active pharmaceutical ingredient (API) only and does not account for clinical potencies. Regardless this is an incredibly useful tool to guide our decision making.
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This informative paper can found here.
For more information on this paper email: Jodi.sherman@yale.edu
