The environmental and financial cost of pharmaceutical waste has been highlighted in a US study of four surgical sites (a private ambulatory care centre, private tertiary care centre, a private outpatient centre, and a federally run medical centre for veterans).
The study, published on 1 August 2019, in JAMA Ophthalmology, evaluated pharmaceuticals, including 116 unique drugs, that were unused following routine phacoemulsification surgery.
The researchers found a cumulative mean 83,070 of 183,304 mL per month (45.3%) of pharmaceuticals were unused by weight or volume across all sites at an annual cost of approximately US$195,200 per site. Eye drops (65.7% by volume) were more often unused compared with injections (24%) or systemic medications (59%). The waste resulted in unnecessary potential emissions at each location of 2,135, 2,498, 418, and 711 kg carbon dioxide equivalents per month, respectively. The investigators observed variance in unnecessary potential air pollution as well as water pollution due to eutrophication.
Melbourne ophthalmologist Dr Christolyn Raj says surgical waste is also being observed in Australia.
“We are increasingly concerned that if we don’t start making a positive contribution towards our environment, our advances in technology will be in vain – being knowledge-wise and green-wise go hand in hand. However, this is a double edged sword – in the surgical world maintaining a sterile environment is key to infection prevention, thus making reusable equipment impossible,” she said.
“Most cataract day surgeries use a combination of sterilised and disposable instruments, sterile devices and liquids in vivo, as well as numerous plastics, equipment covers, wrappings and packaging – often enough to fill two average household garbage bags.”
Dr Raj said most surgeons would agree this is an unavoidable.
“What we should be looking at is how to make this unescapable waste biodegradable. While this will come at further cost, which will filter down to consumers, it will perhaps be a small price to pay to reduce the overall carbon footprint.”
Additionally she said, by maintaining an accurate drug inventory and employing a strict drug batch ordering protocol, surgeries (especially day surgeries) are able to reduce the waste of products like eye drops.
For products that do expire, environmentally friendly disposal is critical.
“Simply pouring them down the sink is not an option with eutrophication threatening our waterways. Herein lies an issue that is outside the scope of heath practice – governments need to step up and create a system for safe disposal of toxic chemicals. These need to be numerous and allocated in each health service area, and should be funded by individual state budgets, as is the case with hard waste disposal which is funded by councils.”