Lions Gate Hospital (LGH) in North Vancouver has an ecological footprint of 739 times its actual size.1 This means the hospital requires an area of land 739 times its actual size to supply the resources it requires and absorb the waste it produces. Waste from items including paper, latex, plastic, medications, and packaging has placed a burden on the environment. Currently, LGH is the only hospital that has had its ecological footprint measured; thus comparisons to other hospitals cannot be made.
In Nov. 2001, physicians and patients were invited to bring to the hospital any unused or expired medications for incineration and proper disposal. All drug products were accepted, including samples, prescription and nonprescription items.
Forty-seven kilograms of medications were collected from 25 people over 2 days. The wholesale cost of identifiable products totalled more than $20 350. Medications that were unidentifiable or no longer available were not included in the total cost. The majority of drugs (87% of total cost) were from physician samples; many of the products collected were cardiovascular medications or items used in women's health (see the accompanying charts to this letter at www.cmaj.ca).
Samples collected from 12 physicians alone valued in excess of $17 000. If this number was extrapolated to approximately 250–300 physicians in the hospital, the wastage would be well over $350 000–$425 000. This cost is borne ultimately by the consumer or third-party payer. The issue of accepting and providing medication samples is beyond the scope of this letter.
The proper disposal of medications is important for preserving our environment. Findings from a recent US Geological Survey have reported pharmaceutical contaminants in US streams, including nonprescription drugs in 81% of their streams, antibiotics (48%) and other prescription drugs (32%).2 Though the clinical relevance of these findings awaits further studies, proper disposal of medications may ease the burden placed on our environment.
Health Canada announced in Sept. 2001 that new legislation will be developed requiring products regulated under the Food and Drugs Act to also meet environmental assessment standards3 (see News, p. 1326). According to their Web site, “Health Canada and Environment Canada will create a scientific expert panel to provide a technical foundation for the development of the regulatory framework … . After September 13, 2001, companies seeking approval to import and manufacture new products regulated under the Food and Drugs Act will need to notify the Minister of the Environment under the New Substances Notification Regulations of the new Canadian Environmental Protection Act (CEPA).”
In our community, 3 end users of medications contribute to waste: pharmacies, patients and physicians' offices. For pharmacies, expired or unused medications are either returned to the manufacturer or incinerated. For patients in British Columbia, the collection of medication waste from patients falls under the Post-Consumer Residuals Stewardship Program Regulation4 and is funded by the pharmaceutical manufactures. Participating community pharmacies will accept expired or unused medications, for proper disposal, at no cost to the patient. Similar programs exist in Alberta, Saskatchewan and Quebec, and various other provinces are now developing programs. For physicians' offices, opportunities are more limited. Although the Code of Marketing from pharmaceutical companies states that “companies are responsible for making sure that all excess and/or expired clinical evaluation packages of their own manufacture are returned to the company's storehouse or head office,”5 this does not consistently occur in practice. As our study showed, potentially 50 kg of medications would have been thrown in the garbage, landfill or toilet (or kept in the office) if we had not provided an outlet.
For physicians with cupboards full of expired medications without a proper outlet for disposal, we strongly urge you to i) accept medication samples only if your pharmaceutical representative will collect expired/unused samples, or ii) just say NO.
Anne Nguyen Coordinator BC Community Drug Utilization Program Vancouver, BC Roula Tzianetas MSc Candidate University of British Columbia Vancouver, BC Sam Louie Manager Lions Gate Hospital Pharmacy Vancouver, BC
References
- 1.Hawaleshka D. Hazardous health care. Maclean's Dec 2001:62.
- 2.Kolpin DW, Furlong, ET, Meyer MT, Thurman EM, Saugg SD, Barber LB, et al. Pharmaceuticals, hormones and other organic waste matter contaminants in US Streams 1999-2000: a national recognizance. Environ Sci Technol 2002; 36:1202-11. [DOI] [PubMed]
- 3.Health Canada. Health Canada to require environmental assessments of products regulated under the Food and Drugs Act. Ottawa: Health Canada; 2001. Available: www.hc-sc.gc.ca/english/media/releases/2001/2001_98e.htm (accessed 2002 Mar 25).
- 4.Province of British Columbia. Waste management act: post-consumer residual stewardship program regulation. BC Reg 111/97. Victoria, BC: Queen's Printer; 2002. Available: http://www.qp.gov.bc.ca/statreg/reg/W/WasteMgmt/111_97.htm (accessed 2002 Apr 10).
- 5.Canada's Research-Based Pharmaceutical Companies. Code of marketing. Ottawa: Canada's Research-Based Pharmaceutical Companies, 1999. Available: www.canadapharma.org/en/publications/code/index.html (accessed 2002 Mar 25).