By Jackie Campbell, B.Sc. (Pharm.), LLB
Creating an environmentally friendly pharmacy
Jackie Campbell, B.Sc. ost studies relating to the impact of pharmacy practice
(Pharm.), LLB (jackie@
envirolaw.com) is a drug on the environment focus on concerns regarding
information pharmacist at
the Ontario Pharmacists’ pharmaceuticals and personal-care products (PCPs)
contaminating our water supply. In many ways, however,
Information and Research
Centre, and an associate the business of pharmacy is much like other enterprises,
at Saxe Law Office, an
environmental law firm in and it is worthwhile to examine the environmental soundness of processes and practices.
Toronto, Ont. She serves
on the Board of Directors Moreover, as healthcare professionals providing both service and product components,
of the Canadian Institute
for Environmental Law and pharmacists have unique opportunities to introduce their patients and customers to
Policy and has a particular
more environmentally appropriate practices in a variety of areas.
interest in the impact of
environmental issues on This article is intended to assist pharmacists in identifying areas in which they can
consider “going green.” It examines environmental issues relating to pharmacy
practice, as well as the store or practice site. It also discusses the important educational
role that pharmacists can play in the community. In addition, resources are provided
for pharmacists to obtain more detailed information.
16 pharmacypractice | march/april 2008 pharmacygateway.ca
—Dr. Seuss, The Lorax
appropriate use of mediCation macists played a critical role in educating
By discouraging inappropriate use and patients about the switch in propellants,
overuse of prescription, nonprescription and promoted patient acceptance of
and alternative medications, pharma- nonaerosol metered-dose inhalers, by
cists already help decrease the amount advising about what changes to expect
of medication that is purchased and after switching to a non-CFC product.7
eventually discarded, or unnecessarily
ingested and excreted into our environ- What about the
ment. For example, pharmacists may pharmaceutical
counsel patients to select single-entity industry?
cough and cold preparations that target The pharmaceutical industry has made
their specific symptom(s), as opposed to progress over the past several years in
multi-ingredient products that contain practising “green chemistry,” for example,
Getting started ingredients they do not need. by minimizing use of reagents that are
Identifying and tackling environmental hazardous to the environment and by
issues in a busy pharmacy might seem minimize Wastage designing alternate synthesis pathways.5
like a daunting task. However, taking one With new prescriptions, it makes sense These practices have proven economically
small step can make a big difference; it to limit initial prescription size and advantageous to the industry. It is antici-
can motivate staff and patients/customers determine patient tolerability, thereby pated that they will extend these princi-
to integrate consideration of environ- minimizing drug wastage. In long-term ples to product design, through such
mental issues into daily practice and daily care facilities and hospitals, moving from measures as increasing therapeutic effi-
life. Pharmacists could begin by identify- blister packaging to automated medica- cacy by enhancing delivery to the target
ing a single environmental issue that tion dispensing and shorter exchange site, thus minimizing dosage required, or
relates to their processes or practice, and cycles decreases drug waste (and accu- using enantiomerically pure agents as
adopt measures to address this issue. mulation of returned stock).5 opposed to racemic mixtures to achieve
lower doses. At the same time, these
What are pharmacists promote environmentally products should be highly susceptible to
already doing? friendly manufaCturing biodegradation and yield innocuous end
Community health surveillanCe Pharmacists can promote the use of medi- products.5
Pharmacists are in an ideal position to iden- cations that are less toxic to the environ- The industry should be encouraged to
tify community outbreaks due to improper ment, and educate the public on the use investigate expiration dates to establish
environmental management. For example, of newer, less toxic alternatives. For a maximum shelf life for a drug product,
two outbreaks due to contaminated water example, inhalers containing chlorofluoro- to minimize wastage. The current require-
(Walkerton, Ont. and the Battlefords area carbons (CFCs), which contributed to ment of merely providing a documented
of Saskatchewan) affected thousands of depletion of the ozone layer, were phased shelf life is not satisfactory.5 Pharmacists
people in entire communities.1,2 Pharma- out as of January 2005 in Canada, and can advocate for and support such indus-
cists assisted public health officials in iden- replaced by hydrofluoroalkanes.6,7 Phar- try initiatives.
tifying these outbreaks by noting the spike
in the sale of antinauseants, antidiarrheals
and rehydration products.2 plastic facts 21-23
• conventional plastic bag will take approximately 1,000 years to
Pharmacists can help to ensure that break down.
unused medications are returned to the I
• n April 2007, Leaf Rapids Manitoba became the first town to
pharmacy and disposed of appropriately, enact a bylaw banning single-use plastic shopping bags; retailers
through hazardous waste companies.3,4 By can be fined up to $1,000 for giving away or selling these bags.
educating patients on proper disposal, T
• here are pros and cons to using plastic bags and paper
pharmacists contribute significantly to bags. Where possible, use reusable bags.
preventing medications from entering the
pharmacygateway.ca march/april 2008 | pharmacypractice 17
What more can ers not to overuse these products, and to that contain fewer ingredients and that
pharmacists do? offer a selection of alternative, more environ- are more environmentally appropriate. Of
promote environmentally mentally friendly products (Table 1). note, information is lacking concerning
friendly produCts Studies that examine the environmental the following chemicals:
Pharmacists sell numerous medications impact of pharmaceuticals and PCPs
and consumer products. The environmental typically do not consider the role of non- Excipients
risks associated with these agents, singly medicinal ingredients in medications and In many drug dosage forms, a number of
or in combination—including the risk to consumer products.8 First, consider excipients have not been examined for
human or animal health when they enter whether these agents are essential com- toxicity, and are excreted in one form or
our water supply—is not known. Accord- ponents of a product. If not, perhaps the another into the environment. These include
ingly, it is sound practice to remind consum- pharmacy could stock similar products binders, fillers, lubricants, colours, sweeten-
ers, preservatives, suspending/dispersing
table1 agents, solvents, surfactants, emulsifiers,
Environmentally friendly products and guides film coatings, flavours and printing inks.8,9
dalhousie university. Scent-free product specifically relates to Little attention has been focused on the
listing. http://environmentalhealthandsafetyoffice. fragrances
dal.ca/radiatio_7455.html environmental fate of PCPs, such as per-
fumes, deodorants, antiperspirants, sham-
environmental health assoCiation of includes well-researched
nova sCotia. Guide to less toxic products. information concerning poos, soaps, sunscreens and cosmetics, and
www.lesstoxicguide.ca toxicities of commonly used their effects on nontarget organisms (e.g.,
personal-care and household aquatic life). These products are supposed
products, along with home-
made alternatives; some
to have minimal biochemical activity, but
entries are province-specific may be used in quantities and amounts
much higher than are recommended, and
environmental defenCe. The toxic nation useful alternatives for
guide to less toxic school supplies. backpack materials, pens,
large volumes may enter our water supply.
www.environmentaldefence.ca/toxicnation/ paper, computers, desks, the As well, scant data are available concern-
resources/newsletter/The%20Toxic%20Nation% lunchbox and even foods ing the unexpected effects of PCPs on
20Guide%20to%20Less%20Toxic%20School% humans.10-16 Consumers typically use their
personal discretion in selecting PCPs;17 by
sierra Club of Canada. Safe alternatives identifies the “bad” chemicals discouraging overuse of these products, the
to household hazardous products for your around the house and
family, pets and environment! suggests alternatives
pharmacist can reduce the amounts that
www.sierraclub.ca/national/programs/health- reach our water supply. As well, pharma-
environment/pesticides/alternative-household- cists can select more environmentally
prod.pdf friendly alternatives to offer for sale.
greater vanCouver regional distriCt. illustrates regional govern-
Buy it, sell it, re-use it, donate it: 101 things ment involvement and PCPs of concern include:
to do with all your old stuff. initiatives
www.gvrd.bc.ca/recycling-and-garbage/pdfs/ Fragrances (musks): These persistent
101Things.pdf pollutants are used in many scented con-
greater vanCouver regional distriCt. tips on reducing human sumer products (e.g., cosmetics, deter-
2007/08 Home pages: choices for wiser living. impact on the environment gents and most PCPs with fragrances). At
muniCipal environmental/reCyCling good examples of excellent
programs. ExampLES: resources available from
City of Saskatoon, Sask. Saskatoon waste and municipalities across Canada
recycling plan. www.saskatoonwasteplan.com
City of Red Deer, alta. Environmental initia-
tives & household tips. www.reddeer.ca/
the consumer action guide to toxic U.S. site, but detailed
chemicals in toys. www.healthytoys.org information and ratings
(based on levels of chemicals
present on the toy surface)
for many brands of toys
available in Canada
pharmacygateway.ca march/april 2008 | pharmacypractice 19
least two classes of musks resist degrada-
tion, are lipophilic and bioaccumulate.10 The pharmacist as environmental educator
A third class, the macrocyclic musks, are A
• s part of routine patient counselling, make customers aware of the environ-
mental consequences of their decisions to consume pharmaceuticals and
more like natural musk; they are likely personal care products.
more readily biodegradable, but are not
• dvise patients to bring back any unused prescription, nonprescription or
used as extensively due to their cost.5 alternative medicines to the pharmacy for proper disposal.
Preservatives: Parabens are among
• nclude an accessory label on all prescriptions that says “bring unused portion back
the most widely used preservatives in to pharmacy for disposal;” alternatively, include this information on patient handouts.
cosmetics (e.g., skin creams, tanning E
• ncourage patients to use OTC products at the lowest effective dosage (and to
lotions), toiletries, pharmaceuticals and bring back outdated drugs for disposal).
some foods. While not acutely toxic, they R
• emind patients that personal care products enter our water supply. Suggest that
appear to be weakly estrogenic. The risk they use smaller volumes or use brands that have less environmental impact.
from topical application is not known, but H
• elp customers decipher product labels.
they may pose a risk for aquatic life.10 For M
- any terms are used that confuse the consumer (e.g., fragrance free, unscented,
example, methylparaben readily degrades hypoallergenic, not tested on animals, preservative-free, dermatologist tested,
natural vs. synthetic). What do these terms really mean? Answers can be found,
and does not bioaccumulate, yet it is toxic for example, at Health Canada’s Cosmetics: FAQ 29
to Daphnia species.18
• nclude environmental issues in the services you provide.
Disinfectants/antiseptics: Triclosan D
- iscuss environmental issues specific to medications, personal care products
is an antiseptic used in toothpaste, hand and other chemicals.
soap, and some acne creams and plastic W
- hen you talk to groups (e.g., patients, students, seniors) about medications,
include environmental impact as part of your discussion.
products. It resists microbial degrada- W
- ork with your municipality to offer free recycling opportunities for customers
tion.10 Several other disinfectants (e.g., (e.g., hold medication return days).
substituted phenolics) are used in hospi- E
- ncourage staff and customers to bring “greening” ideas to you.
- ake it fun; help your customers calculate their ecological footprint, (e.g., take
tals, homes and by livestock breeders; the quiz at www.globalfootprintnetwork.org).
some resist removal from sewage effluent A
• bove all, make sure your patients know that one person can indeed make a
and may be found in surface water.10 difference in protecting our environment.
Sunscreens: Some sunscreens have been
identified in fat tissues in fish, as well as in throughout the world in concentrations were deemed acceptable for registration
human breast milk, indicating that these much higher than occur in nature, and in in Canada. Lavender oil was also
agents are absorbed through the skin and non-native locations.10 re-evaluated; its manufacturer did not sub-
may bioconcentrate in aquatic species.10 mit studies to support continued registra-
Insect repellents tion, and it was phased out in 2007. As
Nutraceuticals, herbal agents The most commonly used agent, DEET, well, Health Canada has proposed phasing
These products are poorly characterized was re-evaluated by the federal govern- out citronella products, due to a lack of
and lack standardization. Many of these ment in 2002. On the basis of a human adequate safety data in humans.12-16
“natural” substances come from isolated health risk assessment, only products
parts of the world, yet are dispersed with concentrations of 30% or lower lobby for more information
electronic waste facts 24,25
The pharmaceutical industry should be
Each year, Canadians discard more than 140,000 tonnes required to provide pharmacists and physi-
of electronic waste (e.g., computer equipment, phones, cians with more information relating to the
televisions, stereos and small home appliances) into environmental impact of medications. In
landfills, equivalent in weight to approximately 28,000 Sweden, for example, a comprehensive risk
adult African elephants. assessment of all marketed pharmaceuti-
About 70% of heavy metals found in landfills originates cals is expected to be completed in 2010.
from discarded electronic equipment. This includes a hazard assessment of the
active ingredient based on biodegradability
hoW Can We do better? (i.e., persistence), accumulation in fat
• Where possible, upgrade or repair electronic products.
tissue in aquatic organisms (i.e., bioaccu-
• onate old equipment to family, friends or a charitable
mulation) and toxicity to aquatic organisms.
• any municipalities have reuse, recycling or disposal
M When such information is available to the
options in your area. prescriber and pharmacist, medication
• ncourage vendors and distributors to take back the
E therapy may be selected according to effi-
products they manufacture or sell. cacy, as well as environmental impact.19,20
Continued on page 41
20 pharmacypractice | march/april 2008 pharmacygateway.ca
Continued from page 20 feature
Environmental checklist: pharmacy policies, premises, processes, products and marketing a
• f you don’t already have one, draft an environmental policy and keep it current. Many organizations have
good environmental policies that can serve as templates (e.g., Nova Scotia’s Pollution Prevention Pro-
• Hire staff members who are committed to improving the environment.
Helpful The City of Richmond’s Environmental Purchasing Guide includes comprehensive information about general
resource building maintenance, furniture, office systems and supplies, lighting, paints and more. 26
Energy audit D
• etermine baseline energy concerns: arrange for a whole-building energy audit (e.g., BOMA Canada’s Go
Green Program for useful general information about audits31).
• nvestigate alternative energy options (e.g., 100% green energy from Bullfrog Power, www.bullfrogpower.com).
Indoor air P
• eople spend 90% of their time indoors. Indoor air may be more polluted than outdoor air, and health risks
quality may be greater.32,33 In particular, more vulnerable individuals (e.g., young children, elderly, chronically ill) may
be exposed to indoor pollutants for longer periods than others, and may be more susceptible to the effects.
• nvestigate sources of indoor pollution; their relative importance depends on how much pollutant is emitted
and how hazardous the emissions are. These include:
combustion sources (e.g., oil, gas furnaces)
building materials (e.g., deteriorated, asbestos-containing insulation)
furnishings (e.g., pressed wood products, upholstery, floor coverings)
chemicals (e.g., cleaning products, air fresheners, paints, varnishes, cleaning products); particularly toxic
chemicals include methylene chloride, benzene, perchloroethylene, formaldehyde
central heating and cooling systems, humidification devices
fungus and mould due to leaks, seepage or construction/design failures and inadequate heating, ventilation
and air conditioning systems34
outdoor sources (e.g., pesticides, air pollution)
• any environmental consultants conduct air quality tests and remediation (e.g., Conestoga Rovers &
Associates, Golder Associates, Water and Earth Science Associates [WESA]).
Electronics • Look for labels on appliances.
EnerGuide tells how much energy an appliance uses
ENERGY STAR identifies the most energy- efficient appliances. Some models use up to 50% less energy
refrigerators, than standard ones.35
• ind out whether the manufacturer offers a take-back program at the end of the life of the product, and/or
equipment) accepts old items when you purchase new.
• Keep electronic products in good working order.
Light bulbs/ • Replace old fluorescent tubes with new, low-energy tubes.
fluorescents • Replace frequently used incandescent bulbs with compact fluorescent bulbs.
• ispose of compact fluorescent bulbs (which contain small amounts of mercury) according to municipal
• Use free recycling programs offered by stores/manufacturers for compact fluorescent bulbs.
• Turn most lights off when the store is closed.
• et thermostat to minimize heat/air conditioning use during hours the store is closed.
• ower the heat by 1°C or use a timer to lower the temperature by 3–4 degrees overnight when the store is closed.
Windows • Prevent escape of warm/cool air via windows.
and doors • Where possible, take advantage of natural light.
• Keep doors closed at all times to prevent escape of warm/cooled air through open doors.
Water supply • Lower the hot water tank temperature by 5°C.
• Ensure the water pipes are insulated.
• Repair all leaky faucets.
• Fix that dripping faucet: a steady drip wastes up to 55 litres of water per day (i.e., over 20,000 litres a year).36
• Install water-efficient (low-flush or ultra low flush) toilets.
Renovations • Investigate energy-efficient options (e.g., heating, air conditioning systems, insulation).
• se environmentally friendly and sustainable materials for floors, walls, ceilings, roof, windows, paints,
• ource eco-friendly alternatives (e.g., low-fume adhesives in cabinetry, flooring that will be long-lasting,
water-based or recycled paints).
Other • Keep live plants to enhance air quality.
• inimize off-gassing: buy furniture and carpeting that do not emit chemicals (e.g., carpets, adhesives used
for installation and padding may emit volatile organic compounds).33
pharmacygateway.ca march/april 2008 | pharmacypractice 41
Environmental checklist: pharmacy policies, premises, processes, products and marketinga
• nsist that cleaners use less toxic cleaning products (i.e., biodegradable), and dispose of pharmacy waste
(e.g., cleaners) R
• educe the number of chemicals used.
• elect products with minimal packaging (especially those in refillable containers).
• elect reusable towelling, bleach-free and with significant recycled content.
• ource an environmentally friendly cleaning service.
Computer • When purchasing, consider up front how the computer will eventually be discarded.
systems • Buy a computer that can be upgraded.
• Purchase an energy efficient system.
• nsure old computer systems are disposed of appropriately (e.g., to a charity for reuse, via manufacturer
• here possible, dispense smaller amounts of drugs, especially for a first dose (test doses). Often meds are
not used, or are discontinued or changed to another med (use starter packs).
• eview dispensing process in long-term care facilities. Is there too much drug dispensed (drugs being
Photocopiers/ • Maximize use of double-sided photocopying.
printers/paper • Is colour copying really necessary?
• What happens to used toner cartridges? Find a supplier that accepts returns.
• Use the “power-save” option on printers when idle.
• eview how much paper is used in pharmacy processes (e.g., documentation, records); look for ways to minimize.
• Use 100% recycled paper.
• Reuse paper rather than discarding (e.g., use as scratch paper).
• Use e-mail (not fax) to receive long documents and read onscreen.
• lan routes and delivery times to minimize time spent on the road, avoid heavy traffic (and frequent delays)
services to decrease fuel consumed.
• iscourage idling of car engine during stops (idling for 5 minutes/day, the average car produces 58 kg of
greenhouse gases a year).37
• se smaller, fuel-efficient vehicles.
• ractise preventive maintenance; keep the car in good running order, including use of proper tires.
• here possible, use public transit, bicycle or walk.
Purchasing • Do manufacturers/suppliers have environmental policies?
• ook for products that reduce environmental and waste disposal costs, and minimize use of toxic components
• urchase items made locally where feasible.
• on’t purchase excessive amounts of chemicals; they may have to be discarded.
• ource the most environmentally friendly vials, jars, labels and other accessories.
Packaging • Discourage overuse of plastic bags by giving small discounts to customers who bring their own bags.
• ncourage suppliers and manufacturers to use less packaging.
• urchase products with minimal packaging.
Uniforms/ • Use a “green” dry cleaner.39
• elect fabrics that are durable and environmentally friendly.
• ontact your municipality to find out how you can more efficiently contribute to the 3Rs: reduce, reuse, recycle.
• tart a recycling program.
• nvestigate what can be recycled in your community (e.g., plastic ointment jars, vials).
• nclude separate waste bins in the store and dispensary for different waste streams.
• eighbouring businesses may be interested in promoting appropriate waste disposal. Talk to them!
• unicipalities may ban certain wastes from landfills (e.g., computers, office paper). Know the rules.
produCts available in the store
• ince many OTC drugs expire in the home medicine cabinet, consider offering a greater selection of
medications package sizes.5
• Encourage customers to purchase only the amounts they require.5
• ncourage manufacturers to enhance packaging and sealing mechanics to extend shelf lives (e.g., to better
resist degradation by heat and humidity that are typically present in home medicine cabinets).5
Food • Sell healthy alternatives (low carbohydrate, low fat, minimal additives).
• Discourage use of single-use plastic water/juice/drink bottles.
42 pharmacypractice | march/april 2008 pharmacygateway.ca
Environmental checklist: pharmacy policies, premises, processes, products and marketinga
Personal care O
• ffer selection of scent- and additive- free products that will break down in the environment and that are
products (e.g., supplied with minimal packaging.
• here possible, sell locally produced products.
Household • Offer less toxic products.
products • Consider providing customers with “recipes” for homemade alternatives (e.g., www.lesstoxicguide.ca).
(e.g., cleaning S
• ource recycled-content greeting cards, wrapping material, toilet paper, tissues, feminine hygiene and other
products, air paper products.
Services • Promote your services as environmentally responsible.
• Tell customers what you are doing!
• rovide customers with customized cotton or recycled plastic bags bearing your store name
(e.g., see www.bringyourbag.com).
• or brochures and catalogues, ensure the supplier uses chlorine-free pulp paper and nontoxic inks.
• ork with the municipality to offer free recycling opportunities for customers (e.g., hold medication return days).
• Encourage staff and customers to suggest “greening” ideas.
ry to source products with EcoLogo certification, an Environment Canada program that lists more than 7,000 products in
more than 120 categories (see www.ecologo.org/en/).
eduCate patients on can help educate the public to adopt more manner in which business is conducted.
environmental issues environmentally friendly practices con- For pharmacies, “greening” the practice
Conflicting information is available con- cerning medication and PCP use. environment could translate into savings
cerning the environmental impact of what through decreased energy use (e.g., lower
we do and the items we use on a daily examine pharmaCy operational costs, fuel costs, hydro bills).
basis. Pharmacists can help put environ- proCesses and premises The goodwill that would result could
mental issues into context for their clients. It is good business practice, in any bring customers to the store more fre-
Table 2 outlines several ways pharmacists industry, to periodically re-examine the quently to purchase products they know
are better for the environment, as well as
ethical purchasing to consult with knowledgeable pharmacy
staff about issues that are important to
When considering purchasing a product to carry in the pharmacy, one them. Several issues to consider are pro-
factor to consider is its environmental impact. for example, ask:
vided in Table 3.
• hat is the environmental policy of the manufacturer and
distributor (e.g., waste management, chemical management, Conclusion
take back/recycling policies, emissions to air and water)? Every step an individual takes towards
• here is the product made? What are the working conditions achieving a healthy environment is impor-
and labour practices?
tant. Our goal should be to reduce overall
• ow far must the product travel to get to the pharmacy?
(i.e., How much fuel must be consumed to get the product energy demand and consumption in our
to the store?) communities, and to consider the impact
• or some products, such as electronics, factor in the
F of everything that we do. It is up to us to
end-of-life disposal cost and consider the ultimate fate convert our wasteful, throwaway society
of the product (e.g., recycled vs. discarded into landfill).
into one that cultivates our environment
Several sources of information are available about for future generations. pp
ethical purchasing. For example, see the city of
Richmond’s comprehensive Environmental Purchasing References available at www.pharmacygateway.ca
Guide26 and FiveWinds International’s Green Procurement.27,28 (Go to Publication Archives, Pharmacy Practice,
March/April 2008, Green Ideas.)
pharmacygateway.ca march/april 2008 | pharmacypractice 43
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