How To Green My Pharmacy. Prepared and presented by Luna El Bizri,Pharm-D, Community Pharmacist
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1 How To Green My Pharmacy Prepared and presented by Luna El Bizri,Pharm-D, Community Pharmacist
2 Learning Objectives At the end of this presentation, pharmacists will be able to : 1. Understand the negative impacts of the inappropriate disposal of pharmaceuticals. 2. Have a guideline on how they green their pharmacy. 3. Adopt a degree of responsibility for changing the entire medication-use process so as to minimize the environmental effects of pharmaceuticals.
3 Outlines Definition Problem and its effects Understanding the term «Medical waste» Hospital pharmacy: 1. Actual situation 2. What measures to take Community pharmacy 1. Actual situation 2. What measures to take The future
4 Green Pharmacy Green pharmacy is the design of pharmaceutical products and processes that eliminate or reduce significantly the use and generation of hazardous substances and the prevention/reduction of environmental/safety and health impacts at the source.
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6 The Problem Global pharmaceutical sales Source: EyeforPharma (
7 Pharmaceutical Global Sales Percentage North America 47% Europe 30% Japan 10.7% Asia,Africa and Australia 8.2% Latin America 4.2% Source: EyeforPharma (
8 Contaminations All Over The World And Everywhere incidents of measured environmental concentrations of pharmaceuticals around the world. Most pharmaceuticals detected : In Europe: Diclofenac and Carbamazepine. In USA: Paracetamol and Estradiol
9 How Pharmaceuticals Enter The Environment? Wastes release from production facilities. Wastes coming from humans and animals after drug consumption. Inappropriate disposal of medicines wastes.
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11 Effects On The Environment Estrogens: feminization effect on male fish. Antidepressants: delay fish and frog development; result in slower heart rates for the water flea Daphnia. Environmental fluoroquinolone: can lead to malformations in embryos of kites. Pharmaceutical residues: can contaminate our diet. Antibiotics: potential role in promoting resistance development in human and animal pathogens.
12 Medical Waste Medical waste or healthcare waste is all the waste generated from health services delivered to people or animals by any healthcare provider, hospitals, institutions (laboratories, radiology and research centers, nursing home ), dispensaries, blood donation centers, clinics, pharmacies, beauty centers, veterinary clinics, or even at home (auto-medication or home care services).
13 Medical Waste Divided into two categories according to its hazards: 1. On health: risks of injury and/or infection during manipulation. 2. On the environment: domestic waste called non-hazardous (75% to 90%) and hazardous waste.
14 Typical categories of healthcare risk wastes (World Health Organisation,CEHA. 1997).
15 The hazards of pharmaceutical/cytotoxic and radioactive waste are: intoxication, cytotoxicity, carcinogenicity, mutagenicity, local irritant effects, disastrous ecological consequences.
16 HOSPITAL PHARMACY
17 Hospital Pharmacy Lebanon 2010: 5000 tons of Medical hazardous waste 2014: tons/year. According to the Ministry of Environment, 19 hospitals in Lebanon still do not have their waste treated in 2015, and that does not take into consideration medical labs and beauty centers. In accordance to the decree 8006 dated 2002, all medical institutions are responsible for the management of its generated medical waste. Lebanon still lacks the adequate infrastructure for management of hazardous waste (with the exception of infectious waste).
18 Hospital Pharmacy Lebanon Around 1250 tons/year hazardous wastes are burnt in hospital incinerators. Since 2003, Arcenciel has carried out sterilizing medical infectious waste generated by 112 hospitals in Beirut and its surroundings. Arcenciel deals with 80 percent of the treated infectious waste.
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21 Hospital Pharmacy Lebanon Hospitals have storage areas on the floors and a central waste storage. (are Location, size and conditions consistent with international recommendations?) Sometimes damaged, expired or unused medicines are simply stockpiled in storage.
22 How to Green Hospital Pharmacy Set up a pharmaceutical waste program in the pharmacy department. Develop a program that nurses and other staff who handles medicines can easily understand and follow since pharmaceutical waste can be generated within the hospital.
23 MOH RECOMMENDATIONS
24 The disposal methods for various categories of pharmaceuticals are identified in the following table.
25 Source: WHO Guidelines for Safe Disposal of Unwanted Pharmaceuticals In and After Emergencies. Geneva: World Health Organization. Available at
26 How To Green Hospital Pharmacy Steps to be taken: 1. Forming work teams 2. Health and safety of work teams 3. Sorting 4. Disposal
27 1. Forming work teams:work should be conducted by teams consisting of supervising pharmacists and general medical workers. 2. Health and safety of work teams: Masks should be worn when tablets or capsules are being crushed; All workers should wear appropriate protective equipment including overalls and boots at all times, and gloves, masks and caps when appropriate. 3. Sorting: Separate the pharmaceuticals into separate categories for which different disposal methods are required
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31 Cytotoxic, Antineoplastic Drugs Cytotoxic waste is produced during the preparation and use of cytotoxic medicines in the treatment of cancer by chemotherapy. Our concern Solution residues or suspension of cytotoxic medicines being prepared in order to be administered to patients. Expired cytotoxic medicines.
32 STORAGE Cytotoxic waste is stored separately. Infectious waste is stored between 3-8 Celsius degrees. Radioactive waste is stored in lead shielded containers with labeling. Pharmaceutical containers should be spillproof, leak-proof and should meet government collection and transportation standards.
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34 HAZARDOUS WASTE Disposal NON-HAZARDOUS NON-INFECTIOUS RX HAZARDOUS WASTE INCERENATORS (HIGH TEMPERATURES,SCRUBBERS) ASH MEDICAL WASTE INCINERATOR ASH MUNICIPAL INCINERATOR PERMITTED FOR SPECIAL WASTE ASH NON-HAZARDOUS LANDFILL LINE HAZARDOUS WASTE LANDFILL LEACHATE
35 Community Pharmacy
36 Community Pharmacy Negative Effects: Accidental exposure to medicine in the home is a major source of unintentional poisonings in the United States In 2007, there were 255,732 cases of improper medicine use reported to Poison Control Centers in the United States. Approximately 9% of these cases (23,783) involved accidental exposure to another person s medicine. Approximately 5,000 of these accidental exposure cases involved children 6 years and younger.
37 Community Pharmacy Measurements USA: 1. Medication disposal system: pharmacy takeback sites to collect unused drugs. 2. U.S. Drug Enforcement Agency (DEA)- authorized collectors.
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39 Community Pharmacy Measurements: Lebanon 1. Flushing liquids. 2. Throwing solid medicines in the general waste As complete package As opened package and as tablets Crushed tablets. 3. Storage of expired or damaged products. 4. Return expired medicines to distributors.
40 How To Green Community Pharmacy Waste generation, particularly of plastics, is a major environmental concern. Be environmentally conscious when ordering stock: adjust inventory. Use eco-friendly packaging. Ask patients if plastic bag is needed, encourage plastic saving. Encourage use of virtual technology instead of paper. And if you can, use recycled paper
41 How To Green Community Pharmacy Refuse samples. Use reverse distribution: return unwanted, unusable and expired medicines to the manufacturer or manufacturer s agents. Create a recycling program: insist that employees use it. Never mix waste pharmaceuticals with other waste.
42 How To Green Community Pharmacy Examine the pharmacy energy use and adopt energysaving heating,cooling,ventilation,water and lighting practices. Conserve energy: Turn off lights, air conditioning, computer monitors and other equipment that isn t needed when the pharmacy is closed.
43 How To Green Community Pharmacy. Educating patients on safe and effective medication practices: 1. use the lowest effective dose for the shortest time. to use certain pharmaceutical products responsibly: 1. Take only what is necessary. 2. Remind patients to return unused or expired medication to pharmacies for proper disposal.
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45 Future Green Pharmacists-Education Universities should include in their educational curriculum topics about green chemistry,enviromental issues of medicines development and varying degrees of emphasis about their future in informing and educating communities and poeple about the enviromental aspects of medicine.
46 One solution Create less waste
47 References 1. Filling a greener prescription: Louise Lau, BSc, Canadian Pharmacists Journal. 2. Green pharmacy pilot program goes national : Fred Gebhart, contributing editor;march, tips for going greener in the pharmacy: Sally Raffie,Pharm D,pharmacy times; November Going to green: how is the pharmacy doing: Jeanette Wick, pharmacy times, November Disposal of Unused Medicines: What You Should Know: FDA guidelines. 6. FIP report 2015:green pharmacy practice; taking responsibility for the environmental impact of medicines. 7. Investigating Unwanted Pharmaceuticals: A Green Pharmacy Research Study; Teleosis Institute 1521B 5th Street Berkeley, CA (510) WHO 1999:Guidelines for Safe Disposal of Unwanted Pharmaceuticals in and after Emergencies. 9. The Hospital waste crisis in Lebanon, Fouad Hamdan, Annual Congress in Hotel Dieu Beirut, Lebanon, October Disposal of Unwanted Medicines::A Resource for Action in Your Community.December Country report on the solid waste management in Lebanon, April EvaluatePharma World Preview 2017, Outlook to Medical waste management: A challenge for Middle Eastern countries, September 10, 2015 in Arab world,lebanon,middle East Public Health. 14. Identifying and Managing Hazardous Pharmaceutical Waste H2E Teleconference,September 12, 2003; Charlotte A. Smith, R. Ph., M.S. President. 15. Guidelines for the storage of essential medicines and other health commodities,deliver JSI,in collanoration with UNICEF,Dec 2003.
48 Medicines recommended for disposal by flushing: medicine and active ingredient Medicine Abstral tablets (sublingual) Actiq oral transmucosal lozenge * Active Ingredient Fentanyl Fentanyl Citrate Arymo ER, tablets (extended release) Morphine Sulfate Avinza capsules (extended release) Belbuca soluble film (buccal) Buprenorphine Hydrochloride, tablets (sublingual) * Morphine Sulfate Buprenorphine Hydrochloride Buprenorphine Hydrochloride Buprenorphine Hydrochloride; Naloxone Hydrochloride, tablets (sublingual) * Buprenorphine Hydrochloride; Naloxone Hydrochloride Butrans transdermal patch system Buprenorphine Daytrana transdermal patch system Demerol, tablets * Demerol, oral solution * Methylphenidate Meperidine Hydrochloride Meperidine Hydrochloride Diastat/Diastat AcuDial, rectal gel [for disposal instructions: click on link, then go to "Label information" and view current label] Diazepam Dilaudid, tablets * Hydromorphone Hydrochloride
49 Oxycodone Hydrochloride, capsules Oxycodone Hydrochloride Oxycodone Hydrochloride oral solution Oxycodone Hydrochloride Oxycontin tablets (extended release) Oxycodone Hydrochloride Percocet, tablets * Acetaminophen; Oxycodone Hydrochloride Percodan, tablets * Aspirin; Oxycodone Hydrochloride Suboxone film (sublingual) Buprenorphine Hydrochloride; Naloxone Hydrochloride Targiniq ER (extended release) Oxycodone Hydrochloride; Naloxone Hydrochloride Vantrela ER, tablets (extended release) Hydrocodone Bitartrate Xartemis XR tablets Oxycodone Hydrochloride; Acetaminophen Xtampza ER capsules (extended release) Xyrem oral solution Zohydro ER capsules (extended release) Oxycodone Sodium Oxybate Hydrocodone Bitartrate Zubsolv tablets (sublingual) Buprenorphine Hydrochloride; Naloxone Hydrochloride
50 Dilaudid, oral liquid * Dolophine Hydrochloride tablets * Duragesic patch (extended release) * Embeda capsules (extended release) Exalgo tablets (extended release) Fentora tablets (buccal) Hysingla ER tablets (extended release) Kadian capsules (extended release) Methadone Hydrochloride, oral solution * Methadose, tablets * Morphabond (extended release) Morphine Sulfate, tablets (immediate release) * Morphine Sulfate oral solution * MS Contin tablets (extended release) * Nucynta ER (extended release) Onsolis (PDF - 297KB), soluble film (buccal) Opana, tablets (immediate release) Opana ER (extended release) Oxecta, tablets (immediate release) Hydromorphone Hydrochloride Methadone Hydrochloride Fentanyl Morphine Sulfate; Naltrexone Hydrochloride Hydromorphone Hydrochloride Fentanyl Citrate Hydrocodone Bitartrate Morphine Sulfate Methadone Hydrochloride Methadone Hydrochloride Morphine Sulfate Morphine Sulfate Morphine Sulfate Morphine Sulfate Tapentadol Fentanyl Citrate Oxymorphone Hydrochloride Oxymorphone Hydrochloride Oxycodone Hydrochloride
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