Waste: the worst medicine

Every week, three tonnes of medicines waste from Bristol, North Somerset and South Gloucestershire is collected by Tradebe, which must be incinerated before the remains go to landfill. This says nothing of the clinical waste, single-use items and packaging generated by hospitals and surgeries.

With eye-watering costs associated with disposing of this specialist waste, tackling the amount generated makes financial sense and is something that everyone can do to help the NHS.

Medicine waste refers to medicines that are requested on prescription and not used. A study carried out in 2016 by Jenny Gibbs for Bristol’s Clinical Commissioning Group (CCG) calculated that in Bristol alone, the NHS spends £5.7m annually on medicines that aren’t used (a figure that rises to an astonishing £300m nationwide).

Jenny Gibbs carrying out a medicines waste audit

This can happen for a number of reasons, such as patients recovering or medicines being changed, but the area for concern is repeat prescriptions where patients are accepting medication that they don’t use.

Often it is only at the time that people pass away and their families return bags of unused medicines that this comes to light. For example, one pharmacist reported two bin bags of unused calcium tablets being returned by a family. They think this could have arisen from a prescription delivery service, where the pharmacist wasn’t able to speak to the patient and review the prescription.

According to one local GP who wished to remain anonymous, surgeries should review prescriptions annually but commonly patients don’t always say what they aren’t taking as they don’t want to upset their doctor. “GPs won’t get angry,” the doctor said. “We are happy to listen to the patient and change the medicine if required or stop it altogether. Patients don’t realise that if they return medicines unused to the pharmacy then they can’t go back on the shelf and we as a local CCG will pay for the medication.”

A pharmacist working at a branch of a high street pharmacy added that their company has a policy to address medicines waste by checking over repeat prescriptions with customers, but with budget and staff shortages it isn’t always possible.

In the case of hospitals, University Hospitals Bristol (UBH) NHS Foundation Trust has employed people to collect up unused medicines from the wards after they found that the first person doing this paid for themselves within a week.

Hospitals have a range of other waste streams, including clinical and packaging waste. Clinical waste is either incinerated or treated before going to landfill and so to reduce the amount of packaging that ends up in this expensive disposal route, dry mixed recycling (DMR) bins are being placed in clinical areas alongside clinical bins within UBH.

Clinical waste is an expensive disposal route for equipment packaging which could be recycled

This is part of the hospital’s recent commitment to reduce reliance on plastics and reduce the amount of waste being sent to landfill. Partly due to pressure from the public and staff, as well as cost-saving opportunities, they will be introducing DMR bins and coffee cup recycling bins into all public areas whilst removing personal bins in offices and replacing them with communal waste disposal areas.

Work is also being done to reduce single-use plastics like straws, cutlery and cups and ensure they are only supplied to those with medical needs by 2020.

Patient dignity, safety and minimising infection will always be the primary concerns for Bristol’s hospitals but considering waste avoidance at the procurement level may provide alternatives and cost savings.

Reuse of items is also a way to save money, and UBH sustainability team are reviewing these; although for items like walking frames and crutches it is currently cheaper to buy new rather than get them tested and sanitised.

Unused medicines can’t go back on the shelf at a pharmacy. Instead, they must be incinerated

Reducing landfill, incineration and costs are all good reasons for the NHS and patients to review what is and isn’t being used. Here are some tips if you have regular prescriptions or know someone who does, and head to medicineswaste.com for more information:

1. Check your cupboards before ordering.

2. Check your medicines bag before leaving the pharmacy and tell the pharmacist if there is anything you don’t need.

3. Tell your pharmacist or doctor if you’re no longer taking any medicines. They will be glad you told them and won’t be angry or offended.

4. Take used inhalers back to your pharmacy for recycling rather than putting them in your bin at home.

5. If you have unused medicines, it is essential that these are returned to a pharmacy for proper disposal: putting in the bin or down the toilet is dangerous.

Inhaler recycling is available at most pharmacies

The presence of pharmaceuticals has been detected in waterways around the world and the impact on fish and birdlife is being studied. Locally, Wessex Water is collaborating on a project in Bath with BANES council and wildlife trusts to address the safe disposal of medicines as well as ways of reducing medicine dependence such as social prescribing (non-clinical community activities such as time in nature and joining cycling groups). It is estimated that 10 percent of medicines ending up in the environment are from tipping medicines down the toilet or sink.

This article is part of a six month series on waste, investigating what is happening at a local and national level and where Bristol businesses and residents can get involved to make change.