It’s one of the greatest issues of our time, but if you look around the pharmacy landscape, environmental issues hardly rate a mention. However, a dedicated band of pharmacists are working to change all this

There has been a plethora of statements calling for action on climate change, water quality and a range of other issues from GP groups and various specialists and allied health bodies.

Yet pharmacy is conspicuously silent on these and other environmental topics. It’s almost as if the profession is removed from the broader community issues around it.

However, a gallant band of pharmacists is determined to work from within the profession to change this attitude and these perceptions—and at the heart of this group is Grace Wong.

The road to Damascus

“I can’t exactly pinpoint the moment that I came to awareness about this. It really crept up on me gradually while I was travelling,” she says.

“In parts of the third world, in particular, you’re exposed to environmental issues, especially pollution of waterways. You do become more aware of the harms of what we’re doing, and you see the issues about the disposal of waste.

“I spent a fair bit of time in India, where I was at one point looking after donated medicines, some of which were expired already or were not appropriate, so you needed to dispose of them. But how? In India there were no processes in place, so the bulk went into the general waste.”

Grace was shocked by this realisation, but intrigued and determined to find out more. Her reading about a wide range of environmental topics, but especially on the issue of disposal of medicinal waste brought the issue home to her as a pharmacist.

“It’s confronting. Waste is confronting, but I saw and read about issues with the disposal of medicines. I looked into the issue more deeply. I began to talk to colleagues when I was back in Australia, and I began to see how there was a disconnect in pharmacy on the role it should play.

“This made me think about the issue. I came across Doctors for the Environment Australia (DEA), but when it came to pharmacy there was nowhere to go. There was no such group. There was basically silence from the big pharmacy organisations such as PSA or SHPA.”

Grace Wong promotes the PEA message

Filling the gap

This absence of leadership from any pharmacy organisation led Grace to decide to start her own group to advocate for awareness and change.

“So, I started Pharmacists for the Environment Australia in 2016 to fill this gap,” she says. “At the moment we’re still small, but we’re growing. Interest is growing among pharmacists and pharmacy staff, but its just the beginning really. The awareness and knowledge in Australia is still relatively unsophisticated compared to other professions, and compared to where pharmacy in Europe, for example, is at.

“But I have been heartened by the interest we’re getting on our Facebook page and at our fundraising events.”

However, she says their last fundraiser, held in Melbourne in September, had a lot more attendees from the general public than from people in pharmacy, and she had a dose of reality delivered by one of these people who said to her that “pharmacy and the environment was an oxymoron!”.

“So yes, we do have quite a way to go, but it’s a start and its gaining traction.”

Practical steps

In her day job, Grace works at Western Health, and she has been fortunate to have been given the opportunity to implement some practical changes into the work practices of the broader organisation.

She was heavily involved with the development of a formalised Local Sustainability Action Plan (LSAP) for the next five years. The initial plan consisted of 22 actions, but this has expanded to over 35 actions either completed or in process/planned.

Some highlights to date include:

  • Pharmacy orientation manuals incorporating sustainability principles from day one;
    scoping out minimum 30% reduction in paper use—in process;
  • Input environmental criteria into pharmacy contract for preferred pharmaceutical supplier—and then working together with the supplier to implement the agreements, e.g. ice brick recycling program;
  • Ice brick returns system—returning to supplier for reuse/reduction going to landfill;
  • Establish a polystyrene recycling trial—found a local recycler (not to China!) who remakes into waffle pods for construction industry (Expanded Polystyrene Australia);
  • Introduce battery recycling, printer toner recycling, mixed recycling streams;
  • Scoping options to reduce medication returns waste from wards;
  • Education sessions for staff to increase engagement;
  • Staff pledge to three specific environmental sustainability changes;
  • Establish Green pharmacy awards for pharmacy staff;
  • Change to reusable crockery/cutlery for all meetings/education sessions; in pharmacy; and
  • Low energy settings for printers, computers, double sided printing, using recycled paper…

The work received a Western Health Green Ward Award 2017 and was acknowledged at the 2017 World Congress on Public Health, 2018 NMS Conference, 2018 FIP Glasgow conference and the 2017 Sustainable Healthcare Forum.

Think local

Membership of PEA has, to date, been largely made up of hospital pharmacists and owners/employees of small independent pharmacies.

Representatives of both groups have been willing to take practical steps like Grace has done. Some have implemented recycling programs. Even for a small pharmacy group, organising regular collections can be a problem, she says, so this is a difficult but effective measure to take.

All members have been keen promulgators of the Return of Unwanted Medicines (RUM) Project initiatives for safe clean disposal of medicine waste—as this is the issue that got many (such as Grace) involved initially, and is such a core part of what pharmacy should be doing, she says.

Other initiatives she highlights are reducing paper usage, reducing use of plastics (especially plastic bags), and even replacing plastic methadone cups with alternatives made from corn starch, which are now available.

“It would be a massive step if a major pharmacy group such as Chemist Warehouse were to make a stand on reducing the use of plastic bags. Think of the difference this would make,” she said.

“But even in smaller stores, we can take these practical steps to begin making a greater contribution to awareness and action.”

Putting it into community practice

Carolyn Nguyen is one of the PEA founding members and has worked over the last few years on greening the community pharmacy in Melbourne, in which she works as the manager.

Carolyn has been at the forefront of the PEA in actively implementing measures in her pharmacy, and Grace Wong says she demonstrates what can be done in a community pharmacy setting.

“I was already interested in sustainability prior to PEA and have been making changes in my private life such as investing in solar panels, reducing food waste, switching to organic gardening, etc,” Carolyn told the AJP.

“When I spoke to Grace, I had a lightbulb moment: I realised that the biggest change I could make would be bringing sustainability to my profession and the workplace. Since then, I’ve been helping out at PEA, including opening my sustainable home to the public as part of the annual PEA fundraiser.”

Carolyn Nguyen

Carolyn described some of the steps she has taken in her pharmacy.

“In Victoria, there isn’t a plastic bag ban yet, but my pharmacy has opted to remove single-use plastic bags. In order to comply with privacy, we still offer paper bags, but we also encourage patients to BYO bag.

“We’ve also swapped over our methadone cups to the PLA (corn-starch based) compostable cups and encourage our methadone patients to reuse their plastic bottles with financial incentives.

“We’ve cut down on waste by switching to electronic faxes, printing double-sided where possible, and adopting reusable glass weigh boats in the compounding lab. Short-dated and dead stock are moved to affiliate stores, sold on Noodnet, or heavily discounted.

“To reduce the amount of electricity we use, we have switched over to LEDs and upgraded our reverse-cycle split system.

“We recommend our SMS-reminder service to patients who come in for ethical lines that we don’t stock or have minimal stock of to help reduce their ‘medicine miles’.

“Our pharmacy also stocks a small range of sustainable and/or ethical lines: vegan cosmetics, TGA-approved menstrual cups, reusable sanitary napkins, bamboo toothbrushes, etc.

“My owner has been really supportive and has opted for 100% recycled paper for all of our repeat backings and business cards from Stirling Fildes,” she said.

“We still have a long way to go. For instance, I don’t have enough space at the back of my store for both a recycling bin and a general waste bin, and I’m still trying to figure out this problem!”

Not all on board

She has received a mixed response from her colleagues, with some staff embracing sustainability, while others remain unsure.

“They don’t understand why laminating single-use tags is wasteful or why paper pompoms are perhaps a better option than balloons in the display window,” she said.

“As a pharmacist manager, I try to focus on sustainable initiatives that save money for the business; it’s easier to convince people to adopt measures that have a dollar sign attached.”

She says this ambiguity exists throughout the profession and that there seems to be a leadership deficit with regard to environmental concerns.

“Pharmacists are respected members of the community. We really should be leading by example in this space, especially since the World Health Organisation has already recognised the ‘unacceptable risk’ that climate change can have on human health.

“Plastic pollution is the next big environmental issue. Plastic waste breaks down into microplastic, which ends up as magnets for pollutants in our water (i.e. heavy metals). They then end up in our food chain. At the moment, the amounts found on our plate aren’t enough to affect human health, but thanks to documentaries like ‘War on Waste’ it’s a concern that has captured the public’s attention. As retailers, we should recognise this interest, and reduce community pharmacy’s use of single-use plastic.”

A study released earlier this year in the International Journal of Pharmacy Practice found that there was a range of shortcomings in pharmacists’ knowledge and understanding of the impact of pharmaceuticals on the environment and the handling of pharmaceutical waste.

“Until this knowledge gap is addressed, the pharmacy profession will struggle to take up a leadership role in ensuring the more sustainable use of pharmaceuticals and reducing the carbon footprint of pharmaceutical care,” said the authors, led by Judith Singleton, from the Queensland University of Technology.

Most participants responded vaguely about the impacts of pharmaceuticals entering the environment, contamination of the environment and harm to wildlife, they found.

Some felt the bigger danger with incorrect disposal lay in the risk of drugs falling into the hands of the general public rather than with any environmental impact.

Only two (3.13%) of 64 participants directly linked the entry of pharmaceuticals into the environment with impacts on human health, said the authors.

They said pharmacists needed information on a range of issues around the negative impacts of pharmaceuticals on the environment, including the entry points of pharmaceuticals into the environment and that sewerage treatment plants do not remove pharmaceuticals from waste water.

A “pervasive thread in the discourse”, particularly from pharmacists, was the attitude that “we already do the right thing” by putting unwanted medicines in bins for incineration, the authors found.

“This attitude of ‘we are already doing the right thing and that’s all we need to worry about’ is suggestive that hospital pharmacists operate in professional silos.”

Down the drain

Findings such as these, or other studies with consumers detailing their confusion over medicines disposal, shows how far we have to go.

Grace Wong says in a pharmacy context, we need to see position statements from bodies such as PSA and SHPA, who have so far been largely silent on environmental issues.

“The Pharmacy Guild, to their credit, does include sustainability—lighting, plastic bags—in its QCPP program, although there’s really not much evidence to see if its done a lot. But it’s there, and it’s a start. It’s really up to all the key groups to start leading the profession.”

As for PEA, they were pleased with the successful turnout at their Sustainable House Open Day Fundraiser, held on 16 September 2018 in Melbourne (at Carolyn Nguyen’s house).

This saw discussions about RUM bins, enviro friendly consumable goods that pharmacies could consider stocking, PEA’s mission and how to get involved.

Here’s hoping these promising beginnings will grow into a force for change and action!

For more information on Pharmacists for the Environment Australia, visit their Facebook page: www.Facebook.com/PharmEnviroAus