UKH

Is it not about time that the pharmaceutical industry addressed the total waste of foil packaging on tablets prescribed by them. I think that just about everybody throws the used blister pack in the bin, without separating out the foil.

Previously tablets came loose, and environmentally, this is a better protocol. Yet the drugs industry can probably make more money by blister packing everything. This also increases the bulk of transport and pharmaceutical storage. So again costing more. Is anyone looking at this?

Was the blister pack not also meant to make it a bit more effort to overdose? Yes, you clearly still can, but if you have to pop every pill out separately, it takes longer and hopefully gives some reflection time rather than opening a bottle and tipping the whole lot out in a oner. 

I thought I had heard something like that anyway.

I am quite bothered by the amount of unnecessary plastic in the LFT kits. There are several stages of plastic packaging which could be cut down on in those and it would still work. 

Blister packs can be recycled in Superdrug pharmacies.

Do you know how they re-process them? Or is it a bit like the Monty Python advert?

"Don't throw your old jam jars away!

Send them to Betty Dago, 14a Leytonstone High street.

And let her throw them away for you."

I don't know but I think it unlikely that they would risk a scam.

The patient facing side of the medical industry is just the tip of the iceberg. You should see the massive clinical waste bins we fill every day with single use aprons, gloves, vials, syringes, spatulas, etc and all the associated packaging.

However the cost and effort required to sterilise this type of equipment means it simply isn't viable at present.

I believe Superdrug have partnered with a recycling company, the packaging is separated by plastic type and turned into pellets, presumably the foil is removed at some point.

It is only Superdrugs with a pharmacy in the shop that have the collection box.

Totally agree, the volume of material and volume of blister packs used are tiny that any substantial effort/infrastructure developed to recycle them would likely outweigh any benefit.

There are bigger battles to fight first I'd say.

Indeed, but on the other hand I have recently been prescribed two types of  drug for high blood pressure that I need to take daily. One comes in a plastic bottle with 98 pills, the other in blister packs of 10x10 tablets.

I know which one I prefer!

The obvious reason for blister packs is of course to stop hygroscopic tablets from accumulating moisture form the air, but I would rather prefer companies would switch to non-hygroscopic formulations.

CB

Just because it's small in the scheme of things doesnt mean it's not worth fighting. As an end user, using recycling facilities and demanding that more pharmacies provide this service is all a step in the right direction.

But yes I totally agree that further along the medical chain the volume of single user products is terrifying.

I am not a medic, but run a molecular biology lab, so I also generate much more plastic waste (mainly packaging) than I would like to.

We have less time pressure than in a clinic (and no need to work as sterile), so I try to use reusaeable, autoclavable glass pipettes for cell culture rather than individually packed disposable ones, have my students and techs sort disposable micropipette tips into recycleable racks rather than chucking the racks after every 96 tips, wash and re-use single use fly food vials, etc. .

However, the amount of sterile packaging waste we generate through cases where recyling/sterilization is not an option is still shocking.

Also, the non-recycleable packaging from shipping has gone down considerably over the years.

CB

Interesting to have two threads on hidden environmental costs this week - this one and the cloud computing one.

Would be good to see an initiative like NC3Rs but targeted at holistically reducing the environmental costs of this sort of work.

My first thought was that an awful lot of pharmacologically active compounds and their metabolites are recycled through our waste water…

You also need to consider whether the blister packs provide better protection for the tablets during transit (yes) and whether they keep the tablets in a condition less likely to downgrade (don't know)

I had some minor hand surgery as an outpatient a number of years ago, and I can remember even then being quite shocked at the quantity of stuff used during the procedure that went straight in to the clinical waste.  As it happens, the problem has occurred again in a different finger and it's due to be operated on next week.  I'm not really expecting anything different in terms of the mini waste mountain that is going to be created, but I want my hand to stop hurting and to be able to climb and play the guitar again.  Guess that makes me a bad person...

Or we quickly realise we can do without manically LFT'ing for an endemic disease that most are vaccinated against/not at risk from, and only use them in really necessary/key areas? That'd reduce waste substantially.

I think water downstream of sewage outflows used to contain high concentrations of oestrogens, which may have contributed to fish changing sex etc.  

Amazingly between the introduction of blister packs and the limit of only being able to buy 2 packets at a time

"The annual number of deaths from paracetamol poisoning decreased by 21% (95% confidence interval 5% to 34%). Liver transplant rates after paracetamol poisoning decreased by 66% (55% to 74%). The rate of non-fatal self poisoning with paracetamol in any form decreased by 11% (5% to 16%), mainly because of a 15% (8% to 21%) reduction in overdoses of paracetamol in non-compound form. The average number of tablets taken in paracetamol overdoses decreased by 7% (0% to 12%), and the proportion involving >32 tablets decreased by 17% (4% to 28%). "
(https://www.ncbi.nlm.nih.gov/pmc/articles/PMC31616/) [2001]

 

On a slight different tack, the effect of Covid on the use and disposal of plastic and other non biodegradable materials must be being disastrous for the environment in general. Discarded masks are everywhere. Before all this started last year, along with many others, I was wont to take a plastic shopping bag when walking around home to pick up other people’s litter, but who wants to handle other folks’ stuff, especially masks, these days? I’m beginning to wonder if it’s time to start again, as I think the risks are probably really tiny. 

Yes December 2019 was the " blue planet effect", six months later.....

Blister packs are a pain. I just spent 15 minutes popping a month's worth and putting them in my daily pill boxes. The 2 types of pills I un blister have lots of dead space in between them, the actual pills probably make up less than 10% of the volume of the packaging. 

I can see that the clinical situation brings up plenty of non-recycled packaging and materials. I finished an extra-qualification in veterinary surgery about 2 years ago, and the thrust from lecturers and the general philosophy, was that you surely don't autoclave gowns and drapes. That autoclaving costs as much as buying disposable gowns and drapes, and that the latter are probably more secure for sterility. So I started to use more of these disposables.

Now I am tending to go more with the autoclave route. We also now have an ethylene oxide steriliser, which means that we can more readily use the single use instruments that don't get re-used in human surgery. (The latter are not allowed to be sold to vets for some reason, but we buy them brand new, and then use them 20 times). As I understand it ethylene oxide is not a problem for the environment, and residues.

I hate the plastic wrappers on some syringes. Those that have paper on one side, I tend to separate out and recycle the paper from. Possibly, we should all go back to glass syringes....Hmmm.

It's not just the blister packs... it's the drugs them selves....

After my Dad died we had silly amounts of morphine and other serious drugs left over from his last prescriptions despite being unopened and still security sealed when I returned it to the local pharmacy I was told it would all be incinerated anyway as they weren't allowed to take it back in to stock

Yes, the blister packaging is designed and validated to ensure the medicine is still safe and effective all the way to the end of its shelf life. 
 

This also explains why patients’ own medicines are not going to be recycled back into use. There are very stringent regulations one storage of medicines in the right conditions. 8 months in the bathroom cabinet next to the radiator - I’ll have fresh ones instead I think. 

It's also the licensing, which says that you have to throw an item away after 28 days, even if the manufacturers have proof that it will be alright for far longer.

I did have the opposite extreme of that once, when I was seeing an eye referral, and the owner agreed about the above, and said that he suffered from bouts of uveitis (inflammation of the middle coat of the eye: essentially the iris and associated structures), and that he still had a bottle of atropine drops that he still used 7 years after opening it, and found that it helped!

Maybe you could wear disposable gloves...

Oh, wait...

Really difficult to get anyone to recycle asthma medication plastic canisters

I have to drive to Harrogate which is 12 miles away. Why not just dispense the pressurised containers from pharmacies?

Sainsburys chemist accepted them. Boots wouldn't. 

I hope that’s not a special journey! 😏

Does the driving offset the benefit from recycling them?

The gas in the pressurised inhalers is the real issue - hydrofluorocarbons - potent greenhouse gases. The carbon footprint of someone using a regular metered dose inhaler is over 400kg CO2 equivalent/year Way more than anything from the production of the plastic parts.

The container and the plastic elements all form part of the ‘combination product’, which is a combination of drug and medical device. If you dispensed just the metal canister, you would need to assure that it could only be used with the device it was designed for, and that the user had assembled it to the same standard as the factory. There are delivery systems that work on this principle, but generally much more expensive. 
 

This is the delicate balance of cost and benefit from ‘stuff’ in general. You have a lifesaving product, but at the cost of 6g of plastic which is not recycled locally. Driving 12 miles just  to recycle it is not a great option, but you could set up a village collection point and take all these plastics to a central point on a cargo bike. Is that cost worth it?

Lego are developing a plant based plastic for their products, and maybe it could be possible to use that with appropriate validation. It wouldn’t be the use case I would go for first though. 

There are more modern versions of these that don’t use CFC propellant now, fortunately. 

These were the ones I was talking about. They use HFCs rather than CFCs. The HFCs are potent greenhouse gases rather than ozone depleting CFCs. The typical propellants used are thousands of times more warming than CO2.

For example a commonly prescribed, modern, "Flutiform" inhaler contains the equivalent of 36kg of CO2 in HFCs. 2 of these inhalers is equivalent to one flight from London to Edinburgh.

Thats an eyewatering figure if correct!

A Flutiform inhaler contains 11g of HFA227ea propellant which has a warming potential 3320x that of CO2, so 36.52kg of CO2 equivalent. Obviously not all of that will be released during use but the remainder will if the metal canister is disposed of incorrectly.

https://bmjopen.bmj.com/content/9/10/e028763#T2

A flight from London to Edinburgh releases 74kg of CO2 per passenger

https://www.icao.int/environmental-protection/Carbonoffset/Pages/default.as...

I recently went to a talk where the environmental impact of asthma medications was being discussed.

Interesting considering the very big NHS push to 'diagnose' asthma in recent years.

Harrogate is  a special place, so, yes. 

Oops, salbutamol has run out, better jump in the car and burn some carbon. Do you think I'm mad? I'm simply suggesting it might be easier to recycle something as obviously re-usable as a perfectly good plastic canister