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Public and prescriber perceptions of pharmaceutical pollution

Research exploring eco-directed sustainable prescribing has found that while awareness is increasing among healthcare professionals and the public, further education is required on the drivers, potential effects and possible interventions – of which the results highlighted several for consideration.

Medications contribute substantially to pharmaceutical pollution, impacting both ecological health and public safety. Growing environmental concerns about this issue highlight the need for more sustainable prescribing practices that minimise environmental harm while ensuring effective patient care.

This study examined public and prescriber perceptions of pharmaceutical pollution in Scotland’s water environment, with a focus on eco-directed sustainable prescribing as a strategy to mitigate this pollution.

Semi-structured qualitative interviews were conducted with nine members of the public and 17 prescribing healthcare professionals to explore perceptions, barriers and opportunities for implementing eco-directed sustainable prescribing practices.

Public participants recognised the environmental issues related to pharmaceutical pollution but stressed the need for further education on the topic. They suggested that pharmacy-specific interventions should include targeted messaging and informative displays at the point of care, clearer labelling on medications to highlight their environmental impact and better access to pharmacy return schemes for unwanted medicines.

Additionally, a more person-centred approach, with an emphasis on regular medication reviews and deprescribing, was seen as useful.

While participants were open to environmentally friendly alternatives, they emphasised that any change to prescriptions should not compromise their effectiveness. They preferred to make informed decisions based on clear, accessible information and discussions with prescribers.

Prescribers also agreed that pharmaceutical pollution should be incorporated into their training. They noted that similar conversations already occurred around changes such as inhaler switches and that eco-directed sustainable prescribing could align with these efforts.

They also emphasised the need for effective multidisciplinary communication and for accessible tools, such as environmental sections in formularies and integrated decision-support in prescribing systems. Key strategies for advancing sustainable prescribing included regular prescription reviews and shorter courses of treatments where possible.

The authors noted the need for healthcare to ‘undergo fundamental changes’ to create more sustainable medicines use practices, although they did acknowledge the difficulties in translating recommendations from prescribers and the public into policy.

Nevertheless, they highlighted ‘the need for accessible and robust knowledge support tools to enable [eco-directed sustainable prescribing], which should be underpinned by policy guidance and embedded into existing systems.’

And they championed cross-sector and transdisciplinary collaborative approaches to overcome the challenges for achieving this.

Further research will be needed to evaluate the long-term effects of eco-directed sustainable prescribing on both environmental health and patient outcomes, they concluded.

Reference
Niemi L, et al. Do you think medicines can be prescribed in a more eco-directed, greener way? A qualitative study based on public and prescriber focus groups on the impact of pharmaceuticals in Scotland’s water environment. BMJ Open. 2025 Jan 20;15(1):e088066. doi: 10.1136/bmjopen-2024-088066.

This article was originally published by our sister publication Hospital Pharmacy Europe.

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