Study: Redispensing Unused Medication Greatly Reduces Waste in Shift Toward Sustainability

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A new study published in JAMA Network Open finds that redispensing unused oral anticancer drugs (OADs) can provide environmental benefits, indicating that redispensing practices could be applied to other medications that have significant environmental burdens to further improve sustainability in healthcare. The authors of the study noted thatmedication is the primary source of greenhouse gas emissions produced by healthcare and contributes substantially to other environmental indicators, such as material extraction, water consumption, and land use.

As such, the researchers aimed to discover the potential environmental benefits of redispensing unused OADs. Conducted across multiple hospitals in the Netherlands, the study consisted of an environmental outcome analysis based on a redispensing program that was evaluated in a prospective, single-group trial between February 1, 2021, and February 1, 2023. All hospitals were followed up with over the course of one year. Consisting of 1071 patients, the study employed a systematic bottom-up life cycle assessment (LCA) methodology, which allows for a detailed evaluation of the environmental outcomes associated with the production, use, and disposal of their medications.

To achieve sufficient results, quality assurance materials such as patient leaflets and seal bags were separated into components containing single materials and weighed. Additionally, it was assumed that paper and plastic products were recycled as per Dutch waste management protocols.

Six different OADs was selected to calculate the estimates of the environmental outcomes of all redispensed OADs: hydroxycarbamide, lenalidomide, olaparib, pomalidomide, sunitinib, and temozolomide. From there, inventory data were gathered for the production, distribution, and incineration of OAD packages, while the production processes of the active pharmaceutical ingredients (APIs) were modeled based on chemical reaction pathways.

A key finding of the study was that redispensing unused OADs can significantly reduce medication waste, thereby minimizing the environmental footprint associated with pharmaceutical production and disposal. Additionally, redispensing was associated with climate benefits estimated at 1.9 kg of CO2 equivalent per patient per year, particularly when quality assurance materials were selectively used for temperature-sensitive drugs.

Further, the lowest outcome for API production was found for hydroxycarbamide and the highest for temozolomide. Outcomes for API production still showed unbeneficial outcomes on all indicators for redispensing according to the base case quality assurance procedure, while environmental benefits were associated with both the optimized and visual quality assurance procedures. This suggests that implementing redispensing practices could be advantageous not only for hydroxycarbamide, but also for a broader range of medications, provided that the total benefits—including economic factors—are carefully considered, according to the study authors.¹

“This study showed that re-dispensing unused OADs can be environmentally beneficial. Because the TTIs used for safe re-dispensing were the main factors associated with adverse environmental outcomes, the optimized scenario in which TTIs were used only for temperature-sensitive OADs (ie, maximum storage temperature of 25 °C) was associated with environmental benefits of re-dispensing unused OADs. Environmental benefits were the largest when using a visual quality assurance procedure,” wrote the authors of the study.

Only 16% of patients were found to have returned unused OAD packages, while around one-third of patients discontinued treatment early, and half of the patients had redundant OAD packages. As a result, the authors of the study concluded that this exceeds the waste-minimizing potential of other interventions, such as individualized dispensing strategies.

Despite these results, the authors acknowledged that there were a lack of historical data on pharmaceutical production processes. Despite employing two retrosynthesis and scale-up principles to eliminate the issue, these strategies introduced large uncertainties, as assumptions were required.¹

“In this quality improvement study, it was demonstrated that re-dispensing unused OADs could be associated with environmental benefits after process optimization. Accordingly, re-dispensing unused OADs could contribute to sustainability of cancer treatment through reduced costs and environmental outcomes. The re-dispensing program was currently tested for OADs, but it could also be environmentally beneficial for other medication groups; specifically, drugs that are frequently wasted or medications that have a high environmental burden of production could be interesting targets,” concluded the authors of the study.

Reference

1. Environmental Outcomes of Reducing Medication Waste by Redispensing Unused Oral Anticancer Drugs. JAMA. October 10, 2024. Accessed October 11, 2024. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2824676