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1 | Research Area | Sub category or additional research area | Title | Authors | Brief Summary of Methodology | Results | Citation | |||||||||||||||||||||
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3 | Climate change adaptation | Emergency planning | Preparing pharmacists for disaster management and practice: A participatory scoping review. | Lydon E. et al. | "In collaboration with an expert panel, a search strategy was developed to identify literature pertaining to 1) participants - pharmacists/pharmacy students, 2) concept - education/training and 3) context - disaster planning/emergency preparedness. We searched Ovid MEDLINE, Elsevier Scopus, Ovid EMBASE, Informit, Web of Science core collection and EBSCO CINAHL databases and reviewed grey literature to identify material relevant to the research question. The expert panel informed the interpretation and implications of findings." | "A total of 32 articles met the inclusion criteria and underwent data extraction and content analysis using NVivoTM software. A range of diverse and innovative training interventions were described by researchers and practitioners from a variety of backgrounds. Themes relating to training objectives, content, delivery methods and evaluation were identified. Implications are that more mainstream, standardised training resources are needed to enable pharmacists to fulfil their potential roles in disaster management and response." | Lydon, E., Scahill, S., Hanning, S.M., Arakawa, N., Cox, A.R. & Schneider, C.R. (2026). Preparing pharmacists for disaster management and practice: A participatory scoping review. Currents in Pharmacy Teaching and Learning, 18(1), no pagination. https://doi.org/10.1016/j.cptl.2025.102482 | |||||||||||||||||||||
4 | Climate change mitigation | Pharmaceutical waste | Reducing packaging waste in care units: a national survey | Chasseigne V. et al. | "A survey was co-constructed by the French Pharmaceutical Society of Medical Devices (SPFDM), the French Society for Sterilisation Sciences (SF2S), the French Society for Hospital Hygiene (SF2H), and the National Association of State-Certified Operating Room Nurses (UNAIBODE). The questionnaire was distributed electronically to healthcare professionals working in operating theatres across France." | "A total of 130 respondents completed the survey, including 72 operating room and registered nurses (55.5%), 30 pharmacists (23%), 20 managers (15.5%) and eight others (6%). Most participants worked in public health establishments (80.8%) with established waste sorting systems (83.1%), mainly for paper/cardboard, metal and plastic. Daily use of single-pack SMD was reported by 61.5% of respondents, although only 11.3% applied this to implantable MD. Packaging was considered an environmental criterion by 71.5% of participants, mainly based on the number of packages. Safety concerns were prevalent, with 66.9% indicating that single packaging alone was insufficient for SMD. A majority (70.8%) supported transitioning to single-pack MD where appropriate, whereas the trend reversed for implantable SMD, with 60.0% opposing single packaging. Most respondents (75.4%) favoured wider availability of dematerialised records, and 97% supported a pictogram indicating recyclability of SMD packaging. " | Chasseigne, V., Thiveaud, D., Ayraud-Thevenot, S., Lambert, C., Laurent, M. & Nativel, F. (2026). Reducing packaging waste in care units: a national survey. European Journal of Hospital Pharmacy, no pagination. https://doi.org/10.1136/ejhpharm-2025-004811 | |||||||||||||||||||||
5 | Pollution and waste | Inhalers | Estimation of carbon emissions from inhaled respiratory medicines in Ireland: a cross-sectional study from a national pharmacy claims database from 2020 to 2022. | Kanwal H. et. al. | "We analysed Health Service Executive-Primary Care Reimbursement Service (HSE-PCRS) dispensing data for inhaled respiratory medicines (ATC R03) products. Items were classified as MDIs or NPIs. Trends of inhalers use were expressed as year-on-year inhalers dispensed. We conducted scenario analysis in which 10%, 25%, and 50% of 2022 MDIs use were replaced with NPIs to calculate the reduction in carbon emissions. Notably, PCRS schemes cover ~ 43% of the Irish population (predominantly older adults and a lower income group)." | "Between 2020 and 2022, a total of 9.94 million inhalers were dispensed under HSE-PCRS schemes, with annual volumes rising from 3.04 million (2020) to 3.60 million (2022). MDIs increased from 1.50 million (2020) to 1.79 million (2021) and 1.95 million (2022), while NPIs declined - 15.7% in 2021 and then rebounded + 26.8% in 2022. The MDIs share of all inhalers changed from 49.2% (2020) to 57.9% (2021) to 54.2% (2022) for which estimated MDIs carbon emissions were 28.6, 34.6, and 37.6 kt COe, respectively. This emission was accounted for 95-96% of inhaler-related emissions annually. In scenario analyses, replacing 10%, 25%, and 50% of 2022 MDIs use with NPIs resulted in estimated emission reduction of ~ 3.6, 8.9, and 17.9 kt COe, respectively." | Kanwal, H., Umm-E-Kalsoom, Khan, A., Ryan, T., Quinn, J. & Ryan, C. (2026). Estimation of carbon emissions from inhaled respiratory medicines in Ireland: a cross-sectional study from a national pharmacy claims database from 2020 to 2022. International Journal of Clinical Pharmacy, 48(1), 228-235. https://doi.org/10.1007/s11096-025-02039-2 | |||||||||||||||||||||
6 | Climate change mitigation | Deprescribing | Impact of Clinical Pharmacists' Interventions on Medication Use and Direct Cost Savings in an Inpatient Medical Oncology Setting. | Faqeer N. et al. | "A retrospective study was conducted by assessing CPIs extracted from the pharmacy documentation system in the medical oncology service between January 2022 and December 2023. The clinical impact of these CPIs was evaluated through including interventions accepted by physicians and resulted in therapy changes, along with their significance levels. Direct cost savings were calculated for deprescribing interventions, including drug discontinuation and intravenous-to-oral (IV-PO) conversions, based on the cost saved per intervention over a 24-hour period." | "A retrospective study was conducted by assessing CPIs extracted from the pharmacy documentation system in the medical oncology service between January 2022 and December 2023. The clinical impact of these CPIs was evaluated through including interventions accepted by physicians and resulted in therapy changes, along with their significance levels. Direct cost savings were calculated for deprescribing interventions, including drug discontinuation and intravenous-to-oral (IV-PO) conversions, based on the cost saved per intervention over a 24-hour period." | Faqeer, N., Sawalha, R., Al Hamad, B., Elshayib, S. & Salmany, S. (2026). Impact of Clinical Pharmacists' Interventions on Medication Use and Direct Cost Savings in an Inpatient Medical Oncology Setting. Hospital Pharmacy, 61(1), 89-95. https://doi.org/10.1177/00185787251372038 | |||||||||||||||||||||
7 | Climate change mitigation | Inhalers, Patient education | Understanding inhaler users’ perceptions of climate change and inhaler carbon footprints: insights from a Canadian survey | Butler S. et al. | "Canadians (aged ≥16 years) who reported using an inhaler in the previous 6months were invited via health organisations’ newsletters to complete an online survey (November 2024–March 2025). Multivariate regression models assessed the association between sociodemographic factors and climate change risk perception, disposal practices and awareness of inhaler climate implications." | "There were 343 respondents (median age 71 years (IQR: 64–76 years), 65% female, 80% MDI users). Individuals were concerned (45%) or very concerned (39%) about climate change, but only 20% were previously aware of inhaler climate implications. Advancing age (OR 0.58, 95%CI 0.45 to 0.74) was associated with being unaware of inhaler climate implications, while a university education (OR 4.86, 95%CI 1.77 to 16.62) and living in a large urban area (OR 2.81, 95%CI 1.21 to 7.45) were associated with greater awareness. Most respondents reported disposing of their inhalers in garbage or recycling bins (70%) and provincial pharmacy return programmes were underused (27%) when available. Nearly all MDI users (92%) were willing to switch to a lower carbon footprint device. Advice from healthcare providers was valued in supporting treatment decisions" | Butler SJ, Digby GC, Roy C, et al. Understanding inhaler users’ perceptions of climate change and inhaler carbon footprints: insights from a Canadian survey. BMJ Open Respir Res 2026;13:e003880. doi:10.1136/ bmjresp-2025-003880 | |||||||||||||||||||||
8 | Climate change mitigation | Pharmacy practice, Pharmaceutical waste | REcycle Soon-to-Expire Program (RESTEP): Sustainability efforts in hospital pharmacy. | Chasseigne V. et al. | "Houston Methodist, a 9-hospital health system, established the Office of Sustainability in 2023 to manifest the system's dedication to being a responsible corporate citizen, promote sustainable practices, and lead reduction in the organization's carbon footprint. To coordinate focused efforts within the department of pharmacy, a workgroup was established to better identify areas of interest for targeted waste reduction strategies and to highlight efforts in different departmental areas. The REcycle Soon-To-Expire Program (RESTEP) team had an overall goal to decrease medication waste and streamline process inefficiencies to prevent unnecessary labor demands. Waste reduction efforts began in the intensive care unit satellite pharmacy, and successful waste reduction resulted in program expansion." | "Through recurring discussions, these stakeholders identified underlying themes that can serve as a framework for other health systems with an interest in strategizing waste reduction efforts. Waste reduction strategies influence how a health system manages resources and environmental sustainability. This can provide better collaboration between healthcare professionals and information technology teams to streamline processes and develop strategies to reduce waste. Key themes were identified to outline a framework to offer guidance to health systems interested in strategizing waste reduction efforts" | Korzec, K., Tang, J., Fahey, M., Putney, D., Haines, L., Blackburn, L.M., Beck, A. (2026). REcycle Soon-to-Expire Program (RESTEP): Sustainability efforts in hospital pharmacy. American Journal of Health-System Pharmacy, 83(4), 204-210. https://doi.org/10.1093/ajhp/zxaf216 | |||||||||||||||||||||
9 | Education | Pharmacy practice | Advancing environmental sustainability in community pharmacy by bridging gaps in education, training and practice. | Caliph S. et al. | "A cross-sectional online survey was conducted with pharmacy students, interns and pharmacists including proprietors and managers working in local community pharmacies. The survey contained twenty Likert scale multiple choice and open-ended questions. Internal consistency of the results was measured using the Cronbach's alpha test. Ethics approval was obtained from the Monash University Human Research Ethics Committee." | "Eighty percent of participants (86) agreed they had a professional responsibility to adopt and promote sustainability practices in their community pharmacy workplace. Key barriers to implementing sustainable practices included lack of time (86%), limited knowledge and awareness (73%), lack of incentives (66%), difficulty sourcing eco-friendly supplies (47%), and limited space or facilities (44%). 15% of pharmacists reported they had specific plans to adopt more sustainable practices. Commonly adopted measures included reducing paper use, recycling, and proper waste disposal. One-third of participants responded non-pharmacological and lifestyle recommendations as a means to help reduce medication use and its environmental impact. Pharmacy students identified a gap in their knowledge and understanding of sustainable practices, highlighting the importance of integrating environmental sustainability education into the pharmacy curriculum." | Caliph, S., Apostolos, M., Nguyen, C., Jayadi, K., Han, T., Vo, W., Khera, H.K. (2025). Advancing environmental sustainability in community pharmacy by bridging gaps in education, training and practice. Pharmacy Education, 25(7), 57. https://doi.org/10.46542/pe.2025.257.167 | |||||||||||||||||||||
10 | Education | Pharmacy practice | Pharmacy students' and pharmacy professionals' knowledge, perception, and attitude regarding environmental sustainability in pharmacy practice: a systematic review. | Hashad N. et al. | "A systematic review was conducted following Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. Seven databases were searched using a prespecified search string for studies published in English between 2011 and 2024. Quality assessment was performed using the National Heart, Lung, and Blood Institute tool for cross-sectional studies, Consolidated Criteria for Reporting Qualitative Research checklist for qualitative research, and Mixed Methods Appraisal Tool for mixed-methods studies. Data were synthesized narratively due to methodological heterogeneity." | Fifteen studies from 11 countries were included. While most pharmacy students and pharmacy professionals recognized environmental risks associated with pharmaceutical waste, significant knowledge gaps existed regarding proper disposal practices, ecopharmacovigilance, and broader ES concepts. Despite positive attitudes toward ES, participants often struggled to translate awareness into action, citing barriers such as a lack of formal training, unclear guidelines, and limited systemic support. Both students and pharmacy professionals expressed a strong interest in enhancing ES education and training | Hashad, N., Jabbari, S., Fahmy, A.M., Ahmed, H., Debelic, I., Arafat, K., Hussien, T.E. (2026). Pharmacy students' and pharmacy professionals' knowledge, perception, and attitude regarding environmental sustainability in pharmacy practice: a systematic review. The International journal of pharmacy practice, no pagination. https://doi.org/10.1093/ijpp/riag010 | |||||||||||||||||||||
11 | Climate change mitigation | Inhalers | Decarbonization of asthma care-could digital interventions provide the key to reducing the carbon footprint of asthma medication?. | Elsey L. et al. | "An electronic database search was carried out on PubMed, Ovid Embase, Ovid Medline, and the Cochrane library, in November 2024 and updated in April 2025. A structured search was used including free text and MeSH terms using the key terms 'asthma', 'adherence', and terms related to 'digital inhaler', 'digital sensor', 'electronic monitoring device', and 'environmental sustainability'. Fully published randomized controlled trials, systematic reviews or meta-analyses, and cohort studies were retrieved." | "The review identifies that EMDs, particularly when combined with education and feedback, have the potential to reduce the carbon impact of asthma through improved adherence to preventer inhalers, reduced reliever overuse, and improved asthma control. However, the current evidence is limited and larger comparative studies demonstrating their impact on clinical outcomes and health economic and environmental factors are required" | Elsey, L., Lewis, P., Steinke, D. & Durrington, H. (2026). Decarbonization of asthma care-could digital interventions provide the key to reducing the carbon footprint of asthma medication?. International Journal of Pharmacy Practice, 34(1), 94-98. https://doi.org/10.1093/ijpp/riaf073 | |||||||||||||||||||||
12 | Climate change mitigation | Pharmacy practice | Patients' and carers' interests and behaviours related to the sustainability of medicines: A qualitative study. | Garfield S. et al. | "Semi-structured interviews were carried out with patients, carers and pharmacy staff who were purposively sampled in three NHS hospital organisations in England. Interviews were transcribed verbatim and subjected to inductive thematic analysis ,Sixty-five people took part: 32 pharmacy staff and 33 patients/carers across the three organisations." | "While themes showed a range of views and behaviours promoting medicines sustainability, interview data also suggested that people had thought less about medicines sustainability than other environmentally conscious behaviours. Barriers included lack of awareness and discussion in consultation, lack of accessible safe means of disposal, lack of confidence in availability of further supplies of medicines, and concerns about cost. Another theme was the competing priority of acute severe illness." | Garfield, S., Su, M., Hassan, R., Yang, K., Jenkin, L., Guo, J., Franklin, B.D. (2026). Patients' and carers' interests and behaviours related to the sustainability of medicines: A qualitative study. SSRN, no pagination. https://doi.org/10.2139/ssrn.6670580 | |||||||||||||||||||||
13 | Education | Pharmacy practice | Future pharmacists and climate action: a qualitative study of students' views on environmental sustainability in education and practice. | Raijiah K. and MArthur A. | "A qualitative study was conducted at a university in Northern Ireland, utilising semi-structured interviews with pharmacy students across all four years of their studies. Purposive sampling was used. Interviews were transcribed verbatim and analysed inductively using Braun and Clarke's six-phase approach to thematic analysis." | "Six themes emerged (mean interview length = 45 +/- 10 min): (1) Sustainability as an overlooked area - limited or fragmented curricular coverage; (2) Narrow understanding of waste - awareness focused on disposal and packaging, with little recognition of wider pharmaceutical impacts; (3) Pharmacy as both waste generator and sustainability site - examples included medicines returns, digitalisation, and hospital "green teams"; (4) Integrating sustainability into education - preference for interactive, experiential learning (e.g., guest speakers, placements); (5) Barriers to change - patient resistance, behavioural inertia, and competing curricular demands; (6) Policy, incentives, and leadership as enablers - systemic and financial support deemed essential for sustainable practice." | Rajiah, K. & McArthur, A. (2026). Future pharmacists and climate action: a qualitative study of students' views on environmental sustainability in education and practice. International Journal of Clinical Pharmacy, 48(2), 656-666. https://doi.org/10.1007/s11096-025-02053-4 | |||||||||||||||||||||
14 | Climate change adaptation | Pharmaceutical waste | Role Of Startups And Student Innovations In Pharmaceutical Waste Management: A Global Review Of Sustainable Practices. | Deshmukh N. et al. | "This review explores the significant contributions of startups and student-led initiatives in promoting sustainable management of pharmaceutical waste worldwide over the last decade (2015-2025). Various technological innovations, such as AI and IoT-enabled smart bins, blockchain systems for traceability, enzyme-driven biodegradation, and 3D-printed neutralization devices, are examined for their efficacy and practicality" | "The review underscores academic efforts like green pharmacy research, awareness initiatives on campuses, and innovation competitions such as the Smart India Hackathon. Despite these advancements, obstacles such as inconsistent regulations, financial challenges in under-resourced areas, and a lack of public involvement persist." | Deshmukh, N., Mandloi, N., Soni, P., Patidar, M., Raghuvanshi, R. & Minz, S. (2026). Role Of Startups And Student Innovations In Pharmaceutical Waste Management: A Global Review Of Sustainable Practices. International Journal of Drug Delivery Technology, 16(11 Supplement), 888-900. https://doi.org/10.25258/ijddt.16.11s.89 | |||||||||||||||||||||
15 | Pollution and waste | Pharmacy practice, Pharmaceutical waste | Impact of centralised reconstitution of biological medicines on the amount and costs of medicine waste. | Tolonen H.M. et al. | "Data from 1 January 2021 to 30 November 2021 were collected from an electronic patient record system, including dose, timing and site of the administration of infliximab, rituximab and vedolizumab across 31 wards. The average wholesale prices were obtained from the Finnish national database. Three hypothetical models were compared. In Model A, the medicine residual was discarded after reconstitution on the ward. In Model B, the medicine residual was reused on the ward within the next 12 hours for the subsequent reconstitutions. In Model C, all medicine reconstitutions were centralised. Mean medicine waste costs were calculated and compared between models" | "The total calculated medicine waste costs at wholesale prices were higher in decentralised models (Models A and B) compared with the centralised model (Model C). The largest cost savings between Models A and C were observed with rituximab (110 012), while the smallest were with vedolizumab (46 162). Comparing Models B and C, rituximab also had the greatest savings (73 524), with infliximab showing the least (23 014). The number of reconstituted medicines was associated with higher waste costs. A 10% increase in reconstituted medicines led to a 3.1% decrease in relative waste costs." | Eestila, S., Tolonen, H.M., Vaarala, K. & Rantsi, M. (2026). Impact of centralised reconstitution of biological medicines on the amount and costs of medicine waste. European Journal of Hospital Pharmacy, 33(2), 106-110. https://doi.org/10.1136/ejhpharm-2024-004382 | |||||||||||||||||||||
16 | Pollution and waste | Pharmaceutical waste | The impact of type of delivery method on medicine waste in households: a questionnaire-based study on outpatients receiving cost-free medicine in the North Denmark Region. | Olesen A.E. et al. | "This study included outpatients from the Department of Neurology or Department of Gastroenterology at Aalborg University Hospital receiving cost-free medication from March to October 2023. Eligible outpatients received a questionnaire via Digital Post. As medicine waste is difficult to measure directly, excess medication was used as a surrogate measure." | "52.8% (233/441) of outpatients reported excess cost-free medication at home. Medication pickup lockers, where 58.9% (132/224) reported an excess, were associated with larger medicine stocks at home compared with home delivery where 46.5% (101/217) reported excess (p=0.009). For 45.5% (106/233) of medicine pickup locker users and 24% (56/233) of home delivery users, the excess was planned with the hospital department. If the excess was not planned with the department, most users reported receiving too much medicine (23/76) or 'Other' (42/76)." | Olesen, A.E., Wisby, H.B., Mejlholm, M.B., Eisenhardt, M.V.G., Andersen, I.B. & Routhe, L.G. (2026). The impact of type of delivery method on medicine waste in households: a questionnaire-based study on outpatients receiving cost-free medicine in the North Denmark Region. European Journal of Hospital Pharmacy, 33(2), 111-116. https://doi.org/10.1136/ejhpharm-2024-004420 | |||||||||||||||||||||
17 | Pollution and waste, Climate change adaptation | Pharmaceutical waste | Making green easy: providing ward-based education and resources to optimise pharmaceutical waste management. | Kay D. et al. | "We developed and implemented a brief education intervention for staff in patient care areas of a regional hospital and introduced a recycling option for medication blister strips. The intervention encouraged better waste segregation and recycling knowledge and practices. Numbers and weights of pharmaceutical waste bins collected for incineration during a five-month intervention period (January-May 2024) were compared with a two-year pre-intervention period (January 2022-December 2023) using interrupted time series analysis. Pre- and post-intervention surveys assessed staff waste management knowledge, attitudes, and behaviour." | "We found weak evidence of lower bin numbers sent for incineration (p = 0.051) and greater bin weights (p = 0.052). Additionally, 140 L of medication blister strips were collected for recycling. Survey responses post-education suggested that staff had improved knowledge of pharmaceutical waste management, disposal, and recycling." | Kay, D., Acosta, M.A., Pickles, K. & Barratt, A. (2026). Making green easy: providing ward-based education and resources to optimise pharmaceutical waste management. Journal of Pharmacy Practice and Research, no pagination. https://doi.org/10.1002/jppr.70064 | |||||||||||||||||||||
18 | Climate change adaptation | Education | Chinese pharmacy students' knowledge, attitudes and practice about environmental risks of pharmaceuticals and their source control from the perspective of One Health. | Ma S. et al. | "A cross-sectional survey was conducted using an online questionnaire, which was self-developed to assess the knowledge levels, current concerns, practices, and attitudes of undergraduate and graduate pharmacy students at a Chinese university regarding One Health, environmental risks of pharmaceuticals and their source control." | "Average self-perceived knowledge scores of students on One Health, environmental risks of pharmaceuticals, and their source control ranged from 2.24 to 2.48 on a five-point scale, and actual knowledge score measured via objective assessment was 2.48 out of 10. Only 46.1% respondents reported considering environmental factors during pharmaceutical use, and 18.0% opted to return unused medications to pharmacies or hospitals. Students who integrated environmental considerations into their pharmaceutical use or routinely returned unused drugs to pharmacies/hospitals achieved significantly higher knowledge scores than their counterparts. Average attitude score reached 4.05 on a five-point Likert scale. Pearson's correlation analysis revealed positive correlations between attitude scores and self-perceived knowledge regarding the environmental risks of pharmaceuticals and their source control from the perspective of One Health." | Ma, S., Wang, Y., & Wang, J. (2026). Chinese pharmacy students' knowledge, attitudes and practice about environmental risks of pharmaceuticals and their source control from the perspective of One Health. Frontiers in public health, 14, 1803589. https://doi.org/10.3389/fpubh.2026.1803589 | |||||||||||||||||||||
19 | Pollution and waste | Pharmacy practice | Assessing the environmental, financial, and social impact of immediate-release morphine tablets compared to oral morphine solution. | Tahir F. et al. | "A bottom-up CF analysis was conducted on packaging materials. Cost comparisons and surveys of patients and staff evaluated financial and social impacts. Formulations studied were oral morphine solution (Oramorph 10 mg/5 ml) and Oro-dispersible tablets (Actimorph 10 mg)." | "Key findings In two sites of a single NHS Trust (inpatients and discharges), switching entirely to tablets could reduce annual carbon dioxide emissions by 7350 kg of carbon dioxide equivalents (53%). Tablets could also eliminate an estimated 275 000 plastic syringes disposed of annually and 16 000 in equipment costs from a 100% switch. A limited patient survey showed that 90% of patients supported the use of environmentally friendly tablets as an alternative to liquid solution." | Tahir, F., McDonald, F., Sudan, A., Whittaker, B., Cartwright, J., Sawyer, M., Tweddle, M., & Parker, E. (2026). Assessing the environmental, financial, and social impact of immediate-release morphine tablets compared to oral morphine solution. The International journal of pharmacy practice, 34(2), 154–161. https://doi.org/10.1093/ijpp/riaf104 | |||||||||||||||||||||
20 | Education | | Fostering climate resilience in healthcare: the role of pharmacy students in understanding and addressing climate change in Karachi, Pakistan. | Maqbool T. et al. | "A cross-sectional online survey was conducted among fourth- and fifth-year undergraduate pharmacy students across various public and private sector universities in Karachi, Pakistan. A content-reviewed questionnaire was used to collect demographic information, awareness, perceptions, and responses of students related to climate change." | "The study revealed that 98.2% (n = 1211/1233) of the respondents were aware of the consequences of climate change, and most of themperceived it as a serious threat to public health. Approximately 43.1% of respondents reported taking steps to mitigate the impacts of climate change, even though 95% agreed that action must be taken to prevent it. Statistical analysis indicated that gender, university affiliation, and sources of information significantly influenced students' opinions and understanding of climate-related issues." | Maqbool, T., Shakeel, S., Ishaq, H., Ali, M., Rehman, H., Naeem, H., Naveed, S., Sadia, H., Mumtaz, N., Azhar, S., Sattar, A., Shanmugham, S., & Jamshed, S. (2026). Fostering climate resilience in healthcare: the role of pharmacy students in understanding and addressing climate change in Karachi, Pakistan. BMC public health, 26(1), 1543. https://doi.org/10.1186/s12889-026-27194-7 | |||||||||||||||||||||
21 | Climate change mitigation | Pharmacy practice | Awareness of and Interest in Green Initiatives and Practices in Hospital Pharmacy: A Canada-Wide Survey | Blanc A. et al. | "A cross-sectional survey was administered securely online to Canadian hospital pharmacy staff, between February 15 and April 30, 2023. The survey contained 38 questions with specified themes related to sustainability and climate resilience." | "Of the total number of participants, 84% (141/167) were motivated or highly motivated to engage in sustainable pharmacy practices. When asked about specific green initiatives planned by their hospital, 53% (109/206) reported not being aware of any initiatives, and 10% (20/206) indicated that no plans existed. The green practices that were at least partially implemented were "reduced paper use" (27% of responses), "improved recycling programs" (18%), and "raised awareness" (11%). The top 3 areas of pharmacy waste were identified as "single-use plastic" (28% of responses), "excessive paper use" (18%), and "improper recycling" (17%). The top 3 barriers to implementing eco-friendly practices were identified as "cost" (50% [83/166]), "time consumption" (50% [83/166]), and "added complexity" (30% [49/166]). | Blanc, A., Moulin, D., & Cameron, J. (2025). Awareness of and Interest in Green Initiatives and Practices in Hospital Pharmacy: A Canada-Wide Survey. The Canadian journal of hospital pharmacy, 78(1), e3608. https://doi.org/10.4212/cjhp.3608 | |||||||||||||||||||||
22 | Education | Education | Student perspectives on the integration of environmental sustainability and climate Change into the doctor of pharmacy program curriculum | Ladhar S. et al. | "An online survey was developed and disseminated via email and social media to the 865 students enrolled in Program Years 1 to 4 of the UBC PharmD program. The survey consisted of 13 questions covering demographics, prior knowledge level on the topic and learning preferences. Descriptive statistics were used to analyze the responses." | " A total of 117 students completed the survey (response rate = 14 %). Approximately one-third (37 %) of participants indicated previous educational exposure to climate change and sustainability separate from their PharmD education, and 21 % indicated exposure during their PharmD education. The majority of respondents (97 %) indicated that they are interested in this topic with 91 % planning to advocate for sustainable pharmacy practices in their future careers. Most students rated their knowledge level as basic or moderate for both the contribution of the healthcare systems and pharmacy practice and pharmaceuticals on climate change and the environment. Lastly, 77 % of participants felt that integrating education on climate change and sustainability into the PharmD curriculum was necessary." | Ladhar, S., Gill, J., Frank, I., & Dahri, K. (2025). Student perspectives on the integration of environmental sustainability and climate Change into the doctor of pharmacy program curriculum. Currents in pharmacy teaching & learning, 17(6), 102347. https://doi.org/10.1016/j.cptl.2025.102347 | |||||||||||||||||||||
23 | Education | Education | Canadian Pharmacy Educators' Perspectives on Sustainable Health Care Topics in Pharmacy Curriculum | Dahri K. et al. | "The study surveyed pharmacy educators across Canada. Questions were categorized into current teaching practices related to the topic; motivators, barriers, enablers, and attitudes toward the topic area; and baseline demographics." | "Overall, 32% of respondents currently include environmental sustainability-related material in their teaching with the most common delivery format being lecture-based. Respondents were overall supportive of the inclusion of such material but expressed concern over where to include such content within the current curriculum and indicated a lack of expertise and faculty support to create the content." | Dahri, K., Pookpun, T. A., & Pammett, R. (2025). Canadian Pharmacy Educators' Perspectives on Sustainable Health Care Topics in Pharmacy Curriculum. American journal of pharmaceutical education, 89(5), 101403. https://doi.org/10.1016/j.ajpe.2025.101403 | |||||||||||||||||||||
24 | Pollution and waste | Inhalers | Clearing the air: Assessing inhaler usage and associated greenhouse gas emissions in a health system. | Smetana K.S. et al. | "A retrospective analysis of the use of albuterol and inhaled corticosteroid/long-acting β2-agonist (ICS/LABA) MDIs over a 1-year period, assessing their CO2e emissions and the environmental impact of their packaging. The total weight of propellant was determined by calculating the difference in canister weight before use and after all contents were expelled." | "A total of 17,589 albuterol and 20,563 ICS/LABA MDIs were dispensed during the study. The total propellant weight led to CO2e emissions of 212 metric tons (MT) for albuterol MDIs and 506 MT for ICS/LABA MDIs. Including resource use and emissions from inhaler components led to an environmental impact that totaled 213 MT of CO2e for albuterol MDIs and 512.5 MT for ICS/LABA MDIs." | Smetana, K. S., Girardot, J., Hopton, S., Trimble, A., Eckl, B., & Wiesler, A. (2025). Clearing the air: Assessing inhaler usage and associated greenhouse gas emissions in a health system. American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists, 82(13), e607–e614. https://doi.org/10.1093/ajhp/zxae384 | |||||||||||||||||||||
25 | Climate change mitigation | Pharmacy practice, Inhalers | Behavioural insights about barriers and facilitators to returning inhalers to the community pharmacy in Wales for safe disposal: patient and community pharmacy perspectives. | Seage, C.H. et al. | "The COM-B Model of Behaviour and the Theoretical Domains Framework (TDF) underpinned the qualitative data collection methodology. Data from eleven patients and five CP staff were mapped to the COM-B, TDF, and Behaviour Change Wheel." | "Patients and CP staff believed widespread knowledge of the need for, and existence of inhaler recycling schemes would encourage participation, building on existing recycling behaviours and aligning with moral obligations. Patients viewed CPs as trusted information sources, well-placed to raise recycling awareness. No patient participants recycled their inhalers and they felt that CPs were not adequately promoting recycling. Despite being involved in a pilot scheme, CP staff described having insufficient time with patients to encourage recycling. Patients saw inhaler recycling as integral to the CP's professional role whereas CP staff felt this responsibility was for the wider healthcare team. Both groups agreed inhaler recycling awareness should be raised, highlighted the busyness of CPs as a barrier to conversations, and considered feedback on the inhaler recycling pilots success an important motivator." | Seage, C. H., Caffoor, A., Harrop, A., Wooldridge, A., Thomas, H., Evans, S., Brown, S., & James, D. H. (2025). Behavioural insights about barriers and facilitators to returning inhalers to the community pharmacy in Wales for safe disposal: patient and community pharmacy perspectives. The International journal of pharmacy practice, 33(4), 393–400. https://doi.org/10.1093/ijpp/riaf037 | |||||||||||||||||||||
26 | Climate change adaptation | Pharmaceutical waste | REcycle Soon-to-Expire Program (RESTEP): Sustainability efforts in hospital pharmacy | Korzec K. et al. | "To coordinate focused efforts within the department of pharmacy, a workgroup was established to better identify areas of interest for targeted waste reduction strategies and to highlight efforts in different departmental areas. The REcycle Soon-To-Expire Program (RESTEP) team had an overall goal to decrease medication waste and streamline process inefficiencies to prevent unnecessary labor demands." | "Waste reduction efforts began in the intensive care unit satellite pharmacy, and successful waste reduction resulted in program expansion. Key stakeholders from other pharmacy operational areas were engaged to target additional efforts for waste reduction. Through recurring discussions, these stakeholders identified underlying themes that can serve as a framework for other health systems with an interest in strategizing waste reduction efforts." | Korzec, K., Blackburn, L., Deyhim, N., Beck, A., Tang, J., Fahey, M., 2nd, Putney, D., & Haines, L. (2025). REcycle Soon-to-Expire Program (RESTEP): Sustainability efforts in hospital pharmacy. American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists, zxaf216. Advance online publication. https://doi.org/10.1093/ajhp/zxaf216 | |||||||||||||||||||||
27 | Pollution and waste, Climate change mitigation | Pharmaceutical waste | Tamper-Proofing Multidose Medications in Hospitals: High-Value, Low-Effort Interventions to Reduce Medication Waste. | Shu T. et al. | "Site visits were conducted at 13 hospitals across 3 health authorities in British Columbia—Vancouver Coastal Health, Providence Health Care, and Fraser Health—to gather data on tamper-proofing practices in hospital pharmacy departments." | "Methods of tamper-proofing varied across departments. Key recommendations for improvement include the implementation of adhesive stickers or other tamper-evident features, standardization of the placement of tamper-evident adhesive stickers, prioritization of patient-specific medications for tamper-proofing, and development of and adherence to policies/procedures for most multidose medications before they leave the pharmacy." | https://doi.org/10.4212/cjhp.3748 | |||||||||||||||||||||
28 | Climate change adaptation | Patient education, Inhalers | Decarbonization of asthma care-could digital interventions provide the key to reducing the carbon footprint of asthma medication?. | "An electronic database search was carried out on PubMed, Ovid Embase, Ovid Medline, and the Cochrane library, in November 2024 and updated in April 2025. A structured search was used including free text and MeSH terms using the key terms 'asthma', 'adherence', and terms related to 'digital inhaler', 'digital sensor', 'electronic monitoring device', and 'environmental sustainability'. Fully published randomized controlled trials, systematic reviews or meta-analyses, and cohort studies were retrieved. Search results were limited to adolescent and adult asthma patients. " | "The review identifies that EMDs, particularly when combined with education and feedback, have the potential to reduce the carbon impact of asthma through improved adherence to preventer inhalers, reduced reliever overuse, and improved asthma control. However, the current evidence is limited and larger comparative studies demonstrating their impact on clinical outcomes and health economic and environmental factors are required." | Elsey, L., Lewis, P., Steinke, D., & Durrington, H. (2025). Decarbonization of asthma care-could digital interventions provide the key to reducing the carbon footprint of asthma medication?. The International journal of pharmacy practice, riaf073. Advance online publication. https://doi.org/10.1093/ijpp/riaf073 | ||||||||||||||||||||||
29 | Pollution and waste | Environmental sustainability criteria, Pharmacy practice | Pharmacists' role in reducing medicine waste: Barriers, solutions, and sustainable practices in Norwegian community pharmacies. | Ali K.H. et al. | " A cross-sectional survey was conducted using an anonymous online questionnaire distributed to pharmacists and pharmacy students across Norway. The questionnaire comprised 21 items categorised into five thematic areas: Demographic background, knowledge, attitudes, practices, and recommendations. A total of 202 responses were collected. Quantitative data were analysed using regression and chi-square tests to assess correlations and trends. A comparative literature review supplemented the findings to contextualise the results." | " Most respondents (55%) perceived reducing medicine waste as "very important". However, only 22.3% reported prioritising it in practice due to resource and time constraints. Key contributors to medicine waste included excessive dispensing (78.2%), patient non-adherence (61.9%), and overprescription (55.9%). Pharmacists identified potential solutions, such as reducing packaging sizes (66%), increasing pharmacist training (66%), and implementing improved disposal routines (46%). Awareness of antibiotic waste and bacterial resistance was high (73%), but this awareness did not correlate significantly with prioritisation efforts." | https://dx.doi.org/10.46542/pe.2025.254.ppr.1108 | |||||||||||||||||||||
30 | Climate change mitigation | Patient education | Patient preferences and attitudes regarding the environmental impact of medicines: A discrete choice experiment. | Sadreghaemy M. et al. | "A cross-sectional survey (December 2022 to January 2023) was conducted using the Dutch AMP pharmacy panel (>25 000 chronic medicine users). It included a discrete choice experiment (DCE) on medicines' environmental impact, ease of use and cost, and questions on environmental sustainability in medicine use and daily life. Latent class analysis identified groups with shared preferences. An environmental sustainability attitude score was calculated from daily life behaviour. | "our preference groups were identified and labelled based on DCE-derived attribute preferences: eco-focused (55.7%), cost-focused (20.1%), indifferent (16.4%) and eco-sceptical (7.8%). Environmental sustainability attitude scores were highest in the eco-focused and eco-sceptical (median 75.0%) groups, followed by the indifferent and cost-focused (median 66.7%) groups. Important factors influencing this were environmental concerns (eco-focused), environmental and personal health concerns (eco-sceptical), costs (cost-focused) and environmental, cost and personal health concerns (indifferent). Only 8.8-15.5% reported good or very good self-assessed knowledge of medicines' environmental impact." | Sadreghaemy, M., Philbert, D., Heerdink, E. R., Bouvy, M. L., Egberts, T. C. G., & Bloem, L. T. (2025). Patient preferences and attitudes regarding the environmental impact of medicines: A discrete choice experiment. British journal of clinical pharmacology, 91(10), 2771–2781. https://doi.org/10.1002/bcp.70244 | |||||||||||||||||||||
31 | Climate change mitigation | Environmental sustainability criteria | Enhancing Environmental Sustainability in Hospital Pharmacy: Initiatives from a Community Teaching Hospital. | Lee M. et al. | "A workgroup consisting of pharmacy management, pharmacists, pharmacy technicians and administrative staff met regularly to brainstorm, develop and implement environmental stewardship strategies in the inpatient and outpatient pharmacies at the hospital. A liaison ensured coordination with the corporate committee. Initiatives were generated by gathering ideas from pharmacy staff as well as from themes originating from the corporate committee and organizations such as Choosing Wisely. Feasibility and impact assessment guided implementation, with metrics collected where possible." | "Green strategies were focused on four key areas: medications, paper waste, recycling, and energy savings. Removing desflurane from the formulary and selecting environmentally-friendly metered dose inhalers were examples of reducing carbon footprint through medication selection. Transitioning from paper to electronic format of reports and medication requests saved over 40,000 sheets of paper annually. Additional measures, such as cancelling unnecessary faxes and magazines, repurposing used paper, promoting double-sided printing, and using scan-to-email features, further minimized paper use. Customized recycling signage developed with waste management companies improved compliance with waste and recycle sorting protocols. Reminder labels added to selected electronic devices and lights encouraged energy conservation after hours. Barriers to implementing additional ideas included limited coordination with other hospital departments, insufficient resources, factors beyond the department's control such as packaging design of pharmaceuticals, and a strict commitment to maintaining safety standards." | https://doi.org/10.4212/cjhp.3850 | |||||||||||||||||||||
32 | Education | Pharmacy practice | Exploring climate-conscious pharmacy: considerations for community pharmacists. | Park, J.Y. et al. | "We used a multi-method sequential design, with an environmental scan of resources for climate-conscious pharmacy practice across selected international jurisdictions, followed by qualitative interviews with key informants in Canada, UK, Ireland, and Norway. Resources identified through the environmental scan were categorized based on frequency of appearance and similarity of considerations seen across sources. Semi-structured interviews generated feedback on the resources identified, their categorization, and identified opportunities for implementing climate-conscious pharmacy practice." | "15 sources were included from the environmental scan and 12 key informants were interviewed. Resources were initially classified into clinical and operational considerations they implied for practice and further sub-classified into mitigation and/or adaptation strategies. Key informants supported or did not disagree with the considerations that were identified. They shared resource constraints as a challenge in implementing climate-conscious practice and highlighted the importance of a patient-centred approach to support the implementation." | Park, J. Y., Semchism, S., Moyana, C. V., Miller, F. A., & Austin, Z. (2025). Exploring climate-conscious pharmacy: considerations for community pharmacists. The International journal of pharmacy practice, riaf095. Advance online publication. https://doi.org/10.1093/ijpp/riaf095 | |||||||||||||||||||||
33 | Pollution and waste | Pharmaceutical waste | Quantifying Antimicrobial Disposals at Six Community Pharmacies With Longitudinal Medication Disposal Programs: An Underappreciated Component of a One Health Approach to Antimicrobial Stewardship. | Hoskins E. et al. | "Medication disposal programs were established at several community pharmacies in central North Carolina. Periodically, pharmacy school faculty and students visited the participating pharmacies to identify, quantify, and dispose of all UUE medication returns. Medications were deactivated using a Deterra Multi-purpose or Rx Destroyer All-purpose Disposal System and disposed of in accordance with product instructions and applicable laws and regulations." | "Between November 2021 and May 2023, 6 community pharmacies maintained longitudinal medication disposal programs. In total, 144 084 UUE prescription medication tablets/capsules containing ∼19.3 kg of active pharmaceutical ingredient (API) were disposed of. Antimicrobials accounted for 2.6% of all tablets/capsules and nearly 1.3 kg (6.6%) of APIs. The most disposed antibiotics were doxycycline, amoxicillin, clindamycin, cephalexin, and ciprofloxacin." | Hoskins, E., Bickenbach, E. M., Buchanan, M., Detter, S., Ferguson, M., Freeman, A., Hoskins, R., Johnston, A., Lee, R., Marks, B., Weger, B. R., Bradley, C. L., Smith, J. R., & Carlson, T. J. (2025). Quantifying Antimicrobial Disposals at Six Community Pharmacies With Longitudinal Medication Disposal Programs: An Underappreciated Component of a One Health Approach to Antimicrobial Stewardship. Open forum infectious diseases, 12(10), ofaf040. https://doi.org/10.1093/ofid/ofaf040 | |||||||||||||||||||||
34 | Pollution and waste | Pharmacy practice | "We throw away an incredible amount of unused medicines": Community pharmacy staff perspectives on environmental responsibility. | Villen J. et al. | "Focus group discussions and individual semi-structured interviews were conducted with pharmacy staff in Sweden between May 2024 and February 2025. All focus group discussions and interviews were audio recorded, transcribed, and analysed using inductive qualitative content analysis." | "The analysis resulted in three main categories. First, while there was an awareness of environmental issues, participants expressed a lack of concrete guidance and requested more information, such as lists of environmentally harmful pharmaceuticals. Second, pharmaceutical waste, originating both from households and pharmacies, was highlighted as a major concern. Third, there appeared to be a sense of limited agency and a wish for support from, for example, regulatory authorities to address pharmaceutical pollution." | Villén, J., Ljungdahl, N., Wettermark, B., Håkonsen, H., Nekoro, M., & Kälvemark Sporrong, S. (2025). "We throw away an incredible amount of unused medicines": Community pharmacy staff perspectives on environmental responsibility. Exploratory research in clinical and social pharmacy, 20, 100662. https://doi.org/10.1016/j.rcsop.2025.100662 | |||||||||||||||||||||
35 | Pollution and waste | Pharmaceutical waste | Assessing the environmental, financial, and social impact of immediate-release morphine tablets compared to oral morphine solution | Tahir F. et al. | "A bottom-up CF analysis was conducted on packaging materials. Cost comparisons and surveys of patients and staff evaluated financial and social impacts. Formulations studied were oral morphine solution (Oramorph 10 mg/5 ml) and Oro-dispersible tablets (Actimorph 10 mg)." | "In two sites of a single NHS Trust (inpatients and discharges), switching entirely to tablets could reduce annual carbon dioxide emissions by 7350 kg of carbon dioxide equivalents (53%). Tablets could also eliminate an estimated 275 000 plastic syringes disposed of annually and £16 000 in equipment costs from a 100% switch. A limited patient survey showed that 90% of patients supported the use of environmentally friendly tablets as an alternative to liquid solution." | Tahir, F., McDonald, F., Sudan, A., Whittaker, B., Cartwright, J., Sawyer, M., Tweddle, M., & Parker, E. (2025). Assessing the environmental, financial, and social impact of immediate-release morphine tablets compared to oral morphine solution. The International journal of pharmacy practice, riaf104. Advance online publication. https://doi.org/10.1093/ijpp/riaf104 | |||||||||||||||||||||
36 | Education | Environmental sustainability criteria | Future pharmacists and climate action: a qualitative study of students' views on environmental sustainability in education and practice | Rajiah K. and Mcarthur A. | "A qualitative study was conducted at a university in Northern Ireland, utilising semi-structured interviews with pharmacy students across all four years of their studies. Purposive sampling was used. Interviews were transcribed verbatim and analysed inductively using Braun and Clarke’s six-phase approach to thematic analysis." | "Six themes emerged: (1) Sustainability as an overlooked area – limited or fragmented curricular coverage; (2) Narrow understanding of waste – awareness focused on disposal and packaging, with little recognition of wider pharmaceutical impacts; (3) Pharmacy as both waste generator and sustainability site – examples included medicines returns, digitalisation, and hospital “green teams”; (4) Integrating sustainability into education – preference for interactive, experiential learning (e.g., guest speakers, placements); (5) Barriers to change – patient resistance, behavioural inertia, and competing curricular demands; (6) Policy, incentives, and leadership as enablers – systemic and financial support deemed essential for sustainable practice." | Rajiah, K., & McArthur, A. (2025). Future pharmacists and climate action: a qualitative study of students' views on environmental sustainability in education and practice. International journal of clinical pharmacy, 10.1007/s11096-025-02053-4. Advance online publication. https://doi.org/10.1007/s11096-025-02053-4 | |||||||||||||||||||||
37 | Climate change mitigation | Environmental sustainability criteria | Promoting sustainable pharmacy for tackling environmental pharmaceutical pollution | Egana I. et al. | "We followed a cradle-to-grave life-cycle approach to identify the role of pharmacy professionals, including drug developers, in enabling mitigation measures for pharmaceutical pollution." | "Some of the emerging initiatives for reducing pharmaceutical pollution that were identified include a benign-by-design approach for drug development, the adoption of a One Health approach in healthcare systems, and advancing regulatory frameworks and education of healthcare professionals." | Egaña, I., Akhrimenko, V., Ayerbe, M., Abasolo, E., Lertxundi, U., & Orive, G. (2025). Promoting sustainable pharmacy for tackling environmental pharmaceutical pollution. Drug discovery today, 31(1), 104559. Advance online publication. https://doi.org/10.1016/j.drudis.2025.104559 | |||||||||||||||||||||
38 | Pollution and waste | Pharmaceutical waste | Excess volume addition method improves human resource efficiency and environmental sustainability of cytotoxic drug preparations | Kroemer M. et al. | "A retrospective study comparing two methods, volume substitution and excess volume addition, for cytotoxic drug preparations was conducted over two periods of 6 months, within a University Hospital chemotherapy production unit. Volume substitution method (period 1; 5527 preparations) corresponded to the use of filled-bags. Excess volume addition method (period 2; 5108 preparations) corresponded to the use of half-filled bags. Preparation time included drug reconstitution and gravimetric controls." | "Median duration of preparation using the excess volume addition method (2.4 min; IQR: 1.9–3.2) was significantly shorter than the volume substitution method (3.2 min; IQR: 2.6–4.1; p < 0.0001). It allowed saving 67 h during period 2, corresponding to 9.8% of a full-time equivalent technician. However, mean cost per preparation was significantly increased by 58% when using the excess volume addition method (p < 0.0001), due to higher costs of the newly designed bags. Broken down over the course of a year, the excess volume addition method would decrease the weight of cytotoxic waste for the entire hospital by 2.21%." | Kroemer, M., Galy, G., Tarun-Coquoz, S., Stampfli, C., Thomann, P., Pierrot, A., Carrez, L., & Sadeghipour, F. (2025). Excess volume addition method improves human resource efficiency and environmental sustainability of cytotoxic drug preparations. Journal of oncology pharmacy practice : official publication of the International Society of Oncology Pharmacy Practitioners, 31(8), 1329–1337. https://doi.org/10.1177/10781552251369431 | |||||||||||||||||||||
39 | Supply chain management | Manufacturing | Environmental Considerations along the Life Cycle of Pharmaceuticals: Interview Study on Views Regarding Environmental Challenges, Concerns, Strategies, and Prospects within the Pharmaceutical Industry | Riikonen S. et al. | "Semi-structured interviews were conducted among representatives (n = 15) from twelve pharmaceutical companies operating in Finland in February-May 2021 . Aim of this interview study was to explore the current environmental actions within the industry, as well as the views and attitudes toward the strategies to address the environmental challenges and concerns" | "there is a keen interest in the industry to foster the introduction of new tools enabling the development of pharmaceuticals intrinsically less harmful for the environment" | Riikonen S., Timonen J., and Sikanen T. “Environmental Considerations along the Life Cycle of Pharmaceuticals: Interview Study on Views Regarding Environmental Challenges, Concerns, Strategies, and Prospects within the Pharmaceutical Industry.” European Journal of Pharmaceutical Sciences 196, no. (Riikonen, Sikanen) Faculty of Pharmacy, Drug Research Program, University of Helsinki, P.O.Box 56, Finland (2024): 106743. https://doi.org/10.1016/j.ejps.2024.106743. | |||||||||||||||||||||
40 | Pollution and waste | Pharmaceutical waste | Advancing the Practice of Pharmacy Technicians: Implementing Waste Control | Winkel R. et al. | "epidurals were stored in a lockable, clear plastic box to which nurses did not have key access, but nursing personnel were required to complete the cycle count on these epidurals by viewing them through the clear box. Discrepancies to the epidural count were created when nurses were unable to visualize all of the epidural bags because of poor placement within the locked box [...] Waste and discrepancy data are tracked by reports generated with our automated dispensing system." | "Involving technicians in the informal and formal performance improvement process has been successful at our institution to reduce waste of a compound that is time and labor intensive" | Winkel R., Burger M., and Rodriguez M. “Advancing the Practice of Pharmacy Technicians: Implementing Waste Control.” Journal of the American Pharmacists Association, Joint Forces Pharmacy Seminar, JFPS 2011. Dallas, TX United States., 51, no. 5 (2011): 656. https://doi.org/10.1331/JAPhA.2011.11542. | |||||||||||||||||||||
41 | Pollution and waste | Pharmaceutical waste | The Impact of the Lloyds Pharmacy Express Repeat Prescription (ExRx) Service on Patient- Returned Medication Waste. | Williams N. | "details of, and reasons for medicine waste returned to the pharmacy was recorded for a four week period prior to offering this service. The data was collected for a further four weeks after six months of implementing this service. Every customer returning medication was asked for reason for return, and the medication details, quantity and cost were recorded." | After implementation of ExRx shows an overall reduction in waste. No patient brought back medication due to over-ordering after implementing the ExRx service. | Williams N. “The Impact of the Lloyds Pharmacy Express Repeat Prescription (ExRx) Service on Patient- Returned Medication Waste.” International Journal of Pharmacy Practice, 2010 Royal Pharmaceutical Society Conference. London United Kingdom., 18, no. SUPPL. 2 (2010): 39 EP – 40. https://doi.org /10.1111/j.2042-7174.2010.tb00511.x. | |||||||||||||||||||||
42 | Pollution and waste | Pharmaceutical waste | Medicines Discarded in Household Garbage: Analysis of a Pharmaceutical Waste Sample in Vienna | Volger S. et al. | "obtained pharmaceutical waste sample [...] reported information on the prescription status, origin, therapeutic group, dose form, contents and expiry date." | "some medicines end up unused or partially used in normal household garbage in Vienna. Our results did not confirm speculations about a high percentage of unused medicines improperly discarded. " | Vogler S., Leopold C., Zuidberg C., and Habl C. “Medicines Discarded in Household Garbage: Analysis of a Pharmaceutical Waste Sample in Vienna.” Journal of Pharmaceutical Policy and Practice 7, no. 1 (2014): 6. https://doi.org/10.1186/2052-3211-7-6. | |||||||||||||||||||||
43 | Pollution and waste | Pharmaceutical waste | Pharmacy Update: Disposal of Unused Pharmaceuticals | Tusa D.P | "Ongoing concerns about the estimated 200 million pounds of unused dispensed prescription and over-the-counter drugs improperly disposed of annually outside the healthcare setting have led to the creation of major regulatory initiatives " | " At least 20 states now have take-back collection programs for unused medications. The greater use of disposal by mail or through in-pharmacy take-back programs creates a further opportunity for patient counseling by pharmacists." | Tusa D.P. “Pharmacy Update: Disposal of Unused Pharmaceuticals.” Drug Topics 155, no. 9 (2011): 30. | |||||||||||||||||||||
44 | Pollution and waste | Pharmaceutical waste | Analysis of Chemotherapy Vial Waste. | Surber S. and Yaniv A. | "All vial waste was recorded daily for the month of May 2010. Waste of the top 24 drugs was recorded in September 2010. The top 24 drugs were targeted based on the volume wasted and their potential financial impact. Wasted amounts were compared to prescribed amounts. Costs of drug prescribed and drug wasted were calculated based on average wholesale price." | "Reduction or elimination of vial waste has the potential to reduce drug purchases at our institution by up to 4.5%. However, the drugs of highest interest are available in single-dose vials." | Surber S. and Yaniv A. “Analysis of Chemotherapy Vial Waste.” Journal of Oncology Pharmacy Practice, 7th Annual Hematology/Oncology Pharmacy Association, HOPA Conference. Salt Lake City, UT United States., 17, no. 1 (2011): 18. https://doi.org/10.1177/1078155210395695. | |||||||||||||||||||||
45 | Pollution and waste | Pharmaceutical waste | Minimization of Preventable Drug Waste through Use of a Vial Combination Calculator Tool | Song J. Y. et al. | "Microsoft Excel–based calculator was developed for use by staff of a large oncology pharmacy network. Twenty-three high-cost chemotherapy and monoclonal antibody medications were identified as initial targets for the drug waste prevention initiative" | "After implementation of an automated vial selection tool, preventable drug waste and the quantity of suboptimal vial combination selections were markedly reduced across 11 outpatient compounding pharmacies." | Song J.Y., Wysocki M., Chen F., Martinez D., and Cabie E. “Minimization of Preventable Drug Waste through Use of a Vial Combination Calculator Tool.” American Journal of Health-System Pharmacy 81, no. 11 (2024): e311 EP-e321. https://doi.org/10.1093/ajhp/zxae023. | |||||||||||||||||||||
46 | Pollution and waste | Pharmaceutical waste | Pharmaceutical Waste Disposal Practices: A Case Study of an Australian Public Hospital Pharmacy Department | Singleton J. A. et al. | Two phase method, Phase I involved semi-structured interviews of hospital pharmacists and pharmacy technicians while Phase II comprised bin audits of the pharmacy department's waste streams. | "Provision of commingled recycling bins and clean office paper waste bins in dispensing areas and education of staff on correct waste segregation processes will improve waste segregation in hospital pharmacy departments " | Singleton J.A., Lau E.T.L., and Nissen L.M. “Pharmaceutical Waste Disposal Practices: A Case Study of an Australian Public Hospital Pharmacy Department.” Journal of Pharmacy Practice and Research 53, no. 2 (2023): 56 EP – 63. https://doi.org/10.1002/jppr.1850. | |||||||||||||||||||||
47 | Pollution and waste | Pharmaceutical waste | Only 62% of Invited Pharmacies Sign up for Chiesi postal Inhaler Recycling Scheme | Robinson J. | News article regarding the UK's first postal inhaler recycling scheme 'Take AIR'. The 12-month scheme was launched by the pharmaceutical company Chiesi in February 2021 in two cities. This involved pharmacies providing patients with pre-paid envelopes for inhalers to be recycled - aluminium canisters will be recycled and reused, plastic components will be recycled and put back into the plastic supply chain, and any remaining propellant gas will be extracted and reused in items such as fridges and air conditioning units; non-recyclable materials will be converted into energy. | A total of 227 community pharmacies were invited to participate, of which 141 were participating after 6 months. During that time, 867 envelops were sent in the mail to the waste company, totalling 3,216 inhalers for disposal or recycling. | Robinson J. “Only 62% of Invited Pharmacies Sign up for Chiesi postal Inhaler Recycling Scheme.” Pharmaceutical Journal 307, no. 7951 (2021). https://doi.org/10.1211/PJ.2021.1.94979. | |||||||||||||||||||||
48 | Pollution and waste | Pharmaceutical waste | First Ever Injection Pen Recycling Pilot Rolled out Nationally across Pharmacies | Robinson J. | News article (based in the UK) | "Following the success of its pilot, in which more than 15,000 pre-filled injection pens were recycled, Novo Nordisk is rolling out the PenCycle scheme nationwide." | Robinson J. “First Ever Injection Pen Recycling Pilot Rolled out Nationally across Pharmacies.” Pharmaceutical Journal 309, no. 7966 (2022). https://doi.org/10.1211/PJ.2022.1.162164. | |||||||||||||||||||||
49 | Pollution and waste | Pharmaceutical waste | Waste in Drug Procurement Process in Pharmacy Department Santa Maria Hospital Pemalang, Indonesia | Prasetya T.L.T et al. | "The study was conducted at pharmacy department of Santa Maria Hospital Pemalang with 17 persons sample size, consisting of a head of pharmacy, 1 procurement staff, 2 warehouse staff and 13 pharmacy staff. The sampling method by a non-probabilistic sampling with purposive sampling type. This research begins with observations on April 1 to 30, 2014 to describe the mapping process and issues surrounding procurement process. After mapping process described, then conducted FGD to seek waste and identify the cause by using the root cause analysis (RCA) 5 whys." | The root causes of these wastes included poor communication, unplanned drug procurement budgets, inappropriate inventory management, ineffective organization of the PTC, and inadequate work area structures. The study found that the process cycle efficiency was only 7.68%, indicating significant inefficiencies in the procurement process. | Prasetya T.L.T., Kristin E., and Lestari T. “Waste in Drug Procurement Process in Pharmacy Department Santa Maria Hospital Pemalang, Indonesia.” International Journal of Pharmaceutical Sciences Review and Research 31, no. 1 (2015): 174 EP – 178. | |||||||||||||||||||||
50 | Pollution and waste | Pharmaceutical waste | A Call for Sustainability: Why Unused Drugs Should Be Redistributed to Pharmacy Schools for Simulated Pharmacy Practice Learning Activities | Pangilinan K. et al. | The authors conducted a literature review to evaluate the potential benefits and challenges of redistributing unused medications to pharmacy schools for use in simulated pharmacy practice activities. They assessed existing policies, sustainability practices, and educational outcomes associated with such initiatives. | "This commentary outlines the proposed call to action through the United Nation's five dimensions of sustainability: planet, prosperity, people, partnerships, and peace. Reuse of medications by schools of pharmacy ensures the lifespan of a product is expanded, thereby reducing the amount of waste in landfills. Forming partnerships between institutions and schools of pharmacy lends to economic prosperity due to cost-avoidance and cost-recovery. This repurposing also prioritizes people by limiting the impact on supply chains and medication shortages, while also resource sharing in times of need. These efforts lead to increased peace through waste mitigation, mutually beneficial business, social responsibility, and community outreach." | Pangilinan K., Pamulapati L.G., and Caldas L.M. “A Call for Sustainability: Why Unused Drugs Should Be Redistributed to Pharmacy Schools for Simulated Pharmacy Practice Learning Activities.” Currents in Pharmacy Teaching and Learning 15, no. 10 (2023): 849 EP – 853. https://doi.org/10.1016 /j.cptl.2023.08.001. | |||||||||||||||||||||
51 | Pollution and waste | Pharmaceutical waste | Pharmaceutical Waste from a Danish Hospital | Overgaard L. K. et al. | "This study aimed to characterize the quantity and composition of pharmaceutical waste from a major Danish hospital. Pharmaceutical waste was collected from Odense University Hospital, including departments located in both Odense and Svendborg." | "The average daily production of pharmaceutical waste was 1150 g/day in Odense and 5967 g/day in Svendborg. Operating rooms contributed a large proportion of the pharmaceutical waste, and propofol accounted for about one third of the pharmaceutical waste obtained from operating rooms. Antibiotics for systemic use and paracetamol were found in several departments and also constituted a large proportion of the pharmaceutical waste in some departments." | Overgaard L.K., Johansen K.B., Krumborg J.R., Nielsen M.L., Christensen M.M.H., and Pedersen S.A. “Pharmaceutical Waste from a Danish Hospital.” Basic and Clinical Pharmacology and Toxicology 135, no. 4 (2024): 499 EP – 511. https://doi.org/10.1111/bcpt.14072. | |||||||||||||||||||||
52 | Pollution and waste | Pharmaceutical waste | Greening the Pharmacy. | Orive G. et al. | The article examines the pathways through which pharmaceuticals enter the environment, including manufacturing processes, improper disposal, and excretion by patients. It also reviews existing measures to mitigate these impacts and discusses the need for further research and policy interventions | The article concludes that the ecological footprint of pharmaceuticals is a growing concern that requires immediate attention. It emphasizes the need for the pharmaceutical industry to adopt greener practices, such as sustainable manufacturing processes and improved waste management. The article also calls for stronger regulatory frameworks and increased public awareness to address the environmental challenges posed by pharmaceuticals. | Orive G., Lertxundi U., Brodin T., and Manning P. “Greening the Pharmacy.” Science 377, no. 6603 (2022): 259 EP – 260. https://doi.org/10.1126/science.abp9554. | |||||||||||||||||||||
53 | Pollution and waste | Pharmaceutical waste | Disposal of Leftover and Expired Medicines by Community Pharmacies and Their Clients in Ghana | Opare-Addo M. et al. | The study employed a cross-sectional design, surveying 100 community pharmacies and 200 clients in Kumasi, Ghana. Data were collected using structured questionnaires to assess disposal practices of leftover and expired medicines. The survey aimed to identify common disposal methods and the factors influencing these practices among both pharmacy personnel and clients. | Improper disposal methods, such as pouring medicines into sinks or toilets, were prevalent among both pharmacies and clients. Factors contributing to these practices included lack of awareness, inadequate disposal facilities, and insufficient regulatory enforcement. The study concluded that there is an urgent need for public education on proper disposal methods, establishment of safe disposal systems, and stricter regulations to mitigate the environmental impact of pharmaceutical waste in Ghana. | Opare-Addo M.N.A., Marfo A.F.A., and Owusu-Daaku F.T. “Disposal of Leftover and Expired Medicines by Community Pharmacies and Their Clients in Ghana.” Waste Management and Research 40, no. 10 (2022): 1539 EP – 1545. https://doi.org/10.1177/0734242X221084060. | |||||||||||||||||||||
54 | Pollution and waste | Pharmaceutical waste | Management of Green Pharmaceuticals | Medhi S. et al. | This review article synthesizes existing literature and regulatory frameworks to explore the concept of Green Pharmacy, focusing on the environmental impact of Active Pharmaceutical Ingredients (APIs). The authors examine various pathways through which APIs contaminate the environment, including improper disposal, wastewater from pharmaceutical manufacturing, and excretion by patients. | Key strategies to reduce the environmental impact of pharmaceuticals, including the design of biodegradable drugs, improved wastewater treatment to remove pharmaceutical residues, and proper disposal of unused or expired medications. Regulatory measures and education programs are also emphasized to ensure compliance and raise awareness. | Smetana K.S. et al. | |||||||||||||||||||||
55 | Pollution and waste | Pharmaceutical waste | A Study on the Quantity, Type, Economic Value and Reasons for Pharmaceutical Waste Returned to Pharmacies in Finland | Louhisalmi M. et al. | "Community pharmacies (n = 82) quantified and qualified the amount of pharmaceutical waste returned to them over three days in May 2022. The data was collected using an electronic form. The reasons for returning medicines were asked from customers who returned medicines using a paper questionnaire. The data was analyzed for frequencies and percentages. To estimate the economic value, we used the Finnish medicines prices at the end of June 2022. The annual economic value was calculated by means of a pharmacy size-weighted average. The confidence intervals were estimated using the non-parametric bootstrap method. Sensitivity analyses were conducted to examine the reliability of the results." | "In total, 5173 medicines were returned to pharmacies, of which 66 % were prescription medicines. The most common medicines group returned were medicines for nervous system (18 %), respiratory system (16 %), and alimentary tract and metabolism (12 %). The estimated annual economic value of the medicines returned was 81 million euros (CI 95 % M€61–M€103), of which the cost to society was 43 million euros (CI 95 % M€30–M€60). 799 customers responded to the questionnaire (Response rate 81.9 %). The limited shelf life of the medicine after opening (36 %), improvement of the medical condition or symptom (25 %), and the unnecessarily large pack size (22 %) were common reasons for returning." | Louhisalmi M., Lavikainen P., Sandler C., Kallio S., Kanerva R., Martikainen J., and Timonen J. “A Study on the Quantity, Type, Economic Value and Reasons for Pharmaceutical Waste Returned to Pharmacies in Finland.” European Journal of Pharmaceutical Sciences 195, no. (Louhisalmi, Lavikainen, Martikainen, Timonen) School of Pharmacy, University of Eastern Finland, Yliopistonrinne 3, Kuopio, Finland (2024): 106729. https://doi.org/10.1016/j.ejps.2024.106729. | |||||||||||||||||||||
56 | Pollution and waste | Pharmaceutical waste | A More Sustainable Pharmacy | Lertxundi U. and Orive G. | Narrative review and policy commentary on pharmaceutical pollution, focusing on regulatory developments, scientific findings, and sustainability initiatives. It draws on international studies (e.g., the Global Monitoring of Pharmaceuticals study by the University of York), European policies such as the Green Deal and Water Framework Directive, databases on environmental contamination, and examples of educational and professional programs to synthesize strategies for reducing environmental impact across the pharmaceutical life cycle. | Pharmaceuticals are widespread environmental contaminants, found in water, soil, air, and biota, often at concentrations comparable to human therapeutic doses. Measures to mitigate pollution include rational prescribing incorporating environmental impact (‘eco-prescription’), improving waste disposal and take-back programs, applying a ‘One Health’ approach across human and veterinary drugs, and developing new treatment technologies at hospitals and wastewater hotspots. Regulatory developments, such as inclusion of priority hazardous substances in the European Water Framework Directive, underscore the need for training healthcare professionals in environmental sustainability, while programs like the Basque Sustainable Pharmacy postgraduate initiative aim to increase professional awareness and capacity. | Lertxundi U. and Orive G. “[Translated Article] A More Sustainable Pharmacy.” Farmacia Hospitalaria, Por una farmacia mas sostenible, 47, no. 2 (2023): T53 EP-T54. https://doi.org/10.1016 /j.farma.2023.03.001. | |||||||||||||||||||||
57 | Pollution and waste | Pharmaceutical waste | Towards Zero Waste in Pharmacy: Challenges and Opportunities in Singapore | Leow J.L et al. | "Preliminary surveys were carried out among pharmacy staff, patients/caregivers to assess behavioral change factors. Recycling rate of staff and plastic bag consumption levels of patients/caregivers were measured." | "46 staff members and 335 patients/caregivers were surveyed. Both populations were optimistic about the suggested green initiatives, 82.6% of staff members viewed recycling as a potential solution to reduce waste and 67.6% of patients and caregivers demonstrated willingness to participate in a Bring Your Own Bag (BYOB) campaign. Recycling efforts improved recycling rates by 53.4% while BYOB campaign resulted in no notable decrease in plastic bag consumption levels." | Leow J.L., Looi L., Lee Y., and Chew L. “Towards Zero Waste in Pharmacy: Challenges and Opportunities in Singapore.” Proceedings of Singapore Healthcare 31, no. (Leow, Lee, Chew) Department of Pharmacy, National Cancer Centre Singapore, Singapore (2022). https://doi.org/10.1177/20101058221146323. | |||||||||||||||||||||
58 | Pollution and waste | Pharmaceutical waste | Pharmaceuticals in the Environment - A Short Review on Options to Minimize the Exposure of Humans, Animals and Ecosystems | Klatte S. et al. | Review that categorizes mitigation strategies into short-, medium-, and long-term options aimed at reducing pharmaceutical exposure in the environment | The review highlights that the most effective approach is prevention at the source, particularly through rational prescribing practices, improved patient compliance, and eco-directed drug design that produces more biodegradable pharmaceuticals. In the medium term, it stresses the importance of proper collection and safe disposal of unused medicines, upgrading wastewater treatment technologies, and improving hospital effluent management to limit environmental contamination. For the long term, the authors emphasize the need for international harmonization of environmental risk assessment guidelines, broader regulatory frameworks, and incorporation of sustainability into drug development pipelines. Public education and stakeholder collaboration—among regulators, healthcare providers, industry, and consumers—are identified as essential across all time horizons. | Klatte S., Schaefer H.-C., and Hempel M. “Pharmaceuticals in the Environment - A Short Review on Options to Minimize the Exposure of Humans, Animals and Ecosystems.” Sustainable Chemistry and Pharmacy 5, no. (Klatte, Schaefer, Hempel) German Federal Environmental Foundation, Osnabrueck, Germany (2017): 61 EP – 66. https://doi.org/10.1016/j.scp.2016.07.001. | |||||||||||||||||||||
59 | Pollution and waste | Pharmaceutical waste | Pharmaceutical Waste Disposal | Kariem J. | Practical recommendations for pharmaceutical waste disposal in community pharmacies using professional experience, South African Pharmacy Council regulations, Good Pharmacy Practice standards, and municipal by-laws as guiding frameworks. | The recommendations emphasize selecting accredited waste management providers, maintaining accurate records of waste type and weight, and ensuring compliance through standardized documentation. The framework offers community pharmacies a structured approach to safely and effectively manage pharmaceutical waste in line with regulations. | Kariem J. “Pharmaceutical Waste Disposal.” SA Pharmaceutical Journal 91, no. 6 (2024): 37 EP – 40. https://doi.org/10.36303/SAPJ.1285. | |||||||||||||||||||||
60 | Pollution and waste | Pharmaceutical waste | Issues around Household Pharmaceutical Waste Disposal through Community Pharmacies in Croatia | Jonjic D. and Vitale K. | " Each pharmacy was asked to weigh the collected waste from the public during a period of 30 days, between June 1st and July 10th of 2011, absent from any media advertisement and answer a specifically designed questionnaire that was exploring possible connections between the amount of collected waste, type of pharmacy ownership, discretion while disposing, location of the container, appropriate labeling and to compare the amount of collected waste between neighborhoods." | "Of 210 pharmacies, 91 participated completing the questionnaire (43 % response rate). The total amount of collected waste was 505 kg. Pharmacies owned by the city of Zagreb had higher response rate (74 %) than privately owned pharmacies (36 %), and collected significantly higher amount of waste. Anonymity when disposing influenced collected quantity, while labelling and location of the container did not. There were differences in the amount of collected waste between neighborhoods due to the demographic characteristics and number of pharmacies per capita." | Jonjic D. and Vitale K. “Issues around Household Pharmaceutical Waste Disposal through Community Pharmacies in Croatia.” International Journal of Clinical Pharmacy 36, no. 3 (2014): 556 EP – 563. https://doi.org/10.1007/s11096-014-9936-7. | |||||||||||||||||||||
61 | Pollution and waste | Pharmaceutical waste | What Are the Reasons for Prescribed Medicines Waste? A Cross-Sectional Survey of Individuals Returning Prescription Medicines to Community Pharmacies | John D.N. et al. | "Following a literature review, a questionnaire was developed to determine the reasons medicines were returned to the pharmacy. This data collection tool, consisting of mainly closed questions requiring tick-box responses, was assessed by key stakeholders for face and content validity. Pharmacies were requested to supply questionnaires to the first 10 individuals who returned prescription medicines for disposal." | "Reasons given were stopped/ changed by a doctor (149/263, 56.7%), clear out of excess prescribed medication (n = 61, 23.2%), patient stopped due to side-effects (53, 20.2%), medicines went out-of-date (n = 54, 20.5%), patent stopped as condition improved (n = 20, 7.6%), medicines were not requested (n = 14, 5.3%), the wrong medicine was prescribed/ dispensed (n = 6, 2.3%), patient stopped because they were unsure why it was prescribed (n = 4, 1.5%), stopped medication as it was inconvenient to take/use (n = 2, 0.8%) and twenty ticked ‘other’." | John D.N., Lees S., Fec S., and Coulman S.A. “What Are the Reasons for Prescribed Medicines Waste? A Cross-Sectional Survey of Individuals Returning Prescription Medicines to Community Pharmacies.” International Journal of Pharmacy Practice, Health Services Research and Pharmacy Practice Conference. Norwich United Kingdom., 19, no. SUPPL. 1 (2011): 45 EP – 46. https://doi.org/10.1111 /j.2042-7174.2011.00124.x. | |||||||||||||||||||||
62 | Pollution and waste | Pharmaceutical waste | Dose Rounding of Ipilimumab in Adult Metastatic Melanoma Patients Results in Significant Cost Savings | Jarkowski III A. et al. | "Doses of ipilimumab were calculated based upon the actual body weight (in kg) of the patient at the FDA approved regimen of 3 mg/kg every 21 days x 4 doses. The exact total mg dose was then rounded to the nearest 50 mg vial size. The potential effect on cost was calculated in US dollars for both the calculated and rounded doses." | " A total of 17 patients have received at least one dose of ipilimumab. 8 patients have completed therapy and received all 4 induction doses. 5 patients discontinued therapy early and 4 patients are still actively receiving induction. A total of 46 doses were given. The maximum potential cost savings by giving ipilimumab to the nearest 50 mg over the period was $113,040." | Jarkowski III A., Nestico J.S., Vona K.L., and KhushalaniI N. “Dose Rounding of Ipilimumab in Adult Metastatic Melanoma Patients Results in Significant Cost Savings.” Journal of Oncology Pharmacy Practice, 8th Annual Meeting of the Hematology/Oncology Pharmacy Association, HOPA 2012. Orlando, FL United States., 18, no. SUPPL. 1 (2012): 9 EP – 10. https://doi.org/10.1177 /1078155212436544. | |||||||||||||||||||||
63 | Pollution and waste | Pharmaceutical waste | Pharmaceutical Waste: A Comprehensive Approach | Hellwig H. et al. | "Pharmacy and environmental health services (EHS) coordinated to identify current pharmaceutical waste needs. To be successful, the program had to address the proper disposal of hazardous, nonhazardous, and controlled medications while remaining easy to incorporate in a new facility, safe to providers and patients, and friendly to the environment. A thorough review of all available options was conducted and reviewed by a joint team of pharmacy, EHS, and public works personnel" | "A review of available alternatives led to the determination that no single product, company, or process could satisfy all the requirements of the agencies involved and the needs of the military treatment facility. " | Hellwig H., Vera D., and Obah P. “Pharmaceutical Waste: A Comprehensive Approach.” Journal of the American Pharmacists Association, Joint Forces Pharmacy Seminar, JFPS 2012. San Diego, CA United States., 52, no. 5 (2012): 689. https://doi.org/10.1331/JAPhA.2012.12540. | |||||||||||||||||||||
64 | Pollution and waste | Pharmaceutical waste | Requirement for Quality Documentation Concerning Investigational Medicinal Product in a Multicentric Clinical Trial. The Experience of an Institutional Pharmacy with the IFM 2005-02 Study | Guillemot C. et al. | "The quality of IMP flow was assessed by the rate of traceability evaluated by the rate of bottles followed from their shipment to their destruction in pharmacy database. " | "The quality of IMP flow is dramatically improved with a PCT, noteworthy in term of traceability that is essential to prove the compliance to GCP guidelines . Moreover, if the average rate of bottles wasted by center observed in the second phase was applied to the first phase, PCT should have saved about 5000 bottles." | Guillemot C., Michenot F., Andissac A., Nobili-Escriva C., Attal M., Llau M.E., Neel V., Puisset F., and Canonge J.M. “Requirement for Quality Documentation Concerning Investigational Medicinal Product in a Multicentric Clinical Trial. The Experience of an Institutional Pharmacy with the IFM 2005-02 Study.” International Journal of Clinical Pharmacy, ESCP 40th International Symposium on Clinical Pharmacy. Clinical Pharmacy: Connecting Care and Outcomes. Dublin Ireland., 34, no. 1 (2012): 224. https://doi.org/10.1007/s11096-011-9602-2. | |||||||||||||||||||||
65 | Pollution and waste | Pharmaceutical waste | Implementing Environmentally Friendly Practices in a Commercial Nuclear Pharmacy | Gray M. et al. | " A recycling program was implemented in the pharmacy and the volume of waste recycled was recorded for 6 weeks." | "The weekly average of recyclable waste generated was 9 cubic yards, which totals nearly 500 cubic yards a year. A cost analysis showed that incorporating recycling services at the pharmacy amounted to an additional $10 a month because adding biweekly recycling services reduced the total weekly trash pickups required. Community break room materials were used and decreased the amount of trash waste generated." | Gray M., Clechanowlcz B., and Gattas F. “Implementing Environmentally Friendly Practices in a Commercial Nuclear Pharmacy.” Journal of the American Pharmacists Association, APhA 2010. Washington, DC United States., 50, no. 2 (2010): 306. https://doi.org/10.1331/JAPhA.2010.10511. | |||||||||||||||||||||
66 | Pollution and waste | Pharmaceutical waste | Assessing the Relationship between Pharmacy Supplier, Thirdparty Prescription Coverage, and Medication Waste | Giroux R. et al. | "This cross-sectional survey study was conducted at six medication disposal sites on September 25, 2010, in coordination with the Drug Enforcement Administration's National Prescription Drug Take Back Day" | N/A => This project will help determine if the type of pharmacy or insurance coverage correlates with the amount of medication waste that a patient disposed. These data will provide valuable information concerning the source of medication waste and guide future initiatives to prevent medication waste and to promote safe medication disposal. | Giroux R., Smolen A., Fiebelkorn K., Monte S., Wrobel M., Wiegand S., Badgley B., Stevens V., and Brown J. “Assessing the Relationship between Pharmacy Supplier, Thirdparty Prescription Coverage, and Medication Waste.” Journal of the American Pharmacists Association, APhA 2011. Seattle, WA United States., 51, no. 2 (2011): 247. https://doi.org/10.1331/JAPhA.2011.11517. | |||||||||||||||||||||
67 | Pollution and waste | Pharmaceutical waste | Evaluation of Returned Medicines from Care Homes to Support the Development of a Returned Medicines Audit for Community Pharmacies Providing Services to Care Homes | Fraser A. et al. | 3 care homes in the UK participated in this study. Data was collected on all medication returns to the supplying community pharmacy. The number of medicines returned, total cost, average cost per patient and type of medication returned were evaluated. 4 months later, data collection resumed following a pharmacy led presentation on medication management. | "This evaluation and training intervention has demonstrated that cost savings in care homes can be realised by assessing the level of returned medicines to effect a reduction in inappropriate prescribing. The intervention highlighted analgesic returns as a particular area of focus. Staff should be encouraged to record the reasons for returns to support reflection on current practice although this is not required by the Care Inspectorate." (table with more details can be found in publication). | Fraser A., Miller J., Downes N., Henderson L., and Thomson D. “Evaluation of Returned Medicines from Care Homes to Support the Development of a Returned Medicines Audit for Community Pharmacies Providing Services to Care Homes.” International Journal of Pharmacy Practice, Royal Pharmaceutical Society, RPS Annual Conference 2014. Birmingham United Kingdom., 22, no. SUPPL. 2 (2014): 30 EP – 31. https://doi.org/10.1111/ijpp.12146. | |||||||||||||||||||||
68 | Pollution and waste | Pharmaceutical waste | Cost Savings Realized by Use of a Closed-System Transfer Device for Preparation of Antineoplastic Agents | Edwards M. et al. | "The objectives of this study are to: (1) prove that the cost of PhaSeal can be offset by the cost savings of its use to extend beyond use dating of single-dose medications; (2) provide a real cost savings plan for chemotherapy in austere times; (3) quantify a second use of closed-system transfer devices other than reduced antineoplastic exposure." "At this facility, a list was developed composed of 25 drugs available in single-use vials, with a chemical stability of at least 48 hours to utilize. Use and waste of these agents was recorded by the technicians during a 50-day period during April through June 2012; in total, 296 vials of 21 antineoplastic agents were recorded. After allowing for the initial use, mean potential percentage of drug waste and potential overall savings were calculated." | "The PhaSeal system created annual savings of approximately 8% of the total budget used on chemotherapy." | Edwards M., Solimando D., Grollman F., Pang J., Preston L., Johnson A., Hightman C., and Mickens M. “Cost Savings Realized by Use of a Closed-System Transfer Device for Preparation of Antineoplastic Agents.” Journal of the American Pharmacists Association, Joint Forces Pharmacy Seminar, JFPS 2013. Orlando, FL United States., 53, no. 5 (2013): e153. https://doi.org/10.1331/JAPhA.2013.13531. | |||||||||||||||||||||
69 | Pollution and waste | Pharmaceutical waste | Logistics Performance: Critical Factors in the Implementation of End-of-Life Management Practices in the Pharmaceutical Care Process | de Campos E.A. R et al. | A literature search for critical factors such as "management factor, collaboration factor, information technology factor, infrastructure factor, politics factor, financial and economic factor, end-of-life management practices, and logistics performance" as well as a questionnaire administered to 67 pharmacy professionals to determine which are barriers to the implementation of reverse logistics. | "The results have indicated that end-of-life management practices exert a direct influence on logistics performance. The analysis confirmed a direct effect of the information technology factor on end-of-life management practices, but not a moderation effect. Findings have contributed to the literature by providing deeper insights into the relationship between end-of-life management practices for medicines and logistics performance. Moreover, it supports health managers’ decision-making in the pharmaceutical care process improvement and engagement with solid waste management policies." | de Campos E.A.R., de Paula I.C., Caten C.S.T., Tsagarakis K.P., and Ribeiro J.L.D. “Logistics Performance: Critical Factors in the Implementation of End-of-Life Management Practices in the Pharmaceutical Care Process.” Environmental Science and Pollution Research International 30, no. 11 (2023): 29206 EP – 29228. https://doi.org/10.1007/s11356-022-24035-z. | |||||||||||||||||||||
70 | Pollution and waste | Pharmaceutical waste | Pharmaceutical Waste Management in Pharmacies in Zagreb | Bosnjak M. et al. | "Pharmaceutical waste was collected in pharmacies from April 14 to May 14, 2014. After collection, the drugs were sorted using Anatomical Therapeutic Chemical Classification (ATC) into different therapeutical groups, noting them in an electronic formulary for waste recording in each pharmacy (Figure 1). We also used Register of Medicines as a source for prices of medicines (Lejla Bencaric, Register of Medicines in Croatia. Zagreb. 2014.) as well as internal data from companies whose core business was pharmaceutical waste disposal as the source for cost of its disposal" | "During the research, pharmacies collected 291.56 kilograms of pharmaceutical waste, containing 6289 medicine packings, including tablets and other formulations of drugs. 4549 (72.3%) of them were prescription drugs and 1740 (27.7%) were OTC drugs. Of all the pharmaceutical units, there were more prescribed medicines than OTCs. The majority of the pharmaceutical waste drugs included Cardiovascular system (17.8%), Alimentary tract and metabolism (14.5%) and Nervous system (12.4%) according to ATC ." | Bosnjak M., Bosnjak I., and Drmic D. “Pharmaceutical Waste Management in Pharmacies in Zagreb.” FASEB Journal, Experimental Biology 2016, EB. San Diego, CA United States., 30, no. Meeting Abstracts (2016). http://www.fasebj.org/content/30/1_Supplement /933.10.abstract?sid=80b9bb56-58d3-4005-bc11-7a4f29eabd15. | |||||||||||||||||||||
71 | Pollution and waste | Pharmaceutical waste | First national survey of medicine waste-minimizing ın Brunei Darussalam | Ali Hazis N.U. et al. | A self-administered questionnaire with 4 segments was given to 76 pharmacist and pharmacy technicians practicing in Brunei. The questionnaire included questions regarding prescribing, dispensing, patient-related and leftover stages for the implementation of drug-minimizing activity. | "More than half of the participants carried out a variety of activities to reduce medicine waste throughout the stages of the medicine supply chain. 40.8% of the participants reported that prescribers could adjust and optimize the prescribed doses for patients, and 30.3% reported pharmacists would counsel the physicians on efficient prescribing practice. The respondents considered activities in the dispensing stage, particularly those associated with the pharmacy organization, the most attainable to be executed as a regular practice, whereas approaches in the prescribing phase are the most important in minimizing medication waste." | Ali Hazis N.U., Kifli N., Chua L.K., Farrukh M.J., Paneerselvam G.S., and Ming L.C. “First National Survey of Medicine Waste-Minimizing in Brunei Darussalam.” Journal of Research in Pharmacy 27, no. 6 (2023): 2362 EP – 2373. https://doi.org/10.29228/jrp.524. | |||||||||||||||||||||
72 | Pollution and waste | Manufacturing | Accountability, Ambition, and Quantifiable Action in the Carbon Emission Reduction Plans of the Ten Largest Pharmaceutical Companies in Australia: A Cross-Sectional Analysis | Burch H. et al. | "Content analysis of publicly available documents for the ten companies using modified criteria from the PricewaterhouseCoopers Building blocks for net zero transformation framework, with three domains: accountability, ambition, and action; the Carbon Disclosure Project (CDP) grading; the Science Based Targets initiative (SBTi) approval system. We focused on measurement, target setting, and achievement of emission reductions, and ranked the environmental sustainability of companies using a points and colour coding system" | "Three groups could be defined by evidence of their commitment to emissions reductions. The first — companies leading emissions reduction efforts, with SBTi-approved near term targets, consistent emissions monitoring, well defined commitments, and quantified evidence of action — includes AstraZeneca, Novartis, Johnson & Johnson, Bayer, and Merck & Co. The second group — companies that had made commitments to SBTi-approved targets but their disclosure records are limited — includes AbbVie and Roche. The third group — without public commitments to achieving net zero emissions, minimal or no SBTi-approved targets, and minimal disclosure or monitoring of emissions — includes Viatris, Vertex, and Arrotex" | Burch H., Brown G., Adler O., Wong J., and Winkel K.D. “Accountability, Ambition, and Quantifiable Action in the Carbon Emission Reduction Plans of the Ten Largest Pharmaceutical Companies in Australia: A Cross-Sectional Analysis.” Medical Journal of Australia, no. (Burch, Adler) Melbourne Medical School, the University of Melbourne, Melbourne, VIC, Australia (2025). https://doi.org /10.5694/mja2.52621. | |||||||||||||||||||||
73 | Education | Pharmaceutical waste | Reducing Pharmaceuticals in Water, a New Module Integrated in the Pharmacy Game: Evaluating the Module’s Effects on Students’ Knowledge and Attitudes | Fens T. et al. | "In this study, we aim to evaluate the effects of the module on students’ knowledge of pharmaceutical residues in water, to describe students’ experiences in taking the module, and to explore their attitudes towards green pharmacy education in general. This mixed- methods study included quantitative measurements, before and after students took the module (intervention group) and in a control group which did not receive the module." | "29 students took the module and 36 students were in the control group. The knowledge score of students in the intervention group (N = 29) increased significantly from 9.3 to 12.9 out of 22 (p < 0.001). The knowledge score of the students in the control group was (8.9 out of 22). Students found the e-learning and the patient cases the most exciting part of this module. Students also recognized the need to including environmental issues in pharmacy education." | Fens T., Moermond C.T.A., van der Maas P., Dantuma-Wering C., Lestestuiver G.H., Szperl A., Schuiling L.C.M., Hak E., and Taxis K. “Reducing Pharmaceuticals in Water, a New Module Integrated in the Pharmacy Game: Evaluating the Module’s Effects on Students’ Knowledge and Attitudes.” Pharmacy 12, no. 1 (2024): 28. https://doi.org/10.3390/pharmacy12010028. | |||||||||||||||||||||
74 | Education | Pharmaceutical waste | Pharmaceuticals in the Environment: An Educational Perspective | Eissen M. and Backhaus D. | Nine worksheets were developed for students to teach on pharmaceuticals in the environment. Themes included emissions, wastewater, degradation, by-products and more. | "Tasks that were presented to students regarding the topic ‘pharmaceuticals in the environment’ contributed to a better understanding of the possible risks of medical care on an introductory level. The tasks have been incorporated into a logic series of worksheets (Online Resource) with sample solutions available. Alternatively, the material would be appropriate for the preparation of a corresponding lecture on this topic." | Eissen M. and Backhaus D. “Pharmaceuticals in the Environment: An Educational Perspective.” Environmental Science and Pollution Research 18, no. 9 (2011): 1555 EP – 1566. https://doi.org /10.1007/s11356-011-0512-6. | |||||||||||||||||||||
75 | Education | Pharmaceutical waste | A Cross-Sectional Study to Assess the Knowledge of Pharmacy Students About Drug Pollution in Spain | Abajo Z. et al. | A self-administered questionnaire with Likert scale was given to Spanish pharmacy students to assess their level of knowledge about drug pollution. | "Around 75% of students reported that they did not know “One Health” or “emerging pollutant” concepts and around 88% declared that they did not know that diclofenac caused a catastrophic vulture decline in Asia. The importance of this topic and their attitude to acquiring new knowledge was evaluated higher than 8 points out of 10, while received training during their studies was a score of 2.8 points out of 10" | Abajo Z., Domingo-Echaburu S., Evora C., Pereda J., Alvarez-Lorenzo C., Rabasco A.M., De la Casa-Resino I., et al. “A Cross-Sectional Study to Assess the Knowledge of Pharmacy Students About Drug Pollution in Spain.” American Journal of Pharmaceutical Education 88, no. 9 (2024): 101254. https://doi.org /10.1016/j.ajpe.2024.101254. | |||||||||||||||||||||
76 | Education | Education | Broad Spectrum Integration of Climate Change in Health Sciences Curricula | Ogunseitan O.A. | The study involved two half-day workshops held at the University of California, Irvine, aimed at integrating climate change into health sciences curricula. Twenty faculty members from various health disciplines participated, discussing sustainability concepts, curriculum integration models, and strategies for incorporating climate change topics into existing courses. A year later, a follow-up workshop assessed the implementation of these strategies and their effectiveness in modifying course content. | The integration of climate change topics into health sciences curricula was more successful when minimal disruption to existing course structures was achieved. Preferred methods included using longitudinal climate datasets for disease outcome analysis and discussing extreme weather events to highlight social vulnerabilities. Elective courses were more adaptable to these changes compared to required courses with fixed competencies. The study concludes that adopting interprofessional training models and developing standalone climate change courses can effectively prepare health professionals for the challenges posed by climate change. | Ogunseitan O.A. “Broad Spectrum Integration of Climate Change in Health Sciences Curricula.” Frontiers in Public Health 10, no. (Ogunseitan) Department of Population Health and Disease Prevention, University of California, Irvine, CA, United States (2022): 954025. https://doi.org/10.3389/fpubh.2022.954025. | |||||||||||||||||||||
77 | Education | Education | Students’ Conception of Local Responses to Global Problems for a More Peaceful and Sustainable World: A Collaborative Education Project between Brazil, Canada, Qatar, and New Zealand | Wilby K.J et al. | Phase 1 of this experiment conducted interviews from international pharmacists to identify global issues for case development. Phase 2 pilot testing developed cases from Phase 1 via individual interviews with target students in Canada and NZ. "Phase 3 consisted of implementation of a 1.5-hours teaching event in New Zealand using the refined case material and formative assessment of final-year pharmacy students " | "Phase 1 resulted in five case scenarios (antimicrobial resistance, drug shortages, ocean pollution, climate change, and rise of nationalism) across three categories (global health and wellbeing, climate and environment, and geopolitics and power) that were tested and refined in Phase 2. Phase 3 resulted in student groups being able to achieve the intended learning outcome on a median of 4 (range, 2-5) of the developed cases. Students' interventions included new dispensing models, use of technology, community engagement, education initiatives, and others." | Wilby K.J., Black E.K., Benetoli A., and Paravattil B. “Students’ Conception of Local Responses to Global Problems for a More Peaceful and Sustainable World: A Collaborative Education Project between Brazil, Canada, Qatar, and New Zealand.” JACCP Journal of the American College of Clinical Pharmacy 5, no. 6 (2022): 605 EP – 612. https://doi.org/10.1002/jac5.1608. | |||||||||||||||||||||
78 | Education | Education | A Scoping Review of Planetary Health Education in Pharmacy Curricula | Urslak R. et al. | Scoping review (methodology suitable for mapping key concepts within a research area and clarifying the working definitions and conceptual boundaries of a topic) | "review offers a framework for understanding the diverse perspectives and topics within this emerging field. It aims to support further discussions on developing prioritized competencies for inclusion in pharmacy curricula at local, national, and international levels" | Urslak R., Ladhar S., Gauthier G., Sajwani S., Kanji S., Pammett R., Domecq M.-C., and Landry C. “A Scoping Review of Planetary Health Education in Pharmacy Curricula.” American Journal of Pharmaceutical Education, no. (Urslak, Sajwani) Ottawa Hospital (2025): 101374. https://doi.org/10.1016/j.ajpe.2025.101374. | |||||||||||||||||||||
79 | Education | Education | Opinions about Climate Change, Health, and Pharmacy Education among Pharmacy Faculty and Administrators in the United States: A Cross- Sectional Survey | Speck C. L. et al. | "electronic survey was sent to faculty and administrators of U.S.-based, fully-accredited Doctor of Pharmacy programs (n = 139) in February 2024 collecting opinions and demographic information." | "need to increase knowledge and awareness among pharmacy educators regarding the connection between climate change, health, and pharmacy practice to prepare student pharmacists to protect public health" | Speck C.L., Newlove C.M., DiPietro Mager N.A., and Mager J.N. “Opinions about Climate Change, Health, and Pharmacy Education among Pharmacy Faculty and Administrators in the United States: A Cross- Sectional Survey.” Currents in Pharmacy Teaching and Learning 17, no. 3 (2025): 102251. https://doi.org/10.1016/j.cptl.2024.102251. | |||||||||||||||||||||
80 | Education | Education | Guidance for Pharmacy Curricula to Incorporate Health, Wellness, and Health Inequities Stemming From Climate Change: The Report of the 2022-2023 AACP Argus Commission | Scott S. A et al. | "Data for this report was gathered through a survey that was sent to deans of 156 MD-granting medical schools, data available from medical school websites, interviews with chief executive officers of 6 teaching hospitals and 9 medical school deans, and information from the Association of American Medical Colleges (AAMCs) Liaison Committee on Medical Part II survey and AAMC Curriculum Inventory" | "leaders in academic medicine, both at health systems and medical schools, are paying attention to the values of students, residents, and younger members of their workforce as they care deeply about climate change and seek to be associated with organizations that align with their values. Therefore, actions taken by health systems and medical schools can directly impact their ability to recruit and retain physicians and other health professionals." | Scott S.A., Allen D.D., Haines S.T., Lin A., Sorensen T.D., and Vermeulen L.C. “Guidance for Pharmacy Curricula to Incorporate Health, Wellness, and Health Inequities Stemming From Climate Change: The Report of the 2022-2023 AACP Argus Commission.” American Journal of Pharmaceutical Education 87, no. 12 (2023): 100612. https://doi.org/10.1016/j.ajpe.2023.100612. | |||||||||||||||||||||
81 | Education | Education | Embedding Pharmacy Practice, Veterinary Pharmacy, and Environmental Pharmacy to Implement ‘One Health’ in Pharmacy Education | Rajiah K. et al. | " By engaging accreditation bodies, regulatory authorities, and professional associations [via IPE, CBL and integration of existing courses], this objective ensures that One Health principles [human, environmental and animal health] are consistently incorporated across pharmacy programs." | "integration of One Health principles within pharmacy education addresses the interconnectedness of human, animal, and environmental health, equipping future pharmacists to handle complex health issues, including antimicrobial resistance and zoonotic diseases." | Rajiah K., Courtenay A., and Pinhey B. “Embedding Pharmacy Practice, Veterinary Pharmacy, and Environmental Pharmacy to Implement ‘One Health’ in Pharmacy Education.” Currents in Pharmacy Teaching and Learning 17, no. 5 (2025): 102320. https://doi.org/10.1016/j.cptl.2025.102320. | |||||||||||||||||||||
82 | Education | Education | Pharmacy Students’ Perceptions on Environmental Sustainability in Pharmacy Education and Practice. | Chen E.Y.H et al. | Participants completed an anonymous questionnaire to assess attitude, perceptions and curricular experience of environmentally sustainable practice. | "Of the 164 complete responses, 99% had previously received information on environmental sustainability. However, only 10% were knowledgeable about ESPP and only 8.5% were aware of ESPP content in their pharmacy school curriculum. Importantly, 70% of respondents saw ESPP as relevant to their future pharmacy practice, and 94% believed the pharmacy profession has a responsibility to undertake sustainability initiatives in the delivery of pharmaceutical care." | Chen E.Y.H., Forrester C., McEvoy A.M., and Singleton J. “Pharmacy Students’ Perceptions on Environmental Sustainability in Pharmacy Education and Practice.” Exploratory Research in Clinical and Social Pharmacy 12, no. (Chen) Centre for Health Economics, Monash University, Melbourne, Australia (2023): 100366. https://doi.org/10.1016/j.rcsop.2023.100366. | |||||||||||||||||||||
83 | Climate change mitigation | Social prescribing | Community Pharmacist Involvement in Social Prescribing for Mental Health: A Qualitative Study | Taylor D.A et al. | "set in a city in southwest England with diverse cultural and socio-demographics. We recruited SP stakeholders, including CP, to either one of 17 interviews or a focus group with nine members of the public." | "CP offer a potential alternative to the general practitioner for people with mild to moderate depression and anxiety seeking access to support and health information. However, CP need appropriately commissioned and funded involvement in SP, including backfill for ongoing dispensing, medicines optimization, and mental health first aid training." | Taylor D.A., Taylor A.D.J., Jones M., and Family H.E. “Community Pharmacist Involvement in Social Prescribing for Mental Health: A Qualitative Study.” Primary Health Care Research & Development 25, no. (Taylor, Taylor, Jones, Family) Department of Pharmacy and Pharmacology, University of Bath, Claverton Down, United Kingdom (2024): e69. https://doi.org/10.1017/S1463423624000409. | |||||||||||||||||||||
84 | Climate change mitigation | Social prescribing | Perceptions of Pharmacy Involvement in Social Prescribing Pathways in England, Scotland and Wales | Taylor D.A et al. | "cross-sectional electronic survey was developed using with question conceptualization arising from the findings of a previous social prescribing study by the authors. This previous study included an interview cohort of six community pharmacists and explored their perceptions of SP and the place and role of community pharmacy involvement." | "There is a willingness in the pharmacy profession to be involved in social prescribing, however further research is required to enable pharmacy to be full participants in social prescribing pathways." | Taylor D.A., Nicholls G.M., and Taylor A.D.J. “Perceptions of Pharmacy Involvement in Social Prescribing Pathways in England, Scotland and Wales.” Pharmacy 7, no. 1 (2019): 24. https://doi.org/10.3390 /pharmacy7010024. | |||||||||||||||||||||
85 | Climate change mitigation | Social prescribing | Community Pharmacists’ Possible Role in Social Prescribing for People with Poor Mental Health | Taylor D. | "study was set in a city in southwest England with diverse cultural and socio-demographics. We recruited social prescribing stakeholders, including community prescribers to either one of 17 interviews or a focus group with nine members of the public." | Concerns about pharmacy dispensing busyness as a potential barrier to involvement and pharmacists requesting mental health training updates. Community pharmacists should find alternate method of aid for anxiety and depression counselling. There is a need for appropriately commissioned and funded involvement in social prescribing such as backfill for ongoing dispensing, medicines optimization, and mental health first aid training. | Taylor D., Family H., Taylor A., and Jones M. “Community Pharmacists’ Possible Role in Social Prescribing for People with Poor Mental Health.” International Journal of Pharmacy Practice, Royal Pharmaceutical Society, RPS Winter Summit 2017. London United Kingdom., 25, no. Supplement 2 (2017): 6. https://doi.org/10.1111/ijpp.12416. | |||||||||||||||||||||
86 | Climate change mitigation | Social prescribing | Primary-Care- Based Social Prescribing for Mental Health: An Analysis of Financial and Environmental Sustainability | Maughan D.L. et al. | "An observational study was carried out to assess the impact of the service on the financial and environmental impacts of healthcare use. GP appointments, psychotropic medications and secondary-care referrals were measured." | "Demonstrate no statistical difference in the financial and carbon costs of healthcare use between groups. Social prescribing showed a trend towards reduced healthcare use, mainly due to a reduction in secondary-care referrals compared with controls. The associations found did not achieve significance due to the small sample size leading to a large degree of uncertainty regarding differences. This study demonstrates that these services are potentially able to pay for themselves through reducing future healthcare costs and are effective, low-carbon interventions, when compared with cognitive behavioral therapy or antidepressants."" | Maughan D.L., Patel A., Parveen T., Braithwaite I., Cook J., Lillywhite R., and Cooke M. “Primary-Care- Based Social Prescribing for Mental Health: An Analysis of Financial and Environmental Sustainability.” Primary Health Care Research & Development 17, no. 2 (2016): 114 EP – 121. https://doi.org/10.1017/S1463423615000328. | |||||||||||||||||||||
87 | Climate change mitigation | Social prescribing | Negotiating Complexity: Challenges to Implementing Community-Led Nature-Based Solutions in England Pre- and Post-COVID-19. | He Y. et al. | The authors combined a literature review with semi-structured interviews of 26 stakeholders from VCSE organizations, local authorities, the NHS, and funding bodies in England. Using purposive and snowball sampling, they explored barriers to community-led nature-based solutions (NbS), analyzing transcripts deductively against themes from the literature to develop an updated typology of challenges. | Eight main challenge categories emerged: perception, political, financial, access, engagement, organizational, coordination, and referral/service delivery. Most pre-dated COVID-19 but were intensified by it, with funding instability, damaged or overused green spaces, reduced engagement, staff shortages, and disrupted cross-sector coordination all worsening. The study concludes that systemic barriers, amplified by the pandemic, limit NbS potential without stronger policy support, sustainable funding, and improved healthcare linkages. | He Y., Jorgensen A., Sun Q., Corcoran A., and Alfaro-Simmonds M.J. “Negotiating Complexity: Challenges to Implementing Community-Led Nature-Based Solutions in England Pre- and Post-COVID-19.” International Journal of Environmental Research and Public Health 19, no. 22 (2022): 14906. https://doi.org/10.3390/ijerph192214906. | |||||||||||||||||||||
88 | Climate change mitigation | Social prescribing | Nature-Based Social Prescribing Programmes: Opportunities, Challenges, and Facilitators for Implementation | de Bell S. et al. | Case study based on workshop of 29 practitioners, researchers and policymakers in the UK and Germany regarding nature-based social prescribing. | "We identified five overarching themes for developing, implementing, and evaluating Nature Based Social Prescribing (NBSP): Capacity Building; Accessibility and Acceptability; Networks and Collaborations; Standardised Implementation and Evaluation; and Sustainability. We also discuss key strengths, weaknesses, opportunities, and threats for each overarching theme to understand how they could be developed to support NBSP implementation." | de Bell S., Alejandre J.C., Menzel C., Sousa-Silva R., Straka T.M., Berzborn S., Burck-Gemassmer M., et al. “Nature-Based Social Prescribing Programmes: Opportunities, Challenges, and Facilitators for Implementation.” medRxiv, no. (de Bell) Exeter HSDR Evidence Synthesis Centre, University of Exeter, 79 Heavitree Rd, Exeter, United Kingdom (2023). https://doi.org/10.1101/2023.11.27.23299057. | |||||||||||||||||||||
89 | Pollution and waste | Pharmaceutical waste | Intravenous Compounding Robots in Pharmacy Intravenous Admixture Services: A Systematic Review | Yang C. et al. | " Comprehensive search of relevant professional health technology assessment websites and electronic databases was conducted from inception to February 3, 2022. Current studies related to intravenous compounding robots were included in this systematic review. Two reviewers independently screened the literature, extracted data, and assessed quality. The results were reported by qualitative description because of heterogeneity in the characteristics of the data in the included studies." | the robots were more efficient in preparation, reduced product pollution and environmental pollution and finally, robots reduced material costs in these studies; however, whether they can reduce labor costs remains unclear. | Yang C., Ni X., Zhang L., and Peng L. “Intravenous Compounding Robots in Pharmacy Intravenous Admixture Services: A Systematic Review.” Medicine (United States) 102, no. 19 (2023): E33476. https://doi.org/10.1097/MD.0000000000033476. | |||||||||||||||||||||
90 | Pollution and waste | Pharmaceutical waste | Cost Reduction as a Result of Bortezomib Vial Sharing in the University Hospital Center ‘Mother Theresa’ Tiran | Rustemi F. et al. | "Retrospective analysis of the use of bortezomib in patients with multiple myeloma in the Hematology Department of the University Hospital Center ‘Mother Theresa’ Tirana, using vial sharing technique to minimise wastage, with focus on cost saving" | "Vial sharing of bortezomib between patients combining multiple infusions on the same day has improved patient experience by increasing access to therapy and reducing waiting times for treatment [...] Decreasing waste is an attractive cost-cutting strategy because it neither limits specific drug use nor affects quality of care " | Rustemi F., Malaj L., Hoti E., and Balla E. “Cost Reduction as a Result of Bortezomib Vial Sharing in the University Hospital Center ‘Mother Theresa’ Tirana.” European Journal of Hospital Pharmacy 26, no. 4 (2019): 237 EP – 238. https://doi.org/10.1136/ejhpharm-2018-001676. | |||||||||||||||||||||
91 | Climate change mitigation | Pharmacy practice | Sustainability Challenges Concerning the Effects of High-Priced Drugs on the Day-to-Day Operations of Community Pharmacies in Finland | Rosenberg S. et al. | "National cross-sectional online survey [...] the study focused on the qualitative data which was analysed by deductive thematic analysis." | Proprietary pharmacists view real-time reimbursement, further pharmacy tax reforms, and the removal of return bans to wholesalers as key measures to reduce risk and enhance sustainability in handling high-priced drugs. They believe these changes would help prevent medical waste and reduce staff stress, thereby improving pharmacy operations and working conditions. | Rosenberg S., Sodergard B., Rosenholm J., and Rauha J.-P. “Sustainability Challenges Concerning the Effects of High-Priced Drugs on the Day-to-Day Operations of Community Pharmacies in Finland.” European Journal of Pharmaceutical Sciences 199, no. (Rosenberg, Sodergard, Rosenholm) Pharmaceutical Sciences Laboratory, Faculty of Science and Engineering, Abo Akademi University, Turku, Finland (2024): 106816. https://doi.org/10.1016/j.ejps.2024.106816. | |||||||||||||||||||||
92 | Pollution and waste | Pharmaceutical waste | Use of an Automated Compounding Device to Extend beyond Use Dating of Pharmaceuticals from Single-Dose Vials | Forrey R. at al. | "The objective of this study was to determine if automated compounding technology could decrease waste of medications while maintaining compliance with USP 797.Two outpatient pharmacies were selected to participate based on volume and specific pharmaceuticals commonly used. Four drugs were studied: rituximab, cetuximab, gemcitabine, and oxaliplatin. Over 7 weeks from April to May 2009, the Gri-fill System 3.0 (Grifols, USA) automated compounding device was used to save the remaining drug from the selected SDVs after 6 h of use. Technicians recorded volume saved from each vial." | "The annualized savings for the limited subset of drugs and sites was $111,532, or approximately 10% of the total waste estimated in the 2008 study. The average savings per vial was: $233.20 for rituximab, $255.55 for cetuximab, $211.50 for gemcitabine, and $535.90 for oxaliplatin" | Forrey R., Harms D., and Day-VanLone D. “Use of an Automated Compounding Device to Extend beyond Use Dating of Pharmaceuticals from Single-Dose Vials.” Journal of Oncology Pharmacy Practice, Hematology Oncology Pharmacy Association Annual Meeting, HOPA 2010. New Orleans, LA United States., 16, no. 1 SUPPL. 1 (2010): 14. https://doi.org/10.1177/1078155209356733. | |||||||||||||||||||||
93 | Climate change mitigation | Pharmacy practice | Carbon Footprint of a Chemotherapy Production Unit within a Hospital Pharmacy: Time for Green Pharmacy | Chabane M. et al. | A retrospective study was completed to identify the main sources of GHG emissions from a chemotherapy producing unit (CPU). This CPU produced more than 51,000 preparations per year. Global warming impact was determined for medicines, single-use material, energy of devices, transportation and waste. | "The carbon footprint of the chemotherapy producing unit was equal to 18’230.7 tons of CO2eq. Antineoplastic drugs accounted for more than 18’179 tons of CO2eq emissions. Excluding the medication part, it was equal to 51.7 tons of CO2eq. More precisely the distribution of CO2eq emission sources were staff transportation (35.9%), waste (21.1%), single-use sterile medical devices (18.1%), energy consumption (9.3%), disposable personal protective equipment (8.5%), and solvent bags and bottles (7.1%)" | Chabane M., Fagnoni-Legat C., Hosotte C., Jehl-Rave M., Barbier G., Bonnot-Perrin S., Sadeghipour F., Carrez L., Limat S., and Kroemer M. “Carbon Footprint of a Chemotherapy Production Unit within a Hospital Pharmacy: Time for Green Pharmacy.” Journal of Oncology Pharmacy Practice : Official Publication of the International Society of Oncology Pharmacy Practitioners, no. (Chabane, Fagnoni- Legat, Jehl-Rave, Barbier, Bonnot-Perrin, Sadeghipour, Limat, Kroemer) CHU Besancon, service pharmacie, France (2025): 10781552251318313. https://doi.org/10.1177/10781552251318313. | |||||||||||||||||||||
94 | Climate change mitigation | Pharmacy practice | Eco-Sustainability in Hospital Pharmacy: A Pilot Survey on ‘Going Green | Blanc A. et al. | "In a quality improvement initiative, pharmacy employees (i.e. pharmacists and pharmacy technicians) completed a cross-sectional survey designed to gauge willingness to ‘go green’ at work, to identify actionable areas of waste, and to assess commuting practices." | "A total of 15 respondents completed the survey conducted March 14th –April 7th, 2022. Most respondents (73%) were willing to engage in more sustainable practices at work. The main barriers to implementing green practices at work were ‘too time consuming’ (20%), ‘adds too much complexity’ (20%), and ‘cost’ (16%). For commuting, 60% indicated the primary mode of transportation as ‘personal vehicle’, where ‘subsidized transit’ and was listed as the greatest incentive that could encourage a greener commute. The three largest areas of waste cited were ‘single use plastic’ (36%), ‘limited of awareness of green practices’ (15%), and ‘lights left on in empty rooms’ (12%)" | Blanc A., Moulin D., and Cameron J. “Eco-Sustainability in Hospital Pharmacy: A Pilot Survey on ‘Going Green.’” Journal of Pharmacy Practice, no. (Blanc, Moulin, Cameron) Department of Pharmacy, Children’s Hospital of Eastern Ontario-Ottawa Children’s Treatment Centre (CHEO), Ottawa, ON, Canada (2024). https://doi.org/10.1177/08971900241295285. | |||||||||||||||||||||
95 | Climate change mitigation | Pharmacy practice | Eco-Friendly Pharmacy Practices to Support a Sustainable Green Transition in Hospital Pharmacy. | Blanc A. et al. | CSHP Excellence in Pharmacy Practice - Leadership Award Winner (2023). A survey and interviews of interdisciplinary stakeholders regarding pharmacy operations. | "The internal survey showed the main barriers to implementing green practices in hospital pharmacy were cost, complexity, and time, and that the three largest areas of waste were single use plastic, lack of awareness of green practices, and lights left on. The external survey showed that 94% of respondents had implemented fewer than 3 green practices in their workplace, with 64% implemented >2 years ago. Twenty-eight percent indicated these initiatives saved money, 26% had considered implementing eco-practices, and for 30% unevaluated programs was the main challenge. Seven pillars were identified as key for sustainability with implementing at least 3 for “green labelling”." | 2023 CSHP National Awards Program Winners. Can J Hosp Pharm. 2023;76(2):142-143. Published 2023 Mar 1. doi:10.4212/cjhp.3455 | |||||||||||||||||||||
96 | Climate change mitigation | Pharmaceutical waste | What Are the Root Causes of Returned Medicines in Hospital Pharmacy?’ A Lean Approach. | Pham R. et al. | "The study was conducted on the ‘Respiratory & Oncology’ ward and focused on all medicines returned in relation to 31 patients who had been admitted to the unit for a period of 5 weeks. Currently, one out of four medicines supplied to the ‘Respiratory & Oncology’ ward is not administered to the patient and is returned to the pharmacy. Cause analysis was conducted retrospectively and according to a lean approach. It is a structured process used to improve process cycle time through the identification, reduction and elimination of process waste and non-value-added activities. First, The authors determined for each medicine returned to the pharmacy the step of the medication use process where the problem originated: the prescription, dispensing by the pharmacy, picking operation by nurses, administration to the patients and management" | "1754 returned medicines were analysed. The three main root causes of returned medicines were: a discharge date not recorded in the CPOE system (22.86%), inappropriate use of electronic prescribing (10.15%), late capture of a known discharge date (7.98%)." | Pham R., Bary M., Garcous R., Remy G., Spinewine A., and Hecq J.D. “‘What Are the Root Causes of Returned Medicines in Hospital Pharmacy?’ A Lean Approach.” European Journal of Hospital Pharmacy: Science and Practice, 2012 European Association of Hospital Pharmacists, EAHP Congress. Milan Italy., 19, no. 2 (2012): 166. https://doi.org/10.1136/ejhpharm-2012-000074.214. | |||||||||||||||||||||
97 | Climate change mitigation | Inhalers | The Environmental Impact of Inhalers: A Framework for Sustainable Prescription Practices in Spain | Garin N. et al. | Pharmacists, pulmonologists and environmental experts created a database on the environmental impact of inhalers marketed in Spain. This was used to develop a decision-making algorithm to estimate benefits from transitioning from a pressurized metered dose inhaler to a dry powder inhaler. | "The national database revealed significant variability in the carbon footprint across inhaler types, with pMDIs showing the highest emissions. A shift of 10% from pMDIs to DPIs could reduce CO2 emissions by approximately 40 000 tonnes/year, and a 50% shift by up to 200 000 tonnes. The decision-making algorithm effectively combined clinical and environmental considerations, facilitating the selection of more sustainable inhalers" | Burch H., Brown G., Adler O., Wong J., and Winkel K.D. “Accountability, Ambition, and Quantifiable Action in the Carbon Emission Reduction Plans of the Ten Largest Pharmaceutical Companies in Australia: A Cross-Sectional Analysis.” Medical Journal of Australia, no. (Burch, Adler) Melbourne Medical School, the University of Melbourne, Melbourne, VIC, Australia (2025). https://doi.org /10.5694/mja2.52621 | |||||||||||||||||||||
98 | Climate change mitigation | Pharmacy practice | Getting to Green: How’s Pharmacy Doing? | Wick J. Y | Commentary on the minimization of pharmacy's environmental footprint through a life cycle perspective from the industry to the patient. | "Ultimately, we need to encourage reduced pharmaceutical use—common sense approaches like using prevention rather than treatment.Ultimately, the solution to sustainability will require all of us to incorporate environmental awareness into our daily practices." | Wick J.Y. “Getting to Green: How’s Pharmacy Doing?” Pharmacy Times 79, no. 11 (2013). http://www.pharmacytimes.com/publications/issue/2013/November2013/Getting-to-Green-Hows-Pharmacy-Doing. | |||||||||||||||||||||
99 | Climate change mitigation | Pharmacy practice | Development of a Hospital Pharmacy Environmental Sustainability Audit Tool | Tangedal K. and Roy C. | "pharmacy environmental audit tool was developed by modifying a generic workplace audit tool to include pharmacy-specific content. The audit tool contained 22 categories, with scoring on a 4-point scale (from 0 to 3).The lowest-scoring categories were then prioritized for action." | "Areas of strength identified in the audit included reuse of packaging materials, carpooling, and paperless meetings. Areas for improvement prioritized by the committee included paper use, plastic use, and recycling" | Tangedal K. and Roy C. “Development of a Hospital Pharmacy Environmental Sustainability Audit Tool.” Canadian Journal of Hospital Pharmacy, CSHP Professional Practice Conference 2024. Virtual., 77, no. 2 (2024): 5 EP – 6. https://doi.org/10.4212/cjhp.3607. | |||||||||||||||||||||
100 | Climate change mitigation | Pharmacy practice | Waiter, There Is a Drug in My Soup - Using Leximancer to Explore Antecedents to pro-Environmental Behaviours in the Hospital Pharmacy Workplace. | Singleton J. A. et al. | " Purposive sampling techniques were used to recruit 64 hospital pharmacists and pharmacy technicians working in five public and private hospitals [...] Qualitative data were analysed using both the text analytics using descriptive statistics." | "pharmacists and pharmacy technicians require environmental information regarding the negative impacts of pharmaceuticals on the environment, and education on systems thinking to enable them to understand that any negative impacts on the environment will ultimately have negative impacts on human health" | Singleton J.A., Lau E.T.L., and Nissen L.M. “Waiter, There Is a Drug in My Soup - Using Leximancer to Explore Antecedents to pro-Environmental Behaviours in the Hospital Pharmacy Workplace.” International Journal of Pharmacy Practice 26, no. 4 (2018): 341 EP – 350. https://doi.org/10.1111/ijpp.12395. |