Event report

The objective of the event was to draw together persons (n=48) from different backgrounds and age groups (including CEOs, accountants, waste management officers, health and safety officers from pharmaceutical companies/services, pharmaceutical waste companies, hospitals, genetic research institutions, government and EC representatives, and University management, pharmacology lecturers and students) to discuss the issue of pharmaceutical waste and its place in a climate neutral Europe. The idea behind the event was to address the various issues and solutions from different perspectives to get a clearer picture of the overall issue. Pharmaceutical waste in industry and consumers is a serious one and directly related to the goal for creating a climate neutral Europe by 2050. The event was participatory, which followed the method "World Café" to give participants the opportunity to express their views by recording the conclusions of the discussion. To set the stage for discussion the event had short presentations from keynote speakers, Nikos Isaris, Deputy Head of the European Commission Delegation to Cyprus and Athena Papanastasiou, Department of Environment, Ministry of Agriculture, Rural Development and Environment (Cyprus) to give the viewpoint of the EC and Cyprus government on the issue. During the World Cafe element and to give a basis for discussions, all participants were given three questions relating to the topic of the event: • Question 1: What are the consequences of pharmaceutical waste disposal in the environment? • Question 2: Give ways / solutions that can help reduce pharmaceutical waste? • Question 3: What are the possible problems we would face when implementing these solutions? All ideas and opinions harvested for the World café were used to direct discussions during deliberations with an expert panel. Key outcomes from discussions Consequences of pharmaceutical waste disposal in the environment The majority of the responses focused on three main areas: • On how poor waste treatment (gaseous / liquid pollutants) impacts the environment, in terms of air, land and water pollution. Responses specifically focused on microbial resistance, marine life, infection of animal tissues and cultures, extinction of insects vital for the ecosystem. • Secondary impacts, such as, risk of toxicity due to consumption of harmful residues of drugs that reach back to humans through the food chain, development of human diseases, especially in reproductive system-hormones; unpredictable consequences in humans (low birth rate / autoimmune diseases / cancer); interaction with other treatments that a person may receive. • Practical issues, such as, incorrect disposal of medicines and the packaging of pharmaceutical drugs (blisters, paper bags, glass bottles of medicines end up in the environment through waste while they could be recycled) Solutions for reducing pharmaceutical waste The discussions led to six main categories for solutions: • Education – the general consensus was that everyone needs to be re-educated, including industry, consumers and health professionals, public and those in all levels of formal education (including instructors/educators). Education/training programmes should focus on: o Rational use of drugs o Dangers arising from excessive inappropriate disposal of medicines o Sensible prescribing practises for health professionals o Raising public awareness to avoid unnecessary prescription of drugs • Work practices o Pharmaceutical companies to implement ‘green practices/chemistry’ when producing drugs o Redesign the method of synthesis and production of drugs o Modify the preparation of medicines in such a way that the degradation of medicines results in minimal harmful effect on the environment o The EU, through its cooperation with third countries, seeks to influence them to comply with European principles and standards so that they too can be upgraded. • Supply & Demand o Multinational Companies require users to purchase a minimum quantity, which in most instances exceeds the level that is required • Use of Medicines o Reduction of overconsumption by consumers o Proper use of medicines, e.g. adding a QR code on medicine packaging so the public has access to the information in a user-friendly format o Integration of a prevention culture to reduce the use of drugs o Proper management of medicines that have passed expiry date • Waste/pollution control o Treatment of waste before disposal by, for example, sedimentation o Use of HEPA filters for gaseous waste o Proper collection / sorting of pharmaceutical waste o Pharmaceutical waste to be transported to licensed waste management companies o Improvement of urban and industrial wastewater treatment methods o Better management of normal secretions o Facilitate correct methods of waste management by providing incentives, e.g. financial benefit or disincentives (financial fines) • Legislation o Adapt current/create EU and national legal framework governing the quantities ordered by resellers/distributors to ensure production does not exceed demand o Abolish minimum quantity purchasing levels o Legislation to enforce both companies and consumers to appropriately dispose pharmaceutical waste, e.g. provision of drug collection points and incentives for consumers Potential problems arising from the implementation of suggested solutions In accordance with European Directives, businesses are required to change work practices and processes. Throughout discussions, three main barriers arose. • Financial burden – a concern raised by the majority of the participants o The cost of new technologies and the application of Green Chemistry is high because the raw materials and the process of creating medicines will have to be redesigned o Changing work-practices in the production of medicines would be a costly endeavour and, therefore, will lead to an increase in the price of medicines o Difficulty in implementing innovative management technologies due to unsustainable costs • Lack of facilities and support o Provision of raw materials – Currently, the majority of raw materials come from China and India because it is not profitable to be produced in Cyprus. To alleviate this problem provision of “Clean technology” incentives will, in turn, reduce the cost of producing raw materials in Cyprus-EU o Large waste generation is difficult to manage due to lack of appropriate technologies and infrastructure o Proposed solutions will increase the workload for pharmacists and for companies undertaking the collection of expired drugs o Lack of compliance by the public; requires motivation in the form of incentives and legislation enforcing greener practices o Close cooperation is required by industry and universities to find solutions to the various problems faced by industry e.g. ozonation.  Industry-funded research for universities would be beneficial for both  Work-experience for students in industry to see practical applications and real-problems in the field of pharmaceutical waste o Decision-making, it was felt that issues would be dealt with more appropriately if it included people from different specialties, e.g. scientist, environmentalists • Culture o Non-compliance of the public, health professionals and the pharmaceutical industry with the legal provisions o Inadequate education o Resistance and lack of acceptance of pharmaceutical waste management by the public and companies due to self-interests o Lack of awareness of health professionals regarding the implementation / observance of legislation as well as correct environmental behaviour o Insufficient commitment of the state in solving the problem At the end of the event many positive comments were expressed by the participants with some stating that the type of event and its activities not only gave the participants a pleasant experience but also strengthened their belief that their views were positively evaluated and taken seriously. They felt that the event also enabled them to gain/exchange knowledge and experiences, which they can take with them and implement them in their work/practices. After the event a report, outlining the outcomes harvested from all the discussions, was sent to all participants for their reference. Many expressed the wish to participate in similar future events.