Sustainable for patients,
Sustainable for health systems,
Sustainable for the planet.
The current health care system is over-prescribing medications. Studies suggest we over-prescribe some drug classes by 20-30%.
Prescribing practices can be influenced by various factors. However, overprescribing can occur as a result of not providing better alternatives, generalization of the use of the medicine for all patients with the condition, not recognizing condition changes, the patient no longer needing the medicine. There are potential harms to these medications, which need to be addressed and led to the formation of the Institute for Safe Medication Practices Canada.
The financial cost of prescribed drug spending can be found in this Canadian Institute for Health Information document. (See page 6)
“Public drug program spending accounted for 43.6% of the $34.3 billion of prescribed drug spending in 2019, as reported in CIHI’s National Health Expenditure Trends, 1975 to 2019. The public share of prescribed drug spending varied among provinces, ranging from 31.7% in New Brunswick and 34.0% in Newfoundland and Labrador to 47.4% in Manitoba and 48.6% in Saskatchewan. Outside of the public sector, prescribed drug spending financed by private insurers was $12.7 billion (36.9%), with the remaining $6.8 billion (19.9%) financed by Canadian households.1 Public drug program spending does not include spending on drugs dispensed in hospitals or on those funded outside public drug programs (e.g., through cancer agencies).”
These costs have increased since 2019 and these numbers do not include over-the -counter medications. The money spent on over-prescribed medications could be moved to other areas of a strained Canadian health system.
Deprescribing and finding alternatives would improve human health, reduce health care spending, and reduce greenhouse gas emissions.
Learn with us!
The production of medications contributes 48% of the greenhouse gases within a Primary Healthcare office. The emissions from metered dose inhalers add another 13%. If an office could decrease medications by 10%, it would be as much as the Building Energy and Water and Waste GHGs combined! The waste from medications results in further harms to the environment.
The data shown above was extracted from The Lancet 2021 Tennison et al. article and translated to percentages.
If we follow appropriate prescribing guidelines, especially for the elderly, we can decrease medications by well over 5%. This would save a 200-bed hospital in Canada over 100 Tonnes of CO2 equivalents, and over $200,000 per year.
Our low-hanging fruit tree illustrates the amount of CO2 saved with various environmental initiatives. In terms of cost and environmental impact, deprescribing is one of the best fruits to pick. Read the full article HERE.
We also need to demand that medications are produced with their carbon footprint in mind. We need to support companies which are working hard to make greener products. We should be able to make choices about medications based, in part, on a climate-score.
The environmental side effects of medications: Reducing the carbon footprint of psychiatry.
We will be adding rating systems for suppliers to our website very soon. We cannot rate individual products yet because we do not know the life cycle analysis for all the things we buy. We can, however, rate the companies which make the products.
Our Projects
The Canadian Coalition for Green Health Care's Sustainable Prescribing working group created an infographic with several like-minded organisations which outlines the options of the green prescriber. View the infographic HERE.
This Medication Optimization Playbook, developed in partnership between the Canadian Coalition for Green Health Care and CASCADES, offers strategies to reduce the environmental impact of polypharmacy through medication optimization in inpatient settings.
This patient-centered approach enhances the effectiveness, safety, and adherence of medication regimens, reducing harm to patients, health systems, and the environment. Aimed at Canadian health care providers, the playbook provides background information, resources, and guidance for implementing these practices, contributing to more sustainable health care delivery.
The lead authors include three registered pharmacists, Ivy Lam, Sarah Fallis, and Lisa McCarthy, and family physician Myles Sergeant.
Read the Playbook HERE.
Purpose and Scope
The Sustainable Prescribing Working Group was established in fall 2022 by the Canadian Coalition for Green Health Care with the aim to transform Canadian health care prescribing practices with a shared vision of a resilient and environmentally sustainable health care system.
This Working Group acts as a catalyst for joint action of provincial and national deprescribing/medication optimization/ appropriate prescribing groups, to communicate the environmental benefits of sustainable prescribing to prescribers.
Priorities
- To support each other in promoting the environmental benefits of appropriate prescribing
- To support each other in promoting the integration of environmental considerations as part of appropriate prescribing
- To support each other in promoting clinically and environmentally sound prescribing
- To unite around the cause of sustainable prescribing
- To help each other with consistent and aligned messaging on various communication platforms and strategies
- To share resources and explore opportunities to collaborate, in terms of education, quality improvement initiatives and research
- To engage relevant stakeholders in sustainable prescribing efforts
We are welcoming new members at any time. If you are interested in joining, please contact us at autumn@greenhealthcare.ca.
Resources
- Medicine Carbon Footprint Formulary
- Canadian Association of Pharmacy for the Environment
- Institute for Safe Medication Practices Canada
- Deprescribing.org
- Deprescribing.org: Long Term Care framework
- Canadian Medication Appropriateness and Deprescribing Network (CADeN): Outpatients or inpatients
- Choosing Wisely Canada: Hospital pharmacists
- Choosing Wisely Canada: Recommendations by specialty
- Climate Resilient, Low Carbon Sustainable Pharmacy Playbook
- Diverse Conversations Podcast Episode: "Sustainability in Healthcare: Dr. Myles Sergeant & Dr. Danette Beechinor (CCGHC)"
Webinars
Climate Change and Pharmacy: A Place for Everyone
On April 23rd, 2024 CCGHC, PEACH, and CAPhE welcomed pharmacy professionals and students from across Canada to discuss their experience tackling climate change and environmental sustainability in the sector.
Learning objectives:
- Identify the various opportunities for tackling sustainability practices change within hospital settings.
- Discuss challenges and potential barriers to implementing sustainable health care practices.
- Understand the perspective of pharmacy students on the integration of climate change and environmental sustainability into pharmacy education.
- Discuss opportunities within the health care settings to reduce environmental impact of medications (example MDI reduction project in primary care).
- Critically evaluate the role of social prescribing in enhancing holistic health care approaches and advocate for its adoption in health care settings.
Watch the webinar recording HERE.
Pharmaceuticals in the Environment: Impacts on non-target organisms
On March 28th, 2023 the Canadian Coalition for Green Health Care, PEACH Health Ontario, and CASCADES welcomed pharmacist Gigi Wong to present on the topic of pharmaceuticals in the environment.
In this one-hour session Gigi describes how pharmaceuticals enter the environment; the environmental classification for pharmaceuticals and the properties of persistence, bioaccumulation and toxicity; as well as provides an example of wildlife that has been negatively impacted by the use of pharmaceuticals.
Watch the recording HERE.
Hospital Pharmacies and the Climate Crisis
On October 26th, 2022 at 8pm ET Canadian Coalition for Green Health Care, PEACH Health Ontario, and CASCADES partnered to welcome Dr. Shellyza Moledina Sajwani, for an overview of climate change's relevance to pharmacy. She specifically focuses on tangible objectives that can be completed within a hospital pharmacy setting, using the example of the Ottawa Hospital Pharmacy Environmental Stewardship Committee.
Watch the recording HERE.