Is waste an ethical issue?Andi Shirtcliffe - Clinical Advisory Pharmacist, Wellington

Prof John Campbell - Dunedin School of Medicine, University of Otago

Assoc. Prof. Paul Hansen - Dept. of Economics, University of Otago

Is waste an ethical issue?Andi Shirtcliffe

YEAH.

RIGHT…

WASTE IS AN ETHICAL ISSUE

Andi Shirtcliffe

Global figures NZ numbers A few examples Environmental stuff Why it happens

and then I’m gonna get personal!

GUIDED TOUR

Billions globally USA $53 million per annum (oral meds only) UK £30 – 90 million per annum

WASTE NOT WANT NOT

~25% collect all their repeats >60% had leftover prescription medicines

Case 1: returned over 70 different medicines Case 2: return included…

1557 paracetamol/codeine tablets 1198 paracetamol tablets 468 doxepin capsules 362 warfarin tablets

NEW ZEALAND

Best Practice 23, September 2009

One individual Four waste sacks full of unused medicines Contained:73 x 10ml eye drops432 temazepam34 tubes of Dermovate® ointment4600 glyceryl trinitrate sublingual tablets+ more

Total value >£800

UK EXAMPLE

NZFP 2007; 34: 258-262

Waste downstream from sewage treatment plants

Leaching into land fill sites/entering groundwater

Effect on wildlife…Diclofenac induced renal failure in vultures!Reproductive failure in fish

ENVIRONMENTAL ISSUE?

The Pharmaceutical Journal (vol 272), 2004. Journal of Primary Health Care Vol3(3) 2011

Quantity too large on ‘prn’ prescriptions Prescriber temptation to give the patient a ‘good deal’ Patient feels they have a right to the medicine Patient not wishing to offend….or be honest

IN SHORT – FOR A NUMBER OF REASONS THERE ARE A WHOLE BUNCH OF PEOPLE NOT TAKING THEIR MEDS!

WHY WASTE?

50% discontinue their medicines within a few months 21% nonadherent after four days?

COMPLIANCE/ADHERENCE/CONCORDANCE

Make the health and well-being of the patient your first priorityPromote patient self-determination, respect patients’ rights,

autonomy and freedom of choiceUse your professional judgement in the interests of patients and

the public and promote family, whanau and community healthShow respect for others and exercise your duties with

professionalismActively seek and apply contemporary pharmacy knowledge and

skills to ensure a high standard of professional competenceAct in a manner that promotes public trust and confidence in

pharmacists and enhances the reputation of the professionPractice in a manner that does not compromise your professional

independence, judgement or integrity, or that of other professionals

PHARMACIST CODE OF ETHICS