Topic

Empty pharmaceutical blister packs

Sarah Cooke
Sarah Cooke • 5 July 2023
19 comments

Hi All,

Recently our environmental audit team have come up with a change of procedure and have suggested that all empty plastic/foil blister packs, should be disposed of in the blue sharps bins, not via household waste. It is reported that the reasoning is to limit environmental contamination with pharmaceutical residues.

Is anyone aware of any analysis of the likelihood of environmental contamination from empty blister packs, including the residues vs the impact of incineration. Clearly incineration is more costly than general waste disposal.

Thanks in advance!

Sarah

Comments (19)

Clare Topping
Clare Topping • 1 year ago

Hi, it depends whether the tablet is encapsulated or not. In most cases we usually go with consignment to the blue waste stream because, if questioned, we cannot say for certain that there is no likelihood of the tablets that have been in the blister pack having been able to contaminate the packaging. It is part of HTM07-01 and I agree the risk is very low. I am not sure how Superdrug square this with the Environment Agency.

James Warham
James Warham • 1 year ago

I should add on a domestic level, all my own blister packs I give to my local terracycle rep
As we network with her as part of the local Transition Towns charity

Nuala Hampson
Nuala Hampson • 1 year ago

Sarah, is this in a hospital setting? I don't know the answer but as you say the risk seems very low and the overall impact of incineration quite significant! I'm not sure if any work has been done on this - more commonly the issue raised on medicines blisters is whether they can be recycled. As already mentioned, Superdrug do this on a limited level, as do Terracycle and MyGroup so may be worth contacting them to see what data they have. The One Health Partnership in Scotland is doing a lot of work on pharmaceutical pollution and may have data on this. Sharon Pfleger is a key contact there https://ohbp.org/contact/ohbp-about-us/sharon-pfleger/
Might be worth posting this on the CSH pharmacy network also. Will be interested to hear what you find.

Sarah Cooke
Sarah Cooke • 1 year ago

Thanks Nuala. This is really useful. Indeed it is in the hospital setting, so volumes currently too high for Terracycle etc I'd guess - triple site trust too!
I will keep everyone posted with the progress.
Hope you're keeping well.
Sarah

Clare Atkinson
Clare Atkinson • 1 year ago

There is a large research initiative underway to recover blister packs, inhalers and insulin pens. Placing these items into a sharps bin will have a huge impact on carbon emissions and cost. The EA has accepted that blister packs should not hold pharma contamination therefore the opportunity to recover these through dry mixed recycling is a great one. I would suggest this seems at first look a good idea but actually isn't necessary and is certainly going to increase your scope 3 emissions. I would be happy to talk this through with more detail/ evidence. Clare

Simon Lenton
Simon Lenton • 1 year ago

my understanding is that only Terracycle in the UK have the capacity to recycle blister packs. They have limited capacity so the service is not widely known about. Pharmaceuticals is one of the largest NHS footprints (about 9%) pharma wastage is considerable often due to non-compliance. Would it be possible to redesign drug distribution to increase compliance, reduce waste (incl cardboard and packaging) release pharmacist time to take on health advice, screening and limited prescribing? (think Circular Economy here) If youre interested lets start a discussion here..........first thoughts attached

Ideas to green the pharma industry.docx50.8 KBdocument
Rumina Önaç
Rumina Önaç • 1 year ago

I’m definitely interested in pursuing a redesign of packaging!
My lone attempts to engage Pharma over 4 yrs on this topic have not been successful and I believe as a larger body of professional voices we’re much more likely to be persuasive. Are you planning on sending this doc as an open letter with as many sigs as you can to Pharma, and then send it to the BMJ or BJpharm or something like that Simon?? Could get 100s if we send round Greener Practice network??
York’s funded empty-blister-pack project (MyGroup) will cease in a few months and i feel strongly it’s not the NHS’s or local council’s responsibility to fund disposal of waste produced deliberately and knowingly by other companies. The ongoing obfuscation of producer responsibility here with greenwashing is really unethical. Pharma really should pay for correct disposal (preferably recycling) now, whilst also rapidly developing better more sustainable reusable packaging. Recycling is not the answer longterm.
🙂Rumina.onac@nhs.net

James Warham
James Warham • 1 year ago

I would suggest contacting Terracycle. They are always looking to partner/ help.
https://www.terracycle.com/en-GB/about-terracycle/partner_with_us
They already work with recycling PPE for instance.
Simon, the Smart Dossette box already exists, I like the circular economy thinking.
Can I share your document?

https://livingmadeeasy.org.uk/category/health-and-personal-care/persona…

On a more immediate note, would it be more feasible to get individual departments on board, or even encourage interested patients to be aware
#bethechange

Simon Lenton
Simon Lenton • 1 year ago

James, glad to hear smart dosette boxes exist. yes pl share ideas. In the short term including blister pack recycling in pharmacy contracts would be good. I like the RethinkX approach - it often takes a number of ideas to come together to transform the way we do things.

Nuala Hampson
Nuala Hampson • 1 year ago

Increasing the use of dosette boxes is likely to increase the carbon footprint as this is a further step in the dispensing process and an additional form of plastic based packaging. The evidence for the effectiveness of dosette boxes is not supportive and in practice they frequently cause more problems than they solve. There are often simpler solutions to help patients to remember to take medicines. In the UK, the CQC provides this guidance on dosette boxes (this links to NICE guidance and a Royal Pharmaceutical Society report) https://www.cqc.org.uk/guidance-providers/adult-social-care/multi-compa…

Sarah Cooke
Sarah Cooke • 1 year ago

Thank you all for your wonderful suggestions! I'm going to get Holly our sustainability lead to jump on the thread too - we're also looking at our dosette process, so fabulous discussions here!

Nuala Hampson
Nuala Hampson • 1 year ago

Hi Simon, the main problem is that a dosette box is not the best solution in many cases (alterntaives like a person-centred medication review, aligning medicines to once daily dosing if possible, use of reminder chart, phone reminders etc are often more effective). Problems often arise due to lack of communication or lack of awareness of fact that patient is on dosette box. This is from personal experience as a general practice-based pharmacist. Examples include, patient being started on dosette box, resulting in her collapsing due to low blood pressure (suddenly started taking multiple BP lowering medication that she had not been taking before), many patients' dosette boxes being returned at the end of the month with meds not taken because dosette box does not help someone remember to take meds / some patients cannot get into the individual compartments, or the opposite problem of patients taking all the meds at one go. Dosette boxes issued monthly but there is change to medication mid month which may not get communicated in a timely way. Not all tablets/capsules can go into a dosette box. Dosette box does not work for "as required" medicines. Patients can no longer tell which tablets are which in a dosette box which is disempowering. Generally dosette boxes take additional time, are more costly and create more plastic waste. The documents linked from the CQC link above provide the evidence base.

Simon Lenton
Simon Lenton • 1 year ago

here is the response and contact details I received from Terracycle: Not sure a Zero box would be a solution for hospital or large care home. But will be interesting to hear how negotiations with bigger trusts are going - anybody know?

Our business model is to partner with companies to fund the collection and recycling of these streams as part of a sustainability or CSR strategy.

Additionally, I would like to let you know that we are in advanced discussions regarding our Zero Waste Box solution with different NHS trusts such as The James Cook University Hospital, NHS South East London CCG, Elmwood Family Doctor NHS and East Suffolk/North Essex NHS to recycle their blister packs, inhalers, plastic packaging and PPE.

Zero Waste Box Solution

This solution allows you to order online or by sales quote (£1000 minimum order), receive the box, set it up in your premises and ship it back to TerraCycle with a prepaid label included in the price.
TerraCycle can deliver to different locations and provide recycling certificates upon request at the end of the calendar year, confirming volumes in kilograms and dates recorded at our waste sorting facility.
The cost of a box includes everything from logistics to recycling fees.
Our bulk discount starts with a minimum order quantity of 25 boxes.

We would love to support your NHS. In order to move forward, as we provide premium recycling services for hard to recycle materials and it requires additional investment from our partners, we would need to understand the level of investment you could set aside.

In the meantime, if you have any questions, please let me know.

Kind regards

--

Fabio Ferrari

Business Development Associate

+44 (0) 7384 449429

TerraCycle Europe

www.terracycle.eu

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