Reducing plastic waste, carbon footprint and cost: inhaler recycling at Musgrove Park Hospital

Abstract

Background: Wasted medication costs the NHS £300 million per year (Trueman, P et al. Evaluation of the Scale, Causes and Costs of Waste Medicines. YHEC/School of Pharmacy, University of London. 2010). As potent greenhouse gases, hydrofluorocarbons (HFCs) in metered dose inhalers (MDIs) produce 8% of the NHS’ carbon footprint (Hillman, T et al. BMJ 2013; 346: f3359). Aim: To collect inhaler devices for recycling, quantify wasted doses and their environmental impact. Methods: We collected inhalers over 90 days at our district general hospital. Number, device type and remaining doses were recorded. Devices without a counter were listed as either ‘empty’ or ‘doses remaining’. We calculated the financial cost of wasted doses and the carbon footprint of MDIs. All devices were sent to the ‘Complete the Cycle’ recycling scheme. Results: There were 481 inhalers collected with 34 device types. 41 capsule devices were excluded. Of returned inhalers, 77.3% had doses remaining. 43 (9.8%) were full, costing £1209. There were 8546 unused doses from 201 inhalers with counters. 71.8% of dry powder inhalers (DPIs) and 79.9% of MDIs had doses remaining. Assuming the MDIs as 50% full on average, our collection represented 2.63 tonnes of equivalent CO2 (CO2e) emissions which may otherwise have been released into the environment, equivalent to 120 return journeys from London to Paris by Eurostar, or 10.8 return flights. Conclusion: There were significant remaining doses in returned inhalers, likely underestimating true inhaler waste. Waste prevention and considering alternatives to inhaled HFCs in addition to recycling are essential as healthcare systems strive to reduce carbon emissions with ever-constrained budgets.