Abstract Number: 015-0318

Green Community Pharmaceutical Supply Chain in UK: Reducing and

Recycling Pharmaceutical Waste

Ying Xie*, Liz Breen**

*Business School, University of Greenwich, Maritime Campus,
London, SE10 9LS UK,
Email: y.xie@gre.ac.uk, Tel: +44 (0)20 83317956

** Bradford University School of Management

Emm Lane, Bradford, West Yorkshire
BD9 4JL UK,
Email: L.Breen@bradford.ac.uk

POMS

21st Annual Conference

Vancouver, Canada

May 7 to May 10, 2010

Abstract
The Pharmaceutical Supply Chain (PSC) is a SC where pharmaceutical medications
are produced, transported and consumed. Disposal of the medication waste is harmful
to the environment and costly, therefore, greening the PSC by properly managing the
medication waste is investigated. A Cross Boundary Green PSC (XGPSC) approach is
proposed to design a green PSC that results in fewer preventable medication waste

and more recycling of inevitable medication waste, therefore improved environmental,

economic and safety performances. This study focuses on the community PSC in UK
where patients get medication from local community pharmacies. To green the PSC,
every producer of waste is duty bound to ensure the safe handling and disposal of
waste. This duty of care spans throughout the chain and includes all participants. This
approach is drawn from the contemporary literature and our collaborative research,
and can be used as a guidance to establish a waste management network in
community PSC.
Keywords:
Green supply chain, pharmaceutical supply chain, environmental practices

1. Introduction
There has been increased consciousness of the environment in the last few
decades. More people realise the worlds environmental issues such as global
warming, carbon emissions, toxic substance usage, and resources scarcity. There is
global advocation for going green, and many organizations respond to this by
applying green principles to their company. In addition to the mandatory regulation
driven programmes, numerous environmental programmes are introduced by
organisations voluntarily. The British supermarket chain Sainsburys has expanded its
trials running vehicles on biogas made from landfilled waste, with an order for five
more of its vehicles to be converted (Navarro, 2009). Pepsi-Cola saved $44 million by
switching from corrugated to reusable plastic shipping containers for one litre and
20-ounce bottles, conserving 196 million pounds of corrugated material. Wu and
Dunn (1995) designed an environmental friendly chain for a single organisation where
greening starts from procurement and work its way through to storage, distribution

and to end-consumers. However, the chain does not include the cross company
activities. In fact, not only within a single organization, the green principles are
extended to the whole supply chain (SC). Printing industries like Hewlett-Packard,
IBM, Xerox and Digital Equipment Corporation have made their SC green via
integrating suppliers, distributors and relocating facilities (Ashley, 1993; Bergstrom,
1993; Gillett, 1993 and Maxie, 1994). Green SC Management (GSCM) emerged in
late 1990s, and it ranges from reactive monitoring of general environmental
management programs to more proactive practices, such as the recycling, reclamation,
remanufacturing, reverse logistics of environmental management and incorporating
innovations (Zhu and Sarkis, 2004). For over 10 years, GSCM has become an
important environmental practice for companies to achieve profit and increase market
share in such a way that environmental risks are lowered and ecological efficiency are
raised (Van Hok and Erasms, 2000). Realising the significance of the GSCM
implemented by the organisations, Sarkis (2003) developed a strategic decision
framework that aids managerial decision making in selecting GSCM alternatives, and
product life cycle, operational life cycle (including procurement, production,
distribution and reverse logistics(RL)), organisational performance measurements and
environmentally conscious business practices serve as the foundations for the decision
framework. Considering the previous literature that addressed various elements of
GSCM (Carter et al., 1998; Walton et al., 1998; Zsidisin and Hendrick, 1998), Zhu
and Sarkis (2004) developed four categories of GSCM practices (internal
environmental management, external GSCM, investment recovery, and eco-design or
design for environment practices), and examined the relationship between these
practices and environmental and economic performance through empirical studies in
the Chinese manufacturers.

The Pharmaceutical SC (PSC) is a special SC in which medications are produced,

transported and consumed. Academic researchers and practitioners believe that
pharmaceuticals are different; they cannot be treated like other commodities
(Savage et al, 2006). The reasons for this sentiment were the high cost and long
duration for research and development and the repercussions of the product not being
available, hence again its criticality. Other unsupported perception-based factors that
appear to make this supply chain distinctive include; the level of regulation in the
product production, storage, distribution, consumption and the complexity of the
fabric of this supply chain

(Knight, 2005). Disposal of medication can be very

harmful to the environment and costly. Vast arrays of drugs are entering 41 million
Americans drinking water from people disposing the unused/expired drugs in the
domestic rubbish or waste water (USATODAY, 2009). Globally, in 2003 at least
0.56 billion worth of unused drugs are flushed down the toilet (Van Eijken, et al.,
2003). From an economic point of view, efficiencies can be made in the form of
potential savings in the pulling back of stock from patients. Medication retrieved from
patients cannot be re-used and must be disposed. It does however provide vital
information and can encourage more prudent prescribing. Safety is also paramount
when broaching pharmaceutical management and storage. Accidents can happen if
products fall into the hands of children or individuals who wish to abuse the product
themselves or support a grey market for product exchange/sales. Global and
domestic pressures on environmental, economic and safety considerations (Breen and
Xie, 2009) drive us to manage PSC greening, i.e., improve the PSC economic and
environmental performance by recycling the unused/unwanted medications and
reducing medications that need disposal As a result of greening processes, the PSC
will become safer when hazardous medications are removed from the supply chain

and be kept away from vulnerable people, like children. However, there is very little
research and practice on drug recycling (Ritchie et al., 2000) or green PSC (GPSC).
As explained above, it is vitally important to properly dispose expired medication
because of its hazardous nature, and it is even more critical for every producer of
medication to take actions on reducing waste. The fate of unused consumer
pharmaceuticals is an issue that has reached public consciousness more recently.
There is emerging concern about the potential impact of medicine that reaches lakes
and rivers via sewage plants and other sources (New Hampshire Department of
Environmental Services, 2009).
This research aims to design a green PSC that results in fewer preventable drug
waste and more recycling of inevitable drug waste, using a cross boundary green PSC
(XGPSC) approach that requires every participant in the PSC to take environmental
practices to improve the economic and environmental performances of the chain. In
order to achieve the aim, the research framework and objectives are established in
Section 2, then a community PSC with reverse logistics is designed in Section 3; and
the XGPSC approach is proposed in Section 4 where participants are recommended to
take environmental practices and actions to green PSC. Section 5 concludes the paper
summarising the findings and potential for future research.

2. Research framework and methodology

The objectives to meet the research aim are: i) design a physical network for
community PSC with RL built in; ii) develop a XGPSC approach, in which the
environmental practices playing important roles in greening PSC are identified from a
broad perspective; iii) under the environmental practices identified in ii), the specific
the actions to be taken by each participant in the PSC are addressed from a detail

perspective.
The research framework is shown in Figure 1, illustrating that each participant in
the PSC network is recommended to adopt the XGPSC approach and take necessary
environmental practices to green the PSC. The environmental practices to be
conducted by the participants in the PSC are complex, collaborative, costly and
different from other business sectors provided that PSC is a special SC, it would be
impossible to conduct any empirical study to test any practice prior to a systematic
conceptual approach is formulated. Therefore, the XGPSC approach is developed
from the literature that identified the practices in the area of environmentally
conscious business practices and from the authors collaborative research in the area
of pharmaceutical supply chain. The recommended practices are made by the authors
after consultation with academic experts, medication users, pharmacists, and
professional and regulatory bodies like Royal Pharmacy Societies of Great Britain
(RPSGB), Department of Health, and London National Health Service (NHS) London
Procurement Programme(LPP). The authors also reviewed the regulations, guidance,
audit results and other publications from the RPSGB and NHS to understand the
current progress and expectations for medication waste management, and developed
the environmental practices incorporating with the good experiences from other
countries.
The drivers of green PSC are summarized as the environmental, economic and
safety considerations and it is expected that the environmental, economic and safety
performances of the chain can be improved when it is becoming green. It has been
argued that new opportunities of competition (Hansmann and Kroger,2001) and many
benefits can be brought to the organisations if environmental protection activities are
taken (Alvarez Gil et al., 2001), including improved organisational reputation

(Welford, 1995), reduced cost, improved organisational efficiency, increased market

share, getting ahead of competitors and legislation, access to new markets, and
increased employee motivations (Porter and van der Linde, 1995; Shrivastava, 1995;
Beaumont et al., 1993; Guimaraes and Liska, 1995).

Using empirical results from

186 respondents on GSCM practice in Chinese manufacturing enterprises, Zhu and

Sarkis (2004), found that an organizations environmental and economic
performances are improved if they take the four GSCM practices, i.e., internal
environmental management, external GSCM, investment recovery, and eco-design or
design for environment practices. The internal environment management requires
commitment and support from senior managers in the organisation, as well as total
quality environmental management (TQEM) and audit programme to be set up. The
external GSCM practices focus on cooperation between suppliers and customers for
environmental objectives, e.g., communication on product design, clean production
and green packaging. The investment recovery is a traditional business practice in
which excess inventories/materials are resold, or the scrap/used materials are resold.
The eco-design requires the organisations involved in manufacturing processes to
design products for reduced consumption of materials by adopting reusable or
recyclable materials, and reducing use of hazardous components. The investment
recovery practice is not applicable to the PSC as returned medication cannot be reused
or resold. So the three GSCM practices except investment recovery will be used as
foundations to develop a XGPSC approach, in which the environmental practices and
specific actions are recommended to be taken by PSC participants in order to green
PSC with improved environmental and economic performances. Considering the
hazards that the out-of-date and unused medicines pose on the children and other
vulnerable people, the green PSC reduce the excess medicines in households and

therefore reduce the propensity for these groups to take the out-of-date or unused
medications which ultimately lead to improved safety performance of PSC.
XGPSC approach

Internal environmental
management
External GSCM
Eco-design

Green PSC

PSC
See Figure-2

Improved environmental
performance
Improved economic
performance
Improved safety
performance

Participant in PSC

Figure 1: Research framework for greening PSC using an XGPSC approach

3. A community PSC network with reverse logistics
As identified in Sarkis (2003), RL is one of the most important but least
developed operational functions that serve as a foundation for GSCM practices. RL is
defined as the process of planning, implementing and controlling the efficient,
cost-effective flow of raw materials, in process inventory, finished goods and related
information from the point of consumption to the point of origin for the purpose of
recapturing or creating value or for proper disposal (Rogers and Tibben-Lembke,
1999, pp2). RL facilitates return of products for recycling in many sectors, like
automobile (Lebreton and Tuma, 2006), electronic waste (Lau and Wang, 2009;
Nagurney and Toyasaki, 2005), computer (Shih, 2001), paper (Pati et al., 2008),
packaging material (Gonzlez-Torre et al. 2004), bottling or glass (Gonzlez-Torre
and Adenso-Daz, 2006) and batteries (Zhou et al., 2007); this can be both for re-use
or disposal. As one of the few research applying RL in the medical area, Breen and
Xie (2009) proposed an integrative customer relationship management (CRM)
facilitated RL system in UK community pharmacy for environmental, economic and
safety reasons.
Considering the operations of a community PSC in UK, a preliminary community

PSC network is designed and presented in Figure 2, where a forward logistics network
is depicted in which medications are produced by the pharmaceutical manufacturer,
transported by the logistics providers community pharmacies, and finally consumed
by the customers who can be the patients or the buyers; also a RL network is designed
for the unused/unwanted medications to be returned to the manufacturer. The
unused/unwanted medications are encouraged to be returned for two reasons (Breen
and Xie, 2009): i) it removes the product from circulation and from the domestic
environment therefore reducing the risk of accidental injury or planned product abuse;
ii) it provides valuable information which can be used to assess the efficiency of the
prescribing process (who the prescriber is, the nature of the product and the quantity
dispensed).
As shown in Figure 2, a RL network is one of the key resources needed by the
customer, pharmacy, GP and manufacturer to conduct recycling behaviour. A channel
must be available for the expired drugs to be sent back to manufacturers, and can be
built in a number of ways: i) customers return the unused/unwanted medication to the
pharmacies or the GPs in person, and the pharmacies or the GPs return them back to
manufacturer via the logistics providers; ii) the pharmacies return the unsold or
expired medications to manufacturer when appropriate; and iii) logistics providers or
wholesalers get involved in the system acting as either independent operators such as
collection, sorting, recycling and disposal or cooperating with other actors in the
system (de la Fuente et al., 2007; Krumwiede and Sheu, 2002). The dashed line in
Figure 2 represents the recycling channel for the expired drugs. In the process of
recycling, logistics providers or wholesalers take the role of collection from the
community pharmacy and transport to manufacturers or suitable places for disposal.
The manufacturers, logistics providers/wholesalers, GPs and community pharmacies

are classified as direct participants in the PSC because their roles and activities have
direct impact on the performance of the PSC, while the professional and regulatory
bodies influence PSC indirectly via giving suggestions to the direct participants. In the
middle of the figure (Figure 2), guidance and instructions from professional and
regulatory bodies (like Royal Pharmacy Societies of Great Britain (RPSGB),
Department of Health, or waste management agencies etc.) will be given to the direct
participants in the PSC, and have a peripheral influence on the actions taken by direct
participants.
Although RL has a great influence in greening the SC, recycling behaviours are
classified as proactive green approaches, and the most far-reaching approach is
value-seeking in which companies have the strategic initiative to integrate
environmental practices into the business strategy and operate the company to reduce
impact on the environment (Kopicki et al., 1993). Community pharmacies are bound
by contractual obligation to offer a returns service for medication; this action is
therefore built into their service provision (Department of Health, 2008; Bellingham,
2004). The strategic aim of which is to facilitate safe disposal, remove excessive
storage of medicines in the home and to reduce the environmental damage from
inappropriate disposal methods (Primary Care Commissioning, 2009).Also,
medications once returned by customers cannot be re-used and must be disposed
therefore they have no residual value. Strategically action must be taken to reduce the
medication waste entry to the PSC for environmental protection, economic savings
and safety considerations. As illustrated in the shaded boxes, the participants in the
PSC are expected to reduce the medication waste by integrating environmental
practices in their main activities. The specific actions to be taken by the participants to
reduce waste will be discussed in the next section.

General Practice

Pharmacetutical
manufacturer

Logistics
provider/
Wholesaler

Professional and regulatory

bodies, and waste management
agencies

customer

Community
pharmacy

Logistics
provider/
Wholesaler

Forward logistics
(product flow)

Reverse logistics
(product flow)
Reduce waste

Figure 2: A community pharmaceutical supply chain with reverse logistics

4. A Cross Boundary Green PSC (XGPSC) approach
To green the community PSC, not only a physical PSC network needs to be
constructed in Figure 2, but also GSCM practices should be implemented by all
participants in the chain from the holistic system perspective, which is the
far-reaching approach that will minimise the total environmental impact of a business
(Van Hoek, 1999).
A cross boundary green PSC (XGPSC) approach is proposed in this section (as
shown in Figure 3) to propose environmental practices to be adopted by participants
in the PSC, in order to convert the community PSC in Figure 2 to be a green PSC.
Based on the three categories of GSCM practices in Zhu and Sarkis (2004), the
XGPSC approach recommend the four environmental practices in Table 1: i) top
management commitment: each participant in the PSC make commitment to GSCM
from top management team and setup environmental management system; ii)
supplier certification and cooperation: each participant should evaluate his
suppliers environmental practices and cooperate with suppliers for environmental

objectives; iii) customer cooperation: each participant cooperate with customers or

support them for eco-design, cleaner production, green packaging and proper
recycling or disposal; and iv) eco-design: the participant should become involved in
the manufacturing process, designing products for reduced materials/energy, for reuse,
recycle, recovery of materials, and for reduced use of hazardous components. The
recommendation i) and iv) are classified as internal environmental management that
take place inside an organisation and plays key roles in improving the performance of
individual organisations (Carter et al., 1998). The ii) and iii) are external
environmental practices that are more difficult to be implemented and require the
information, support and collaboration from other participants. However, to
successful green the PSC, the recommended practices are integrative and need
cross-functional cooperation rather than oriented towards a single department or
organisation (Xie, 2009).
Under the environmental practices recommended above, the specific actions to be
taken by each participant vary along the chain and are illustrated in Figure 3.
Table 1: environmental practices recommended in XGPSC approach
XGPSC approach
Internal Environmental

Top management

practices

commitment

External environmental

Supplier certification and

practices

cooperation

4.1 The Manufacturer

Eco-design

Customer cooperation

i) Top management support: As the producer and designer of the pharmaceutical

products, the manufacturer can contribute to the green PSC through innovative and
environment friendly medication designs, so the commitment of GSCM from the
management team are essential to realise and ensure total green operational processes
ranging from procurement, production, distribution and reverse logistics.

It is also

recommended that an environmental management system should be designed to

improve the TQEM and make the ISO 14000 certification the target of the
organisation and its suppliers (GEMI, 2001). To monitor and evaluate the organisation
and its suppliers practices, a series of environmental compliance and auditing
programmes should be set up (Zhu and Sarkis, 2004).
ii) Supplier certification and cooperation: Florida (1996) claimed that close bonds
with suppliers facilitate cleaner production. The supplier selections and procurement
decisions have an impact on the GPSC through purchase of materials that are
hazardous or non-hazardous, recyclable or reusable, or have already been recycled
(Sarkis, 2003). The manufacturers are encouraged to add environmental, health and
safety elements to their strategic sourcing initiatives, and provides practical resource
for procurement staff to understand and pursue opportunities that will add business
value to their companies (GEMI, 2001). The suppliers who have ISO 14000
certification are recommended to be selected to lessen the environmental risks
associated with the materials procurement.
iii) Customer cooperation: By collaborating with the customers (the wholesalers or
the pharmacies in this research) and communicating for design specifications and
recycle feasibility of products , the manufacturers can contribute to innovative
medication designs, cleaner production and green packaging (Zhu and Sarkis, 2004).

A strong relationship with wholesalers and pharmacies will encourage the returnable
packaging adopted by them provided that reverse logistics channel is available.
iv) Eco-design: According to (Kreisberg, 2007), medications can be designed to be
more ecologically sensitive, e.g., biodegraded more quickly, more efficient for lower
doses, or less harmful. The shelf life of medication can be brought into closer
alignment with real time by refining the expiration dates. It is also recommended in
(Breen and Xie, 2009) that medication product life cycle can be maximised so that
customers will feel it is worth returning them back for economic benefits.
In terms of medication packaging, recyclable materials can be used; the package can
be designed by adding more complete/direct information about proper ways of
disposal; and the package shapes and sizes can be designed for easy returning and
transportation (e.g., mail back returning). In addition, multiple choice of the
packaging size can be made available for the GPs or pharmacists to minimise the
unused portion of prescriptions.
4.2 The wholesaler and logistics providers
The development of a RL system has enabled pharmacies to transport all unsold
or expired drugs as products go back through these firms for the purpose of returning
them to the manufacturer for credit. The activities of transportation in the RL system
can be implemented by the wholesaler, or the logistics providers including the third
party logistics (3PL) company.

Any expired items that do not meet the

manufacturers return policy become waste at the RL which becomes the waste
generator, since this is where the decision to discard the item is made (Smith, 2002).
Waste need to be properly dealt with by the wholesalers and logistics providers in
collaboration with manufacturers and community pharmacies, for the purpose of
greening PSC.

i) Customer cooperation: The role of the wholesaler is to support manufacturing

operations through warehousing and distributing stock to community and hospital
pharmacies. They have an established logistics network and so are well placed to
enhance their service package through RL activities. They provide such a service for
their own products (manufactured by their company or their customers) in retrieving
defective products e.g. short-dated or incorrect items. The role of a 3PL has been
investigated in hospital pharmacy in consolidating deliveries. Wholesalers can
provide such a service in their current position in the PSC (Breen, 2004).
The service provided by the wholesaler and logistics providers can go beyond
transportation, and include classification, storage, manifest, destruction, and disposal
of medications. If the wholesalers or the logistics companies act as the waste
management brokers, they are expected to classify and segregate the medication
according to the hazardous or non-hazardous characteristics, then manage them under
appropriate streams (Smith, 2002). Employing them in the RL network can reduce the
amount of pharmaceutical waste generated and disposed improperly. But it is
important to select a wholesaler or logistics provider that complies with
environmental regulations, and acquires the licenses for these services before they are
contracted in the RL network.
4.3 General Practitioner
i)

Customer cooperation: A General Practitioner (GP) plays an important role in

the community PSC, as s/he is the first point the patient (customer) contacts in the
chain, and it is an ideal time point to educate the patient how to properly dispose or
return the unused medications when the GP prescribes the medications.

According to waste audit conducted by Rowlands Pharmacy (2009), GPs might

prescribe medication for a longer period than customers need, which results in
unused medication accumulating in household. Therefore, GPs need to consider the
timeframe needed for prescriptions prior to dispensing. Shorter periods of
prescriptions have been trialed in Canada based on 7-14 days (Paterson and Anderson,
2002). GPs should also be consulted regarding patients involved, and an efficient
Management Information System (MIS) is proposed to facilitate GPs to monitor
patients progresses and remind them to return pharmaceuticals via text, call or email.
In the MIS, patients consultation and personal details will be recorded, together with
Medicines Use Reviews (MUR) results.
ii) Supplier certification and cooperation: The GPs should evaluate their
pharmacy suppliers environment friendly practices and make proper suggestions or
support to help them go green. Medication Use Reviews (MURs) are thought to have
a vital role to play in medication management (Lammy, 2007), and Dispensed Review
of the Use of Medicines (DRUMs) are regularly conducted by GPs and community
pharmacies (as part of NHS contract obligations) to improve the way that medications
are used, to reduce unnecessary medication in circulation and to make informed
decisions regarding pack sizes and synchronization as advised by the National
Prescribing Centre etc (NHS Cumbria, 2009). The DRUM can be conducted based on
the medication information recorded in the GPs MIS which are appropriately shared
with pharmacies to facilitate the whole process.
4.4 Community Pharmacies
Community pharmacies play different roles in the process of green PSC: i) they are
customers

of

the

pharmaceutical

manufacturers,

and

are

responsible

for

communicating with manufacturers or wholesalers regarding product information; ii)

they are a communication point with customers for advice and education on proper
disposal of medication; iii) they act as an accessible site for customers returning back
unwanted/unused medication; iv) and they act as a site where pharmacists conduct
repeating or supplementary prescription to reduce unnecessary medication entering
the PSC. So the environmental practices to be taken by community pharmacies will
be:
i)

Supplier certification and cooperation: The pharmacies are supposed to

evaluate suppliers environmental practices and choose the one with ISO14000
certification or higher environmental compliance. In addition, they can manage their
inventory with manufacturers, and launch collaborative planning, forecasting and
replenishment (CPFR) to minimise the amount of expired medication. They also
should collaborate with manufacturers for ecological medication design, and feedback
manufacturers on the package sizes and labelling information on recycling, etc.
Efforts can be made to introduce supplier development initiatives which would
encourage interaction between suppliers and customers and facilitate knowledge
exchange (Breen, 2004b). It could also allow for development opportunities such as
vendor managed inventory services where pharmaceutical companies can share their
supply chain management expertise.
ii) Customer cooperation: As seen in Figure 2 it is clear that community pharmacy
is closer to the customer so has greater opportunity to build relationships with these
parties. They act as a site to communicate with customers about proper disposal of
unused/unwanted medication, and provide facilities for customers to drop off those
medications. According to the research, 95% of pharmacies in British Columbia
have recycle bins, which allow consumers to bring their unused/expired medicines
back (Kreisberg, 2007). While in UK, there is no figure showing the percentage of

pharmacies providing drop in/recycle boxes, and it is recommended the pharmacies

acting on the provisions. In addition, open events for returning medications can be
organised by the pharmacies in collaboration with local councils, to launch a public
campaign on reducing medication waste and protecting the environment e.g.
Calderdale Primary Care Trust Wasted and Dangerous Campaign (2006).
The information obtained from pharmacist-led and GP-collaborated MURs can be sent
to GP for proper description and manufacturers for medication design and it also can be
used by pharmacies to identify the reasons of returning and take appropriate actions to
reduce waste. MURs completed in Huntingdonshire for 100 patients indicated that 49%
of patients were found to have medicines that could be stopped and 430 interventions
were made to reduce wasting these no longer needed medicines (Lammy, 2007).
Similar conclusions regarding medication reviews were raised by Braybrook et al
(1999) and Boivin (1997). Effective MURs in community pharmacy have also been
linked to a reduction in hospital admission for asthma patients (Jerram, 2009).
More advanced systems are being launched in the NHS medication management
system, such as repeating dispensing (Department of Health, 2007) and
supplementary prescribing (PSNC, 2005; RPSGB, 2006), and these services are
treated as essential steps in green PSC.
Repeat dispensing in community pharmacies allows patients to collect their repeat
medication directly from their chosen pharmacy without consulting with a GP each
time (Department of Health, 2007). Supplementary prescribing revolutionised the way
medicine management was traditionally organised allowing more flexible team
working. Supplementary prescribing allows pharmacists to prescribe drugs within the
context of a Clinical Management Plan which is signed and agreed with a patients
GP prior to the consultation (PSNC, 2005; RPSGB, 2006). The two systems allow

patients improved access to medicines and is seen as an important advance in the

management of patients long term conditions. The service offered by the two systems
allows community pharmacists to engage in a two way conversation with patients to
ascertain that they are taking their medication as they should be and/or if they are
experiencing any side effects (concurs with Jesson et als findings, 2005). It also
increases the patient convenience and will help develop good links between
pharmacies and GPs. If designed in this way, this will reduce unnecessary
medications entering into the RL pharmaceutical system.
4.5 Professional and regulatory bodies and waste management companies
The professional and regulatory bodies and waste management companies are
treated as indirect participants and have peripheral influences on the direct
participants in the PSC. Public awareness on the importance and necessity of drug
recycling can be raised, and advice, instructions and support from professional and
regulatory bodies given to individual organisations will have positive impact on
greening the PSC, and these practices have been conducted in the United States
(Practice Greenhealth, 2009). The waste management companies can make
suggestions and advice. In this case, the PSC participants who are guided and
instructed are treated as the customers, and the prior communications and cooperation
with them are essential to define the guidance and instructions.
i)

Customer cooperation: In 2006, the Department of Health and Royal Pharmacy

Society of Great Britain (RPSGB) in UK produced guidance on best practice

pharmaceutical waste management (Department of Health, 2006) and regulations on
hazardous waste (RPSGB, 2005), which provide practical advice and guidance for
waste producers in the healthcare system. The pharmacists in the PSC are required to
understand and ensure their compliance with the guidance and regulations. However,

legislations are also required to oblige manufactures to make compliance on

environmental protection in terms of procurement, production, distribution, reverse
logistics and packaging. The rules defining customer compliance in returning the
unused/unwanted medication will also facilitate the success of green PSC.
Waste management companies are providing services and advice to their customers
on secure disposal of medication waste and compliance with legislations (Phs
management, 2007; Veolia environmental services, 2007). It is expected that waste
management companies propose reasonable suggestions that would reduce medicines
waste.
The data collated from MURs and DRUMs can be fed back into the PSC via
professional bodies and associations e.g. RPSGB and Association of the British
Pharmaceutical Industry (ABPI), and they can make suggestions to manufacturers on
medication design and package or to GPs on prescription period or further medication
monitoring.
4.6 Customers
To green the PSC, the role of the customer is not only a consumer of
medication/healthcare service, but also an actor to reduce unneeded medication and
return the unused medication. They need to be educated to manage unwanted
medication differently e.g. rather than dispose of medication into water or domestic
waste systems, bring the medication to a collection site or hazardous waste facility.
They can also buy smaller quantities of medication if possible, and buy products with
recyclable packaging. There is a need therefore to raise awareness of the impact of
medication and effective disposal methods.
i)

Supplier cooperation: The management of returned medication cannot happen

unless the customer is compliant and becomes involved, e.g., corporately or

proactively return the unused/unwanted medication to the suppliers (either GPs or

pharmacies). Breen and Xie (2009) recognise that the customer operating in this new
role is the only party in the PSC who pays for a product but is then expected to act
altruistically for the good of PSC by initiating product recycling. Any guidance and
support infrastructure put in place by the government and regulatory bodies will not
ensure success in this area, unless the customer participates. Unlike the traditional
model of recycling, e.g. where goods can be recovered and reused, pharmaceutical
products take a different recycling pathway, that is, final disposal by a third party. The
customer, as an existing patient, can also hold a strong position on an individual basis,
as determined by the potential risk attached to the medication that is returned. The
value in this case is based on the reduction of risk due to the product being taken out
of circulation and no longer a hazard to patients or extended family etc.
Besides this, the patient engagement with the service is sometimes purely on a
transactional basis or if there has been a length of servitude, it can result in something
akin to loyalty. It is this element that community pharmacy management needs to
secure and build upon to ensure the success and sustainability of returning medication
in the PSC. This can be facilitated by a CRM system which places customer
involvement at the forefront of this system, but also prompts and supports customer
involvement by the use of information systems and technology (Breen and Xie, 2009).
4.7 A Green PSC
The cost of recycling medication in the PSC is difficult to quantify. The cost of
final disposal is easy to identify but the cost of retrieval is a different matter. What is
the price of an effective RL system which facilitates effective customer management
and ensures recycling behaviour? How much does it cost to raise awareness and
educate/energise customers to want to bring back unwanted medication? Regardless

of cost, the message is clear. For economic, environmental, and safety considerations,
medication within the PSC needs to be reduced in order to reduce the quantity of
stock destined for final disposal. The effective delivery of this objective requires the
efforts of the complete PSC. Successful contribution of all participants will lead to a
greener and more sustainable PSC.

Provide advice & suggestions

on reducing medication waste

Produce guidance and legislation on

pharmaceutical waste managment

Professional & regulatory bodies, and waste

management agencies

Top
management
commitment
Supplier
certification &
cooperation

General
practitioner

Community
pharmacy

Environment
management system;
environmental
compliance audit

Select supplier who

are have ISO14000
certification

Medication use
review

Customer
cooperation

Eco-design

Customers

Communicate with
wholesalers or
pharmacies for
recycling feasibility
and product designs

Stock and
transport returned
medication;
Classification,
storage,
segregation,
destruction
disposal

Educate patient of
proper disposal of
medication;
Prescribe for
reasonable
periods;
Remind patients
returning
medication

Evaluate and select

suppliers with high
environmental
compliance;
Manage inventory with
suppliers to minimise
expired medication;
Collaborate with
suppliers for eco-design,
packaging, and labelling

Communicate with
customers for proper
disposal of medication
Collect returned
medication
Repeat or
supplementary
prescription
Medicine Use Review

Ecologically sensitive
design;
refine the expiry date;
use recyclable
packages;
design multiple
package sizes

Figure 3: The cross boundary green PSC (XGPSC) approach

Get compliant
and involved in
returning
medication;
Reduce wasting
medication

A Green PSC

Logistics
provider/
Wholesaler

Pharmaceutical
manufacturer

5. Conclusion
There are increasing concerns regarding the adverse environmental consequences
of inappropriately disposed medications, the economic loss caused by the
preventable medication waste, and the safety problems caused by the expired or
hazardous medications. To address these concerns, proper medication waste
management becomes a new frontier in health care system and are investigated in
this paper limited to community PSC in UK, which is one of the most frequently
participated SC by the patients and the medication buyers. The medication waste
management requires the involvement of the entire supply chain, from manufacturers,
through wholesalers/logistics providers, to GPs, community pharmacies and finally
to customers to green the PSC that results in fewer preventable drug waste and more
recycling of inevitable drug waste.
To provide a channel for taking back the unused/expired medication, a PSC
network is designed encompassing the RL to enable community pharmacies and
customers to recycle medication. However, the recycling behaviour is only counted
as a proactive environmental practice, and a XGPSC approach is designed as a
far-reaching approach to integrate environmental practices into the business strategy
and operate the companies in the PSC to reduce impact on the environment. The
environmental practices and actions to be taken by the participants in the PSC are
identified in the XGPSC approach that requires total involvement and cross-sector
collaborations from participants. Four environmental practices are recommended:
top management commitment, supplier certification and cooperation, customer

cooperation and eco-design. Under these environmental practices, specific actions

are addressed for direct participants including manufacturers, wholesalers/logistics
providers, GPs, community pharmacies, and customers. The key actions include
making commitment to environmental objectives, evaluate and select suppliers with
ISO14000 certificate, educate patients for proper disposal of medication, collaborate
with customers for medication use review, change prescription period, and
ecologically sensitive medication design. Indirect contribution is also recognised
from peripheral influences from the professional and regulatory bodies and waste
management agencies.
The proposed XGPSC approach can act as the guidance for all those involved in
the management of medication waste, and provides practical advice and guidance for
waste producers. With a firm commitment to take actions reducing and recycling
medication waste, like changing habits, becoming stewards of medication rather than
only consumers, the PSC will become greener in the future. Professional bodies or
government may use it as a reference to define regulations and instructions for best
practice of medication waste management.
The research work is built on the contemporary literature review and the
collaborative research, so the proposed XGPSC approach needs to be further
validated and improved in the future through empirical study.

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