1. 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

2. Is waste an ethical issue? Andi Shirtcliffe

3. YEAH. RIGHT… WASTE IS AN ETHICAL ISSUE Andi Shirtcliffe

4.  Global figures  NZ numbers  A few examples  Environmental stuff  Why it happens and then I’m gonna get personal! GUIDED TOUR

5.  Billions globally  USA $53 million per annum (oral meds only)  UK £30 – 90 million per annum WASTE NOT WANT NOT

6.  ~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

7. One individual Four waste sacks full of unused medicines Contained:  73 x 10ml eye drops  432 temazepam  34 tubes of Dermovate® ointment  4600 glyceryl trinitrate sublingual tablets  + more Total value >£800 UK EXAMPLE NZFP 2007; 34: 258-262

8.  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

9.  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?

10.  50% discontinue their medicines within a few months  21% nonadherent after four days? COMPLIANCE/ADHERENCE/CONCORDANCE

11.  Make the health and well-being of the patient your first priority  Promote patient self-determination, respect patients’ rights, autonomy and freedom of choice  Use your professional judgement in the interests of patients and the public and promote family, whanau and community health  Show respect for others and exercise your duties with professionalism  Actively seek and apply contemporary pharmacy knowledge and skills to ensure a high standard of professional competence  Act in a manner that promotes public trust and confidence in pharmacists and enhances the reputation of the profession  Practice in a manner that does not compromise your professional independence, judgement or integrity, or that of other professionals PHARMACIST CODE OF ETHICS