Sustainable pharmacy practice can lead the way to a healthcare net zero

Amid the background of the COP30 UN Climate Summit being held on 10–21 November 2025 in Brazil, it is timely to revisit the role pharmacy practice can play in reducing carbon emissions and ensuring a sustainable future.

The themed collection ‘Climate, nature and pollution crises — how more sustainable medicines use can make a difference’, published in the International Journal of Pharmacy Practice (IJPP) on 14 November 2025, highlights recent international research to advance greener pharmacy practice. The collection includes articles on pharmacists’ knowledge and awareness gaps, pharmaceutical water pollution and greener respiratory care, as well as practical ways to adapt medication supply and policy to support more sustainable medicine use. 

This themed collection is guest edited by Sharon Pfleger, consultant in pharmaceutical public health at NHS Highland, who works to reduce the environmental impact of medicines. Pfleger was the first pharmacist and NHS staff member to join an expedition to Antarctica as part of the Homeward Bound programme, a global network of women with a background in science, technology, engineering, maths and medicine working to build a healthier planet. She is also the co-founder of the One Health Breakthrough Partnership, a group of five Scottish organisations working to reduce pharmaceutical pollution.

“The manuscripts contained within the collection will increase knowledge and awareness of the diverse ways in which medicines contribute to the triple planetary crisis and offer solutions to improve practice and include sustainability in education,” she said^​1​.

The following selection of papers from the collection illustrates the range of activities that pharmacy professionals engage in to decarbonise pharmacy practice. 

Closing pharmacists’ knowledge and training gaps

‘Pharmaceuticals in drinking water: a scoping review to raise pharmacists’ public health and environmental awareness on contamination in groundwater, surface water, and other sources’

This scoping review, by Caroline Sirois, professor at the Faculty of Pharmacy, Université Laval, Canada, and colleagues provides an overview of the medications contaminating drinking water sources across North America and Europe. Non-steroidal anti-inflammatory drugs (NSAIDs) and acetaminophen are among the most reported contaminants, while diclofenac and antibiotics are the most studied medications owing to their severe adverse effects on ecosystems.

The study calls upon pharmacists to adopt “best practices, such as prescribing only when necessary, deprescribing, social/green prescribing, and opting for environmentally friendly alternatives”.

‘Pharmacy education for sustainable healthcare: a UK progress update and call to action’

This commentary — by Nuala Hampson, associate at the Centre for Sustainable Healthcare, Oxford; Lisa M Fitzpatrick, senior lecturer in clinical pharmacy and pharmacy practice, De Montford University, Leicester; and Minna Eii, advanced pharmacist practitioner at Sunderland Royal Hospital — advocates for pharmacy professionals to acknowledge the public health threat posed by the climate crisis and train the upcoming workforce to adopt sustainable practices. The Sustainability in Pharmacy Education group, established in 2022, works to provide resources and embed “teaching on planetary health and sustainability within the pharmacy undergraduate curriculum” in the UK.

Policy changes supporting practice change

‘Exploring climate-conscious pharmacy: considerations for community pharmacists’

Zubin Austin, professor at the University of Toronto, Canada, and colleagues have employed a multi-methods study to identify the topics that climate conscious community pharmacists should consider engaging in. These include addressing climate-related health impacts and disasters, energy, infrastructure and inventory management, medication optimisation, sustainable procurement and waste management. The outputs from this article act as a catalogue of actionable resources available to support education and upskilling for improved practice.

‘The impact of policy changes on the sales of the environmentally harmful drug diclofenac in Sweden’

Diclofenac, an analgesic and anti-inflammatory, has been widely recognised as a high environmental risk drug owing to its wide use and the fact it is not fully degraded in wastewater treatment plants, leading to its presence in rivers, groundwater and even drinking water.

Christine Ljungberg Persson, senior lecturer at the University of Gothenburg, Sweden, and colleagues have demonstrated that policy changes by the Swedish Medical Products Agency and Swedish Pharmacy Association to make oral formulations of diclofenac prescription-only and move over-the-counter (OTC) topical forms behind the counter, respectively, have significantly reduced the volume of the drug being sold in Sweden. 

Greening asthma care

‘Decarbonisation of asthma care — could digital interventions provide the key to reducing the carbon footprint of asthma medication?’

Inhaler therapy continues to be a significant contributor to the NHS’s carbon emissions. Lynn Elsey, consultant respiratory pharmacist at the Manchester University NHS Foundation Trust, and her team identified that “electronic monitoring devices (EMDs), particularly when combined with education and feedback, have the potential to reduce the carbon impact of asthma through improved adherence to preventer inhalers, reduced reliever overuse, and improved asthma control”.

‘Formulary optimisation to reduce the carbon footprint of inhalers in a tertiary hospital’

Iarlaith Doherty, senior clinical pharmacist at Tallaght University Hospital, Dublin, and his team have reduced the carbon footprint of inhalers dispensed from the hospital by changing its preferred salbutamol pressurised metered dose inhaler from Ventolin (GSK) to Salamol (Teva).

Salamol contains less propellant and hence has a lower carbon footprint. The study results showed that “hospital pharmacists can significantly reduce the environmental impact of inhalers by choosing to procure lower-emission inhalers”.

Themed collections in journals highlight topical issues of interest to the community and rarely is a themed collection more urgent and relevant than this collection on the impending climate-driven public health threat.

Regulatory bodies around the world are taking action and this themed collection highlights the evidence-based interventions that are already having an effect. In the UK, the Royal Pharmaceutical Society (RPS) launched the Greener Pharmacy Toolkit on 8 April 2025 to facilitate community and hospital pharmacies reducing their carbon footprint, while the NHS ten-year health plan for England, published in July 2025, has committed to achieving net zero “by 2024 for the emissions the NHS controls and by 2045 for the emissions it can influence”. 

Pfleger concludes: “I hope that you take away at least one thing to improve your practice and help make a difference to the climate, nature, and pollution crises with more sustainable medicines use.”^​1​