Greener medicines: brand strategy or business necessity?

Most doctors would like to take environmental impact into account when prescribing medicines, but few know how to translate that intention into everyday clinical practice.

Research led by University Medical Center Groningen (UMCG) found that more than 90% of the 440 participating doctors were willing to prescribe more sustainable medicines. Yet environmental considerations currently play only a limited role in prescribing decisions. The main barriers are a lack of accessible information and the additional time doctors fear it would take to compare medicines.

The problem is becoming increasingly important. In the Netherlands, more than 500,000 kilograms of pharmaceutical residues enter the sewage system every year through urine, faeces and the incorrect disposal of unused medicines. Around 190,000 kilograms eventually reach rivers, lakes and other surface waters because wastewater treatment plants cannot completely remove them.

Pharmaceutical residues can affect aquatic ecosystems and may also complicate drinking-water treatment. Examples highlighted by researchers include anti-inflammatory gels such as diclofenac, which can wash directly into wastewater after showering or washing clothes.

At the same time, pharmaceutical use is expected to increase as the population ages. Dutch medicine consumption could be around 25% higher by 2040.

The information gap

The difficulty for prescribers is that environmental information is rarely presented alongside the information they already use to select a medicine.

A doctor may know, for example, that certain topical medicines can enter wastewater more directly than tablets. But identifying which active ingredients persist in the environment, comparing manufacturing impacts or distinguishing between different delivery systems is considerably more difficult.

The researchers therefore suggest integrating environmental information into clinical guidelines and electronic prescribing systems. One possibility would be a simple sustainability indicator that appears when doctors choose between clinically appropriate alternatives.

Such a system could allow sustainability to become another consideration alongside efficacy, safety, patient preference and cost, rather than requiring doctors to conduct their own environmental research during a consultation.

 

Pharmaceutical companies are beginning to respond

Some of the clearest examples can be found in respiratory medicine, where the environmental impact of inhaler propellants has become an increasingly visible product-development issue.

Metered-dose inhalers traditionally rely on propellants with a relatively high global-warming potential. Manufacturers including Chiesi, AstraZeneca, GSK and Lupin are therefore working on alternatives designed to reduce the climate impact of these devices.

In October 2024, Lupin announced that its R&D teams were developing pressurised metered-dose inhalers using a propellant with what the company describes as “near-zero global warming potential”. Lupin said the aim is to maintain comparable efficacy and safety while substantially reducing the environmental impact of its inhalers. The company also positioned the programme as part of its broader respiratory strategy and its response to changing European environmental requirements.

Chiesi has similarly described a programme for “Carbon Minimal Inhalers”, while AstraZeneca and GSK have announced work on lower-carbon propellant technologies.

Other products take a different route. Boehringer Ingelheim's Respimat is a soft-mist inhaler that does not depend on a conventional propellant gas, and reusable device designs can further reduce the material footprint associated with treatment.

Brand positioning and brand story

These initiatives are significant from a brand perspective as well as an environmental one. Sustainability is beginning to influence not only corporate commitments, but also product design, R&D investment and portfolio positioning. For pharmaceutical companies, the question may therefore be shifting from whether sustainability should be part of the brand story to how deeply it should be built into the product itself.

At the same time, inhalers remain an unusually visible example. For many tablets, injections, creams and gels, doctors still cannot easily compare the environmental footprints of competing products.

Sustainability cannot replace clinical judgement

A greener option is only useful if it is also clinically appropriate. Switching medicines solely for environmental reasons could be counterproductive if it reduces disease control, creates additional side effects or leads to poor adherence.

Patient involvement is therefore essential. The Dutch doctors interviewed in the research emphasised that sustainable alternatives should be discussed with patients rather than imposed on them.

There are also opportunities beyond prescribing. Easier collection of unused medicines could prevent patients from flushing them down the toilet, while health insurers and procurement organisations could incorporate environmental criteria alongside price, efficacy and safety.

The willingness among doctors appears to be there. What is missing is the infrastructure: reliable environmental data, agreed methods for comparing medicines and simple tools that bring that information directly into the prescribing process.

Without those tools, asking doctors to prescribe more sustainably risks giving them a responsibility without giving them the information needed to act on it.

Industry and regulatory sources for further reading

Lupin – https://www.lupin.com/sustainability

Chiesi — Sustainability:https://www.chiesi.com/en/sustainability/

AstraZeneca — Sustainability:https://www.astrazeneca.com/sustainability.html

GSK — Environmental sustainability:https://www.gsk.com/en-gb/responsibility/environment/

Boehringer Ingelheim:https://www.boehringer-ingelheim.com/

European Medicines Agency — Environmental Risk Assessment of medicinal products for human use:https://www.ema.europa.eu/en/environmental-risk-assessment-medicinal-products-human-use-scientific-guideline