Pharmaceuticals are a significant and often overlooked source of environmental harm. Active pharmaceutical ingredients (APIs) enter ecosystems through human excretion and improper disposal, persisting in water, soil, and wildlife. Wastewater treatment systems cannot fully remove these compounds, while landfill and low-temperature incineration can further release contaminants and contribute to antimicrobial resistance. At the same time, pharmaceutical production and disposal carry a substantial carbon footprint, accounting for a notable share of healthcare emissions. Even high-temperature incineration, while effective at destroying APIs, has environmental trade-offs, including greenhouse gas emissions and toxic byproducts. Reducing pharmaceutical waste is therefore critical for both environmental and public health.
The most effective approach is waste prevention, reducing unnecessary prescribing, dispensing, and disposal. Proper segregation of pharmaceutical and associated physical waste (e.g., packaging, PPE) enables safer and more sustainable handling. Applying reduce, reuse, and recycle principles, alongside safe return and disposal programs, can further minimize environmental impact and support a shift toward more circular systems.
A systems approach is needed, guided by the waste hierarchy: rethink and redesign, reduce, reuse, and then manage residual waste. Key actions include conducting waste audits, strengthening education and training, and embedding sustainable practices across healthcare. Empowering professionals as stewards and supporting policy and operational change will drive more sustainable pharmaceutical use and waste management.
Evidence-based ready-to-use planning documents with project goal, scope, problem/opportunity statement, current state, root causeanalysis, change ideas, potential metrics, and strategies for embedding and spreading.
This playbook aims to support informed decision-making related to foodinfrastructures for planetary health throughout the planning, design, construction and ongoing operation of Canadian healthcare facilities.
This playbook focuses on strategies to work effectively with biomedical waste management policies in order to reduce the environmental impact of both the waste itself and the processes required to manage it.
This playbook provides background information, an overview of reusable opportunities in healthcare, as well as implementation resources and suggested strategies to adopt reusables at care sites.
To help organizations measure and maximize these benefits, the CASCADES Virtual Care Carbon Accounting Tool (VCCAT) supports the estimation of travel-related carbon and financial impacts associated with virtual and in-person care. Combined with thoughtful implementation strategies, equitable access planning, and sustainable technology practices, virtual care can play a meaningful role in building a lower-carbon healthcare system
The Playbook provides background information and resources to guide more environmentally sustainable inhaler practices in inpatient settings. The content of this playbook, including its associated resources, has been developed by the Critical Air Project (CAP) at the Royal Jubilee Hospital, part of Island Health in Victoria, British Columbia. The Critical Air Project, which has been led by Dr. Valeria Stoynova and Dr. Celia Culley, is a climate-conscious inhaler initiative aimed at decreasing Island Health’s inhaler-related carbon footprint through changes in health policy, operational changes and a widespread educational campaign. The project, which is ongoing, was initiated in April 2022 with support from CASCADES.
