Abstract
A letter written by Baroness Nichol to the Institute of Wastes Management (IWM) has prompted the authors to review the increasing social and environmental responsibilities of pharmacists over the management of pharmaceutical wastes.

The Baroness was concerned that supplies of Prednisolone, originally dispensed in a small bottle, now come to her in much bulkier blister pack cartons each with a leaflet. She complains that this step runs counter to government policy on waste which is to reduce the production of non-recyclable items, in particular the quantities of packaging, going to waste.

Underlying this simple example are a vast range of wider waste management issues that are steadily growing in significance for pharmacy practice. Drawing on secondary published data and a review of policy and guidance, the paper will expand on this list which includes:

• The requirement on community pharmacies, under the 1990 Environment Protection Act, to uphold a Duty of Care in the disposal of all wastes, and in particular the disposal of pharmaceuticals which are a defined clinical waste.
• A review by the Tidy Britain Group (formerly Keep Britain Tidy) on the subject of drug-related litter, in particular used needles issued by pharmacists through Needle Exchange Schemes (there is no assurance that issued needles are ever returned, a probable breach of the Duty of Care).
• A survey of healthcare waste produced within a sample of hospital premises, undertaken by M.E.L Research, which showed the hospital pharmacy to be one of the largest sources of waste and proportionally, the largest producer of used packaging.
• A review of practice on potentially unwanted and out-dated medicines (e.g. DUMP, brown bag and medicines exchange schemes as in Bromley) and whether these need to be expanded.
• A review of the growing international pressure for tighter legislation on healthcare wastes management, and the new Healthcare Waste Special Interest Group of the IWM which is reviewing current practice including the handling of hospital and community pharmacy wastes.
• The growing use of healthcare waste disposal options not involving incineration (e.g. autoclaving, heat disinfection and microwaving) which may require future separation of pharmaceuticals as unsuited to this form of treatment (already starting to happen in Scotland).

The authors see healthcare waste management as a source of increasing pressure on pharmacy practice, and an indicator of the wider social and environmental responsibility to which pharmacy practice is becoming exposed. Evidence from other waste management contexts imply it is only a matter of time before a comprehensive 'Cradle to Grave' pharmacy waste management approach will be needed, based on the concept of waste reduction at source.