The study, led by Sara M. Hanning of the University of Auckland’s School of Pharmacy with colleagues from the university and Middlemore Hospital, set out to answer three practical questions: how unwanted medicines are currently disposed of in community pharmacies, how many metered-dose inhalers are actually returned for disposal, and whether pharmacists would support a dedicated, low-carbon return scheme for inhalers. Between December 2023 and January 2024, an anonymous online questionnaire was emailed to 1,043 community pharmacies across New Zealand, drawn from the Medsafe pharmacy licence register. After reminders and data cleaning, 102 responses were complete enough for analysis, a response rate of roughly ten percent.

The headline finding was encouraging: 98 percent of responding pharmacies already collect unwanted or expired medicines for disposal, and most reported receiving returns at least weekly, with nearly 16 percent receiving them daily. The dominant disposal route was a dedicated pharmaceutical waste bin collected by a third-party contractor. In New Zealand, non-cytotoxic pharmaceutical waste is steam sterilised by autoclave and then sent to a dedicated landfill, because the country no longer operates any high-temperature incinerators for pharmaceuticals or other waste. Cytotoxic medicines are the exception, exported offshore for incineration.

But the survey also uncovered practices that fall short of the official pathway. Some pharmacies reported pouring liquid medicines down the sink, a method that introduces pharmaceutical compounds into wastewater, where they can persist through treatment plants and reach rivers and coastal waters. A handful of respondents said they returned unopened, in-date medicines to stock for re-dispensing, a practice the researchers warn against, since pharmacies cannot verify how medicines were stored once they left the premises. Others mentioned giving sealed, in-date medicines to medical aid charities or destroying controlled drugs by dissolving them into kitty litter. The variety of reported methods, the authors suggest, reflects a deeper problem: most pharmacists simply do not know what happens to waste after it leaves their premises. Only 15.7 percent felt informed or well informed about the fate of pharmaceutical waste, and 67.4 percent said they were not at all informed about the environmental impact of inhaler disposal.

The inhaler numbers were stark. Respondents estimated their pharmacies dispensed an average of 214 metered-dose inhalers per month, but received only about eight back for disposal, a return rate of under four percent. This aligns with earlier research showing that most consumers toss empty inhalers into household rubbish, despite consumer information leaflets instructing them to bring devices back to a pharmacy. Passive information channels, the authors conclude, are clearly not enough to change behaviour.

The climate stakes are considerable. Pressurised metered-dose inhalers accounted for 66 percent of inhalers prescribed in New Zealand in 2020, largely because they are cheaper than dry-powder or soft mist alternatives and better suited to patients who cannot generate the inspiratory force needed for powder devices, including children, older people and those with severe symptoms. The hydrofluorocarbon propellants they contain were introduced to replace ozone-destroying chlorofluorocarbons after the Montreal Protocol, but they are powerful greenhouse gases. A common propellant, HFA134a, has a heat-trapping potential roughly 1,300 times that of carbon dioxide, and a typical 200-puff salbutamol inhaler carries a footprint equivalent to 28 kilograms of carbon dioxide, comparable to driving a petrol car more than 120 kilometres. Because manufacturers fill canisters with excess propellant to guarantee every dose, gas remains even after all the medicine is used, and it lingers in the atmosphere for an average of 15 years.

When asked whether they would be interested in a dedicated recycling scheme for metered-dose inhalers, 42.7 percent of pharmacists said yes and 39.3 percent said maybe, with only 18 percent declining. The two biggest barriers, ranked by a weighted scoring method, were the administrative load on pharmacy staff and the financial cost to the pharmacy. The small number of inhalers returned by consumers ranked lowest among the barriers. Free-text comments captured the tension: one pharmacist wrote that they would want to know the procedure and full rationale first, since delivering medication was the priority and environmental concerns secondary; another noted that pharmacies spend significant staff time on returned medicines with no financial reimbursement, calling it yet another service community pharmacies provide for free.

Pharmacists also had clear views on what would motivate patients. Media advertisements promoting the scheme and financial incentives for returning inhalers ranked highest, while reminders at the point of dispensing ranked lowest, echoing the finding that passive advice has little effect. International evidence suggests such schemes can work. A 12-month postal pilot in one English region collected more than 20,000 inhalers, 77 percent of them pressurised devices, and recycled the propellant gases for refrigeration, the aluminium canisters into smelting bricks and the plastic casings into pellets, preventing an estimated minimum of 119 tonnes of carbon dioxide equivalent from entering the atmosphere. Yet scale matters: the UK’s Complete the Cycle scheme, which recycled two million inhalers over nine years, closed in 2020 because its creator concluded that a standalone scheme could not achieve adequate scale without industry-wide cooperation. In New Zealand, a six-month inhaler recycling trial began in the Bay of Plenty in June 2025, and a refrigerant destruction facility using plasma arc technology is under construction in the North Island, potentially offering a domestic route for capturing and destroying propellant gases.

The researchers argue that a product stewardship model, in which responsibility is shared across manufacturers, importers, distributors, pharmacies and consumers, may be the fairest path forward, with pharmacies forming one link in a larger technological chain. New Zealand already has precedent for such schemes with synthetic refrigerants, and the regulatory and administrative infrastructure exists. To ease the burden on pharmacies, the authors propose a scheme that integrates seamlessly with existing medicine return systems, supported by centralised automated administration, government funding, space-conscious collection containers and regular scheduled pick-ups. Consumer-side measures could range from money-back incentives on prescription costs, as trialled in Sweden, to low-cost local prize draws like one running at a general practice on Vancouver Island, Canada.

The study has limitations the authors acknowledge candidly. The ten percent response rate, likely worsened by staffing shortages, pharmacist burnout and the timing of invitations over the Christmas and New Year holiday period, means the sample may over-represent pharmacists already interested in sustainability, potentially inflating estimates of willingness to participate. Still, the direction of the findings is clear: pharmacies overwhelmingly accept returned medicines, most feel responsible for safe disposal, and most are open to an inhaler scheme if cost and paperwork are addressed. The next phase of the research will use semi-structured interviews with pharmacists and inhaler users to map barriers and encouragers in more detail, alongside work to establish cost-effective pathways for emptying and decontaminating canisters so that aluminium and plastic components can re-enter the circular economy. With New Zealand committed to cutting net carbon dioxide emissions to 50 percent below 2005 levels by 2030 and reaching net zero for most greenhouse gases by 2050, capturing the greenhouse gases hiding in medicine cabinets and rubbish bins may prove one of the quieter but more achievable wins in healthcare’s climate transition.

Subject of Research: Pharmaceutical waste disposal practices in community pharmacies and the feasibility of a low-carbon return scheme for metered-dose inhalers in New Zealand

Article Title: Disposal practices for unwanted medicines in New Zealand community pharmacies and their willingness to support a low-carbon return scheme for metered-dose inhalers

Article References: Hanning, S. M., Barnes, M., Burrell, R., & Aspden, T. J. (2026). Disposal practices for unwanted medicines in New Zealand community pharmacies and their willingness to support a low-carbon return scheme for metered-dose inhalers. Clean Technologies and Environmental Policy, 28(10), Article 262. https://doi.org/10.1007/s10098-026-03622-5

Image Credits: AI Generated

DOI: 10.1007/s10098-026-03622-5

Keywords: community pharmacy, pharmaceutical waste, metered-dose inhalers, hydrofluorocarbons, greenhouse gas emissions, inhaler recycling, New Zealand, planetary health, medicine disposal, product stewardship, environmental sustainability, asthma

The study, conducted by researchers affiliated with Georgetown University School of Medicine and the Department of Dermatology at MedStar Washington Hospital Center in Washington, DC, and approved under Georgetown’s institutional review board, addresses an issue that sits at the intersection of clinical practice, health economics, and environmental sustainability. The work arrives at a moment when medicine broadly, and dermatology specifically, is being asked to account for its environmental footprint. Health care is a major contributor to greenhouse gas emissions, and outpatient specialties have increasingly turned their attention to the waste generated by everyday procedures, from single-use instruments to discarded medications.

Triamcinolone acetonide is typically supplied in small vials that are labeled for single-dose use, even when the vial contains far more medication than a single injection requires. Regulatory guidance discourages the reuse of vials designated as single-dose because of the risk of contamination, which means that whatever remains after a patient’s injection is discarded. The scale of that discard is easy to underestimate. A clinic that injects a fraction of a milliliter into a hypertrophic scar may open a vial containing several milliliters, use a small portion, and consign the rest, along with the vial itself, to the waste stream. Multiplied across thousands of patient encounters, the arithmetic becomes sobering.

The problem is not unique to dermatology, and the authors situate their work within a broader policy conversation. A 2021 report from the National Academies of Sciences, Engineering, and Medicine examined the implications of discarded drugs from single-dose vials, highlighting how weight-based dosing and conservative vial sizing combine to produce systematic waste across medicine. That report noted that the issue is structural rather than a matter of individual carelessness: clinicians follow labeling and infection-control rules, and the waste follows from how products are packaged and regulated. The dermatology research letter brings that structural analysis down to the level of a single, ubiquitous injection practice.

To quantify waste, the researchers drew on established methodologies from the emerging field of sustainable health care. Their reference list points to a carbon footprint analysis of an outpatient dermatology practice at an academic medical center, published in JAMA Dermatology, which demonstrated that routine clinical activities carry measurable emissions when materials, energy use, and waste streams are tallied. It also cites the United Kingdom Government’s greenhouse gas conversion factors for electricity, accessed through the Climatiq emissions database, and the United States Environmental Protection Agency’s greenhouse gas equivalencies calculator, tools that allow researchers to translate consumption and waste into carbon terms that can be compared across settings.

The technical logic of such analyses is worth unpacking, because it explains why a seemingly trivial injection can carry a nontrivial footprint. Each vial of medication embodies not only the active pharmaceutical ingredient but also the glass, rubber stopper, aluminum seal, packaging, sterilization processes, and cold-chain or ambient transport that brought it to the clinic. When a fraction of a vial is used and the remainder discarded, all of that embedded material and energy is written off. Add the syringe, needle, alcohol prep pad, gauze, and gloves used for the injection itself, and each procedure generates a stream of single-use items destined for regulated medical waste, which is often autoclaved or incinerated, processes that themselves consume energy and generate emissions.

Crucially, the authors also looked toward solutions rather than merely documenting the problem. Their references include a 2023 study on vial-splitting and repackaging into aliquot-specific syringes as a cost-effective and waste-decreasing strategy for sugammadex, an anesthesiology medication. That approach, in which a larger vial is divided under sterile conditions into pre-measured aliquots matched to typical doses, has been proposed as a way to use more of each vial’s contents while preserving safety. Adapting such strategies to dermatology, where triamcinolone injections follow fairly predictable dosing patterns, offers a concrete pathway for reducing both pharmaceutical waste and the per-injection carbon burden.

The broader context for this work is a growing sustainability movement within dermatology. A 2025 review in the Journal of the American Academy of Dermatology’s sister journal, titled Going Green in Dermatology, surveyed the specialty’s environmental impact and the strategies available to shrink it, from waste segregation and recycling programs to rethinking supply chains and medication use. Dermatology clinics are well positioned for such efforts because much of their work is procedural and outpatient-based, meaning that changes in practice patterns can be implemented locally without the complex infrastructure changes required in operating theaters or intensive care units. The triamcinolone study adds a granular, medication-specific data point to that agenda.

What makes the research letter notable is its framing of waste as a quantifiable, and therefore manageable, quantity. By measuring how much triamcinolone is discarded under current practice and modeling what could be saved under alternative approaches, the authors convert an abstract concern into a set of numbers that clinic managers, pharmacy committees, and professional societies can act upon. The methodology also demonstrates that such analyses can be carried out with publicly available emissions factors and standard calculators, lowering the barrier for other departments and specialties to replicate the approach for their own high-volume medications and procedures.

The implications extend beyond one drug or one specialty. Single-dose vial policies exist for good reasons, and any strategy to reduce waste must navigate infection-control standards, regulatory constraints on compounding and repackaging, and the practical realities of clinic workflow. The National Academies report made clear that meaningful change will likely require action at multiple levels, including manufacturers, regulators, payers, and professional bodies, rather than relying solely on individual clinicians to squeeze more use from each vial. Studies like this one supply the evidence base that such systemic conversations require, showing where the waste concentrates and which interventions offer the greatest return.

For clinicians, the message is that sustainability and good stewardship can align with patient care rather than compete with it. Reducing discarded medication lowers costs, shrinks the waste stream, and cuts emissions, all without altering the dose a patient receives. For patients, the sight of a syringe drawn from a vial is unlikely to change, but the systems behind it may. As health systems face increasing pressure to decarbonize, the humble triamcinolone injection has become an unlikely case study in how careful measurement, borrowed techniques from other fields, and attention to the full life cycle of a medication can turn routine practice into an opportunity for meaningful improvement. The Georgetown and MedStar team’s work suggests that even the smallest procedures, examined closely enough, reveal both the scale of medicine’s waste problem and the practical routes out of it.

Subject of Research: Quantifying and reducing pharmaceutical waste in dermatologic triamcinolone injection practices

Article Title: Quantifying and reducing waste with triamcinolone injection practices

Article References: Bui, J. K., Chow, C., Greer, M., Lindberg, M., & Stringer, T. (2026). Quantifying and reducing waste with triamcinolone injection practices. Archives of Dermatological Research, 318(1), Article 492. https://doi.org/10.1007/s00403-026-04988-8

Image Credits: AI Generated

DOI: 10.1007/s00403-026-04988-8

Keywords: triamcinolone acetonide, dermatology, pharmaceutical waste, single-dose vials, vial-splitting, carbon footprint, sustainable health care, greenhouse gas emissions, medical waste, corticosteroid injections, health care sustainability, National Academies report