Pharmacists Help Drive Environmental Sustainability

Environmental stewardship has long been an issue that matters to Laura M. Blackburn.

“I love to travel, and I scuba dive,” said Blackburn, drug information and formulary management specialist at Houston Methodist Hospital in Texas. “Seeing the corals bleaching and hearing about the warming oceans, and just understanding what goes into that — it’s something that’s impacted me.”

About four years ago, Blackburn met someone during her travels who had a degree in sustainability within the hospitality industry.

“So that got me thinking, ‘Well, that’s interesting. What is there available [related to sustainability] in healthcare?’” Blackburn said. “After doing a little bit of searching, I realized there wasn’t much.”

That’s no longer the case, and Blackburn’s own health system is helping to advance the sustainability movement in healthcare.

In 2023, Houston Methodist launched its Office of Sustainability as part of a systemwide effort to reduce waste and carbon emissions. Blackburn described the sustainability enterprise as top-down with grassroots support.

“There are local sustainability committees at each of the hospitals that are working on different projects. And then they’re supported through the Office of Sustainability to ensure that we are, in fact, doing the right things,” she said.

One issue the sustainability group has explored is how to reduce medical waste by recycling IV saline flushes.

“What we found out is that not all the saline flushes were actually recyclable,” Blackburn said. “We’re still working with the recycling company ... to make sure that the plastics we use are, indeed, recyclable.”

Houston Methodist Hospital is also collaborating with intensive care unit (ICU) clinicians at the Houston Methodist Center for Critical Care through the Green ICU movement. The hospital’s Green ICU goals include reducing the use of excessive resources, reusing equipment when possible, optimizing ICU length of stay, and maximizing recycling efforts.

Houston Methodist Hospital has described its critical care services as large producers of medical waste, with a single ICU reportedly using 1,464,262 medical supplies in six months.

“I think the biggest surprise for people, when we start talking about [sustainability], is the impact that healthcare has” on the environment, Blackburn said.

Since its inception in 2024, the hospital’s Green ICU initiative has expanded to critical care units throughout the Texas Medical Center and also led to the launch of Houston Methodist’s inaugural Green ICU Conference, held in September 2025. Blackburn was a featured speaker at the conference, and she has presented educational sessions on sustainability at other professional meetings.

A 2020 Health Affairs report estimated that the U.S. healthcare sector accounts for approximately 8.5% of domestic greenhouse gas emissions and about a quarter of all healthcare greenhouse gas emissions worldwide. The report urges healthcare organizations to measure and reduce their carbon emissions and adopt sustainable practices that reduce healthcare pollution and improve public health.

Results from ASHP’s 2026 Pharmacy Forecast report indicate that many pharmacists expect environmental sustainability practices to influence the everyday business of healthcare in the near future.

Forty-two percent of respondents who were surveyed for the forecast agreed that it’s somewhat or very likely, over the next five years, that health systems will factor waste minimization into purchasing decisions and reduce reliance on single-use supplies. And 30% of respondents said it’s somewhat or very likely that health-system pharmacies will opt to purchase medications that have a reduced carbon footprint.

Keaton Smetana, clinical pharmacy manager at OhioHealth in Columbus and a member of the recently formed ASHP Task Force on Environmental Sustainability, is helping put real numbers on the carbon cost of certain medications.

Smetana led a study on greenhouse gas emissions from metered-dose inhalers (MDIs) that use hydrofluoroalkane (HFA) propellants. The study results were published in the July 1, 2025, issue of AJHP.

Smetana and his colleagues found that over a single year, OhioHealth’s inpatient dispensing of albuterol MDIs and corticosteroid/long-acting β2-agonist MDIs produced the equivalent of 725.5 metric tons of carbon dioxide emissions. HFA propellants accounted for 718 metric tons of the emissions, and packaging components were responsible for the rest.

According to a federal online tool used for the study, the total emissions from the inhalers had an environmental impact equivalent to driving a gas-powered car about 1.8 million miles. Smetana said a single MDI produces emissions that are “the equivalent of driving 25 miles in a gas-powered car.”

Smetana said his health system is considering a switch to a common cannister system to reduce the environmental impact of MDIs. And he has been asking respiratory therapists to place partially used MDIs in bins for incineration when a patient is discharged.

“If you throw them away in trash, what happens is they’ll go to the landfill and then they’re off-gassing,” Smetana explained. “And over time, the entire contents of the HFAs are released.”

But he cautioned that these actions, though worthwhile, won’t solve the problem of MDI emissions.

“Even if we were to come up with solutions to mitigate a majority of HFAs on the inpatient side, it only accounts for 2% of inhalers that are dispensed across the nation,” Smetana said. “This is a much larger issue outside of hospitals.”

Smetana described OhioHealth’s sustainability group as like-minded people who want to mitigate waste, recycle what they can, and reduce environmental harm.

One topic that’s gotten the group’s attention is the need for hospitals to shut down their piped nitrous oxide systems. The gas is considered ozone-depleting, and it contributes far more than carbon dioxide to global warming.

The American Society of Anesthesiologists recommends that hospitals use portable nitrous oxide gas cannisters instead of piped systems. The recommendation is based on research showing that far more of the piped gas leaks into the environment than is used for clinical purposes.

“We’re opening up a women’s health tower in about a year’s time,” Smetana said. “And I think a big win for our sustainability team is they’re not even going to put in the piping for nitrous oxide. They have an agreement to move all of it over to these cylinders.”

Smetana said all pharmacists can take simple actions on their own — such as minimizing the purchasing of single-use plastics and reducing paper waste — to make their work more environmentally sustainable.

Blackburn urged pharmacists to view their everyday work through a sustainability lens. She said sustainable pharmacy practices encompass appropriate prescribing and deprescribing, antimicrobial stewardship, IV-to-oral therapy conversions, taking medication histories to inform prescribing, and performing medication reconciliation at hospital admission and discharge.

“I think that everything that the pharmacists do on a daily basis can be reframed as sustainability,” Blackburn said. “And reframing some of the things that we do can inspire others with different types of projects. Because sustainability needs to involve every aspect of the healthcare chain.”