Pharmaceutical Waste Reduction Strategies

Provide non-pharmalogical alternatives

This strategy involves creating an environment or offering treatment alternatives which can help people heal faster with fewer drugs. For example, a healthcare provider may serve healthy fresh food and beverages, incorporate natural designs, increase use of natural light, or create spaces for meditation such as healing gardens. The provider may also offer non-pharmalogic interventions, such as acupuncture or yoga or playing meditative music before surgery, in order to help patients rely less on medications.

Reduces Amount: Yes
Reduces Toxicity: No

Examples of Applying this Strategy

Music Medicine Interventions: "People awaiting surgical procedures often experience high levels of anxiety. Such anxiety may result in negative bodily responses, such as increased blood pressure and heart rate, leading to slower wound healing and increased risk of infection. High anxiety may also affect the start of anaesthesia and slow down postoperative recovery. To reduce patient anxiety, sedatives and anti-anxiety drugs are regularly administered before surgery. However, these often have negative side effects, such as causing drowsiness and breathing difficulties, and may interact with anaesthetic drugs to prolong patient recovery and discharge. Therefore, increasing attention is being paid to music therapy and music medicine interventions, amongst other non-pharmacological interventions, for reduction of preoperative anxiety. Interventions are categorized as 'music medicine' when passive listening to pre-recorded music is offered by medical personnel. In contrast, music therapy requires the implementation of a music intervention by a trained music therapist, the presence of a therapeutic process, and the use of personally tailored music experiences. A systematic review was needed to gauge the efficacy of both music therapy and music medicine interventions for reduction of preoperative anxiety. The review included 26 trials with a total of 2051 participants. The findings suggested that music listening may have a beneficial effect on preoperative anxiety. Most trials presented some methodological weakness. Therefore, these results need to be interpreted with caution. However, these findings are consistent with the findings of three other Cochrane systematic reviews on the use of music interventions for anxiety reduction in medical patients. Therefore, we conclude that music interventions may provide a viable alternative to sedatives and anti-anxiety drugs for reducing preoperative anxiety." The above paragraphs are the Plain Language Summary of the article, quoted from the Cochrane Library.

For more information:

Bradt J, Dileo C, Shim M. Music interventions for preoperative anxiety. Cochrane Database of Systematic Reviews 2013, Issue 6. Art. No.: CD006908. DOI: 10.1002/14651858.CD006908.pub2.

Bradt, Joke
Department of Creative Arts Therapies, College of Nursing and Health Professions, Drexel University
1505 Race Street, Rm 1041
Philadelphia, PA, 19102


The mirthful laughter experience appears to reduce serum levels of cortisol, dopac, epinephrine, and growth hormone. These biochemical changes have implications for the reversal of the neuroendocrine and classical stress hormone response. Positive emotional activities have been suggested as modifiers of neuroendocrine hormones involved in the classical stress response. To detect changes in these components during a mirthful laughter experience, the authors studied 10 healthy male subjects. Five experimental subjects viewed a 60 minute humor video and five control subjects did not. Serial blood samples were measured for corticotropin (ACTH), cortisol, beta-endorphin, 3,4-dihydrophenylacetic acid (dopac)--the major serum neuronal catabolite of dopamine, epinephrine, norepinephrine, growth hormone, and prolactin. Repeated measures analysis of variance showed that cortisol and dopac in the experimental group decreased more rapidly from baseline than the control group (p = 0.011, p = 0.025, respectively). Epinephrine levels in the experimental group were significantly lower than the control at all time points (p = 0.017). Growth hormone levels in the experimental group significantly increased during baseline (p = 0.027) and then decreased with laughter intervention (p less than 0.0005), whereas, the controls did not change over time (p = 0.787). ACTH, beta-endorphin, prolactin, and norepinephrine levels did not significantly increase.

For more information:

Berk, LS, et al., 1989. Neuroendocrine and stress hormone changes during mirthful laughter, Am J Med Sci, 1989 Dec;298(6):390-6. PubMed PMID: 2556917.

Berk, Lee S.
Dept. of Pathology, Loma Linda University School of Medicine
Loma Linda, CA

Generic Drug: Nitroglycerin

BACKGROUND: Catecholamines, especially epinephrine, are implicated in causing arrhythmias, hypertension, and recurrence of myocardial infarction (MI). Diminishing or blocking the effect of catecholamines is useful in cardiac rehabilitation. We have shown previously that a single 1-hour viewing of a humorous video attenuates epinephrine production. DESIGN: We hypothesized that daily participation in viewing humor would diminish catecholamine production and improve cardiac rehabilitation. METHODS: Forty-eight diabetic patients who had recently experienced an MI were divided into 2 matched groups and followed for 1 year in their cardiac rehabilitation programs. The experimental humor group was asked to view self-selected humor for 30 minutes daily as an adjunct to the standard cardiac therapy. Blood pressure, urinary and plasma epinephrine and norepinephrine levels, and 24-hour Holter recording were monitored monthly in both experimental humor and control groups. RESULTS: The patients in the humor group had fewer episodes of arrhythmias, lower blood pressure, lower urinary and plasma epinephrine and norepinephrine levels, less use of nitroglycerin for angina, and a markedly lower incidence of recurrent MI (2/24) than did the control group (10/24). CONCLUSION: Humor appears to attenuate catecholamines and MI recurrence and thus may be an effective adjunct in post-MI care.

Proprietary Drug(s): Nitroglycerin
Delivery Method(s): Oral Tablet

For more information:

Tan SA, Tan LG, Lukman ST, Berk LS., 2007. Humor, as an adjunct therapy in cardiac rehabilitation, attenuates catecholamines and myocardial infarction recurrence, Adv Mind Body Med. 2007 Winter;22(3-4):8-12.

Tan, SA
Section of Endocrinology, Loma Linda University
Loma Linda, CA

This study investigated whether clown intervention could reduce preoperative worries and the affective responses of children undergoing minor surgery. Parental anxiety was also tested. Child's age, previous hospitalization, and temperament were tested as predictors of the child's responses during this preoperative phase. Seventy children were assigned to one of two groups: children accompanied by their parents and a pair of clowns or, those accompanied by the parents but without the clowns. The results emphasized the relevance of clown intervention on the reduction of preoperative worries and emotional responses, not only in children but also in their parents.

For more information:

J Health Psychol. 2010 Apr;15(3):405-15. doi: 10.1177/1359105309350231

Fernandes, SC, Lisbon University Institute
Lisbon, Portugal

Pediatric hypnosis has a useful role in pre-, peri-, and post-anesthesia to minimize anticipatory anxiety, and as adjunctive treatment to reduce and control pain. This article reviews the literature in the use of hypnosis in pediatric anesthesia to highlight its role and relevancy.

For more information:

Kuttner, L. (2012), Pediatric hypnosis: pre-, peri-, and post-anesthesia. Pediatric Anesthesia, 22: 573577. doi: 10.1111/j.1460-9592.2012.03860.x

Leora Kuttner
#204-1089 W Broadway, Vancouver, BC V6H 1E5, Canada

Generic Drug: Leptospermum scoparium

Citation presents information that honey has very little (if any) side effects when used topically for infection, and cites studies that show honey can be 5 times as effective as an antimicrobial. Further study may be needed, but this could be a viable option for reducing pharmaceutical costs for wound healing. Although the article does not document waste reduction in a specific case study, it does assert that Manuka honey is currently used widely in wound care and as a topical antibacterial, antifungal, and anti-inflammatory. Review of the literature supports a very effective and low-risk botanical intervention that is both cost-effective and easily accessible. There is future scope for the use of L. scoparium oil products in nursing and potential for further research to continue to discover its effectiveness.

Proprietary Drug(s): Manuka honey products; MEDIHONEY
Delivery Method(s): Topical Ointment/Cream

For more information:

J Holist Nurs. 2013 Sep;31(3):200-3. doi: 10.1177/0898010113481405. Epub 2013 Mar 27.

Old, Natasha
Gold Coast, Australia

Additional Resources

The NCCAM Clearinghouse offers information, publications and searches of medical and scientific literature related to Complementary and Alternative Medicine. NCCAM is part of the US National Institutes of Health.

The Center for Health Design (CHD) can help you transform your healthcare environments for healthier patient outcomes

CHD offers a library of evidence-based design references.  It includes healthcare design research papers, articles and references produced by both CHD and the industry.

Laughter is well known for its health benefits.  Neuroscientist Robert R. Provine has written Laughter: A Scientific Investigation for those who wish to know more.  Laughter yoga, started by a doctor and a yoga teacher, is an international movement.

Huddleston, Peggy, "Prepare for Surgery, Heal Faster: A Guide of Mind-Body Techniques." Angel Rivers Publishing, 2012. Print.

Smith, Jerry, 2007, “Design with Nature,” Healthcare Design Magazine

Kreisberg, Joel, 2008, "Green Medicine: An Integral Approach that Benefits Physicians, Patients, Communities and the Environment," Integrative Medicine, Vol. 6, No. 6, Dec 2007/Jan 2008 

Avis, Kristen, 2013, "The Impact of Green in Healthcare," Design Build Source

Loder, Angela and Jerry Smith, 2013, "Designing Access to Nature in Healthcare," Healthcare Design Magazine

One might search the internet for "non-pharmalogic interventions" for more on this strategy.  

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