Assessing the environmental, financial, and social impact of immediate-release morphine tablets compared to oral morphine solution

Objectives Medications contribute 25% of NHS England’s carbon emissions, with the pharmaceutical sector significantly impacting its carbon footprint (CF). Limited research exists on the environmental impact of different formulations of the same drug. This project evaluated morphine, a potent opioid for moderate to severe pain, focusing on immediate-release (IR) formulations: oral tablets, oral solutions, and injections. Oral morphine solution is commonly the first line for acute or breakthrough pain. This study evaluates the environmental, financial, and social advantages of transitioning from IR oral morphine solution to IR oro-dispersible morphine tablets within a single National Health Service (NHS) Trust. Methods A bottom-up CF analysis was conducted on packaging materials. Cost comparisons and surveys of patients and staff evaluated financial and social impacts. Formulations studied were oral morphine solution (Oramorph 10 mg/5 ml) and Oro-dispersible tablets (Actimorph 10 mg). Key findings In two sites of a single NHS Trust (inpatients and discharges), switching entirely to tablets could reduce annual carbon dioxide emissions by 7350 kg of carbon dioxide equivalents (53%). Tablets could also eliminate an estimated 275 000 plastic syringes disposed of annually and £16 000 in equipment costs from a 100% switch. A limited patient survey showed that 90% of patients supported the use of environmentally friendly tablets as an alternative to liquid solution. Conclusions In conclusion, transitioning from oral morphine solutions to tablets has several benefits, including improving environmental sustainability, reducing costs, and enhancing patient care. Collaborative decision-making between healthcare providers and addressing operational challenges are essential for realizing these benefits.