Your Inhalers and EpiPens Aren’t Very Healthy for the Environment

Single-use insulin pens changed Brian Brandell’s life.

Growing up with Type 1 diabetes in the 1970s, he had to carry glass syringes and vials of insulin wherever he went. So in 1985, when Novo Nordisk debuted a disposable prefilled pen that combined several doses of medication with a syringe, Dr. Brandell readily adopted the new device.

“They were a godsend,” he recalled.

But more recently, he began weighing the effects of all the plastic in the pens he had thrown away over the years, and the potential harm to people and his surroundings.

“I’m using this lifesaving product,” he said with frustration, “but in order for me to use it, I’ve got to be willing to damage the environment.”

It’s no secret that the world has a plastic problem. The versatile, durable and cheap material is clogging the world’s oceans, leaching toxins into its biomes and contributing to climate change. Some countries have been drafting a treaty proposal that might ban select single-use products and set goals for reducing plastics production worldwide. But negotiations have snagged over opposition from the fossil fuel and chemical industries.

Worldwide, the health care industry used more than 24 billion pounds of plastic in 2023, and is forecast to generate 38 billion pounds annually by 2028, according to BCC Research, a global market research firm.

Typically manufactured from fossil fuels, plastic is also a major source of greenhouse gas emissions. In the United States, the health sector accounts for eight percent of the country’s carbon footprint.

Medical device companies say they are trying to reduce the waste, whether by recovering and recycling products, decreasing the amount of plastic in devices and the packaging, or by redesigning items with materials that are not petroleum-based.

For the average person, the most visible health care detritus are disposable apparatuses used at home, from respiratory inhalers to syringes to tampon applicators to oxygen masks and tubing.

Mitch Ratcliffe, the publisher of Earth911, a website containing a vast database of U.S. recycling facilities, said there was little hope of recycling these items right now. That’s in part due to their irregular size, safety concerns that non-sterile elements could spread disease, and because they are often composed of materials that can’t be processed together. “We have an incredibly complex economy full of intricately designed stuff. We just never thought about taking it apart again.”

Few devices are more ubiquitous than insulin pens. About a third of the 37 million Americans with diabetes manage the disease with insulin, according to the Centers for Disease Control and Prevention.

Novo Nordisk alone manufactured 750 million insulin pens in 2021, made of more than 28 million pounds of plastic. The pens include a glass vial in a plastic frame, and are not designed to be disassembled into parts for the purpose of recycling. Nearly all are believed to end up in the household trash.

Dr. Brandell, of Oregon City, has been trying to do something about the discarded devices. A biomedical engineer, he spent his career developing pacemakers, defibrillators and catheters. Semi-retired in 2021, he worked with a partner to design a hand-held gadget that neatly cuts the insulin pens so that they can be taken apart. It also works on the plastic dispensers for Ozempic, the diabetes drug that millions of people are now taking for weight loss.

But Dr. Brandell conceded that dismantling the pens was just the first step. The plastic in the pens is high quality, but not a type easily processed by municipal recycling sites. It would probably get bundled with other plastics and could still wind up in a landfill or incinerator.

He is also exploring whether his gadget, also made of plastic, can be manufactured with bamboo or another sustainable material. “It’s pretty hard to sell somebody on the idea that I want you to buy this plastic device so you can save some plastic,” he said.

Global biomedical giants are facing increasing public pressure to change the life cycle of their products. Novo Nordisk has said that it planned to redesign its products to meet a goal of net zero emissions by 2045.

That’s a shift from the company’s history, when disposability was a desirable convenience. “Nobody thought about designing it for circularity, or thinking about the material that we should use, or limiting the thickness of the plastic,” said Katrine DiBona, a company vice president.

In 2020 the company started a program in three Danish cities to recycle used insulin pens. It provided pharmacists with collection bags to give to patients picking up prescriptions, who could then return the used devices on the next visit. Then a third-party recycling company collected the pens for disassembly, sterilization and processing.

Novo Nordisk has since expanded the program nationwide and opened it up to its competitors, and begun pilot efforts in the United Kingdom, France and Brazil. But public behavior is difficult to alter. By the end of 2023, only 21 percent of the company’s pen users in Denmark had returned devices.

GSK, which sells more than 200 million respiratory inhalers a year, ran into similar problems with a take-back scheme for the devices in the United Kingdom from 2011 to 2020. The inhalers’ plastic components are recyclable by most curbside collection programs, but the aluminum canisters containing the medication are not. So the company collected used devices at pharmacies, recycled the components that it could, and incinerated the rest.

The program never generated much interest from consumers, however. Over nine years, only 24,000 pounds of plastic were recovered from the inhalers, which Claire Lund, the company’s vice president for sustainability, called “absolutely minuscule” in comparison to the roughly 5 million pounds of plastic needed to produce the inhalers each year.

Of more concern to environmentalists is the propellant in many inhalers, typically a fluorinated gas that is a more powerful driver of global warming than carbon dioxide. In 2021, GSK began developing a substitute, which Ms. Lund suggested could significantly reduce carbon emissions.

But the company is still running tests on the new formulation, and anticipates that it will take years to obtain approval of the replacement in the 140 markets where the existing ones are sold.

Ms. Lund said the company had toyed with creating a reusable product. “It’s been on the table so many times and then kicked back,” she said.

In contrast to Novo Nordisk’s boutique focus on recovering material from a specific product, the U.S. waste management company Triumvirate Environmental is seeking commercial applications for repurposed medical waste.

In 2014, the company purchased machinery from a plastic lumber business and grafted it onto the back of a medical waste plant in Jeannette, Pa., with the idea of converting some refuse into useful products.

John McQuillan, the company’s chief executive, said that the plant, after $70 million in investment, was receiving waste from hospitals and pharmaceutical companies — “some of the most disgusting stuff on the face of the planet” — and processing it through a complex set of machines.

Much of the waste is still incinerated, but items composed of useful plastics, including containers stuffed with syringes and surgical tools wrapped in packaging, are identified, shredded and converted into building materials.

“It’s like a smelly Willy Wonka,” he said.

The process is six to eight times costlier than bulldozing the waste into a hole in the ground, Mr. McQuillan estimated, although Triumvirate recoups some costs from the sale of the final products.

There is no lack of interest from health care companies, which provide far more plastic waste than the Triumvirate plant can process. The rate-limiting factor, instead, is demand for the structural plastic lumber they produce, which is utilitarian and has to compete with alternatives made from cheap plastics. “It comes in whatever color you want, so long as it’s black, and so long as your definition of black is pretty liberal,” Mr. McQuillan said.

Still, in 2022 Triumvirate sold 12 million pounds of the stuff, including to Menards and Home Depot, which market it for landscaping and as underlay for turf fields.

Like most recycling, the process is energy intensive. The plant mainly receives plastic waste from customers in the northeastern United States, because the materials tend to be loosely packed, so they are expensive to transport long distances.

Scientists point out that this expenditure of energy nearly eliminates the environmental benefits. Recycling a product typically recovers less than 10 percent of its carbon footprint, according to Dr. Andrea MacNeill, founder of the Planetary Healthcare Lab at the University of British Columbia, because most of a product’s environmental impact occurs during its manufacture. “We’re never going to recycle our way to a healthy planet,” she said.

It was far more important that manufacturers design products capable of years of reuse, she said, adding that this would require transforming their business models, too. “Right now, their profit margin depends on high-volume consumption.”

The next advances in sustainable medical device design might occur in the stocky brick and glass headquarters of Battelle, a nonprofit research and development institute in Columbus, Ohio. Although the organization mainly handles yearslong projects for the U.S. military and the Department of Energy, hundreds of staff members work with name-brand medical companies to redesign their products.

The medical devices team dominates an entire floor of one building. Some scientists there are trying to turn soybeans into usable plastics that could be substituted for traditional petroleum-based ones. Others are using large stainless-steel reactors to study how the substances degrade.

Erik Edwards, one of Battelle’s principal materials scientists, said that the Food and Drug Administration’s review process for new devices has led the team to tweak existing products rather than propose wholesale changes. For example, they are helping a drug company redesign an insulin device to remove a single disposable plastic part. “The approach that you take is more of a thousand small steps,” he said.

Improving packaging could be low-hanging fruit, he said. Several years ago, the lab received an order of palm-size medical devices, and they arrived in several pallets worth of boxes. “There was all this shipping of air that had been done just because the packaging took up more room than it needed to,” he recalled.

Mr. Edwards said Battelle’s clients generally prefer changes that reduce costs or improve performance, but sustainability was becoming more of a factor.

Grace Lillie, a mechanical engineer, compared the evolution to changes in the ways milk was sold over time. People once retrieved glass bottles from their doorstep and returned empty ones for reuse, but the introduction of disposable plastic jugs eliminated the profession of the milkman. Reducing reliance on plastic may mean resurrecting some processes and roles.

“You want people to do something different, but then you have to rely on the culture to adjust,” she said.