The true price of overprescription
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· 5 min read
Pharmacy exists to help people. Yet many health systems prescribe more medicines than patients need. The result is waste, avoidable harm, and a growing load on the environment. The problem looks technical. In truth, it is cultural. It sits in habits, systems, and incentives that drifted from patient care toward volume. We can fix this. But first, we need to see it clearly.
Overprescribing is not rare. A national review in England estimated that at least one in ten prescription items may be unnecessary. That is tens of millions of items a year. It comes with risk of side effects, drug interactions, and waste. The review set out a plan: more shared decisions with patients, better guidance, and real alternatives to pills. It also linked overprescribing to the NHS net zero agenda, since every item carries a carbon cost.
The World Health Organization’s Medication Without Harm challenge asks systems to cut severe, avoidable medication harm by half. It targets three high-risk areas: polypharmacy, transitions of care, and high-risk situations. All three tie into overprescribing and waste.
Waste figures reveal the human and financial cost. A University of York analysis for the English NHS put annual medicines waste at about £300 million. That includes drugs stored unused at home, items returned to pharmacies, and stock discarded in care homes. Money aside, unused drugs signal deeper issues: weak follow-up, poor alignment with patient goals, and repeat prescribing that.1
Why do clinicians overprescribe? Studies point to a set of pressures. Doctors face time limits, guideline overload, and fear of missing a serious condition. This feeds defensive medicine. Some doctors prescribe to close a visit fast or to avoid a complaint. Patient expectation also matters. People often arrive wanting a drug — especially an antibiotic — and the easiest path is to say yes. These are rational responses inside a stressed system. But they are poor medicine.2,3,4
Repeat prescribing adds fuel. Most primary-care items in England are repeats. Until recently, there was no modern national guidance on how to run the process well. That gap made it easy for outdated items to keep printing month after month. In 2024, professional bodies released the first Repeat Prescribing Toolkit in 20 years and an “oversupply” dashboard — a step toward tighter stock control and safer renewals.
Polypharmacy is the other force. Many people live with more than one long-term condition. Each guideline adds drugs. The total list grows, often past what is safe or useful. NICE guidance on multimorbidity (NG56) urges a shift: start with what matters to the person, then reduce treatment burden where possible. That includes deprescribing — the planned and supervised dose reduction or stopping of medicines that may no longer help.5
Antibiotics deserve special attention. Misuse and overuse in primary care drive antimicrobial resistance (AMR). AMR already kills many people and threatens common care. Cutting unnecessary antibiotics reduces harm now and preserves future options.6
In homes. Surveys around the world show that many households keep unused medicines. Reasons include side effects, symptom resolution, dose changes, and death. Most people throw unused drugs in the trash or flush them. Only a small share use take-back routes. A 2024 systematic review found poor disposal knowledge and practice in the public.
In water. Every tablet has an afterlife. Some of the active ingredient is excreted. Unused drugs enter wastewater when flushed. Conventional treatment plants do not remove many compounds. Trace levels then show up in rivers. A global PNAS study found pharmaceutical pollution in more than a quarter of sampled rivers at levels that may pose risks. The list includes metformin, carbamazepine, and antibiotics. Drug residues alter fish behavior and reproduction.
Clinical ethics starts with the person in front of you. But prescribing to help one person can harm others through resistance, pollution, and cost. Shared decisions can help. Ask what the person values. Explain options, including no prescription. Many patients welcome fewer medicines if they understand the trade-offs. The NHS overprescribing review puts shared decision-making at the center for this reason.
Make repeat prescribing safe by default. Adopt toolkit processes. Use the oversupply dashboard.
Build deprescribing into routine care. Evidence supports structured medication reviews and taper plans.
Tackle antibiotics with precision. Follow antimicrobial stewardship guidelines.
Design disposal people will use. Reviews show uptake of take-back programs and community pharmacy pilots, though impact is mixed.
Cut environmental load at the plant. Advanced oxidation processes, ozonation, and activated carbon are already scaled in some European plants.7,8
Train for culture change. Teach deprescribing, stewardship, and sustainability in curricula and CPD.
Every prescription has a footprint: raw materials, synthesis, packaging, shipping, cold chain. Overprescribing adds carbon for no gain. Cutting low-value prescribing, therefore, means safer care and lower emissions. Policy now recognises this: the NHS overprescribing plan places carbon reduction alongside safety and value.
Patients deserve care that fits their lives: fewer drugs when fewer drugs are better, honest talk about benefit and risk, smaller initial supplies, easy return routes, and regular review.
Pharmacists can:
• Clean the list. Check duplication and indications.
• Coach the patient. Ask about unused items and explain return options.
• Close the loop. Report refill patterns and stockpiles to prescribers.
Stop equating “doing something” with prescribing. Stop 90-day quantities for new starts. Stop automatic repeats for short-term conditions. Stop assuming more guidelines mean more drugs. Stop outsourcing disposal to households.
Overprescribing risks patients, wastes money, and pollutes the environment. The fixes are practical: better repeat systems, deprescribing, antibiotic stewardship, easy returns, and cleaner wastewater. The ethics are simple: do what helps, avoid what harms, spend wisely. If we act on those rules, the numbers will move.
illuminem Voices is a democratic space presenting the thoughts and opinions of leading Sustainability & Energy writers, their opinions do not necessarily represent those of illuminem.
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