Objective To examine the environmental life cycle from poppy farming through to production of 100 mg in 100 mL of intravenous morphine (standard infusion bag).
Design ‘Cradle-to-grave’ process-based life cycle assessment (observational).
Settings Australian opium poppy farms, and facilities for pelletising, manufacturing morphine, and sterilising and packaging bags of morphine.
Main outcome measures The environmental effects (eg, CO2 equivalent (‘CO2 e’) emissions and water use) of producing 100 mg of morphine. All aspects of morphine production from poppy farming, pelletising, bulk morphine manufacture through to final formulation. Industry-sourced and inventory-sourced databases were used for most inputs.
Results Morphine sulfate (100 mg in 100 mL) had a climate change effect of 204 g CO2 e (95% CI 189 to 280 g CO2 e), approximating the CO2 e emissions of driving an average car 1 km. Water use was 7.8 L (95% CI 6.7– to 9.0 L), primarily stemming from farming (6.7 L). All other environmental effects were minor and several orders of magnitude less than CO2 e emissions and water use. Almost 90% of CO2 e emissions occurred during the final stages of 100 mg of morphine manufacture. Morphine's packaging contributed 95 g CO2 e, which accounted for 46% of the total CO2 e (95% CI 82 to 155 g CO2 e). Mixing, filling and sterilisation of 100 mg morphine bags added a further 86 g CO2 e, which accounted for 42% (95% CI 80 to 92 g CO2 e). Poppy farming (6 g CO2 e, 3%), pelletising and manufacturing (18 g CO2 e, 9%) made smaller contributions to CO2 emissions.
Conclusions The environmental effects of growing opium poppies and manufacturing bulk morphine were small. The final stages of morphine production, particularly sterilisation and packaging, contributed to almost 90% of morphine's carbon footprint. Focused measures to improve the energy efficiency and sources for drug sterilisation and packaging could be explored as these are relevant to all drugs. Comparisons of the environmental effects of the production of other drugs and between oral and intravenous preparations are required.
- INTENSIVE & CRITICAL CARE
- PUBLIC HEALTH
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Contributors FMG conceived the study, obtained funding, assisted in the methods and in obtaining results, wrote and revised the manuscript, and agrees to be accountable for all aspects of the work involved. SMA assisted in study design and was the primary author who developed the methods and obtained the results. SMA also cowrote the manuscript and revisions. YO obtained the data and assisted in drafting the work as well as approving the final manuscript version. EN assisted in grant funding, data acquisition, analysis and interpretation, as well as manuscript preparation and approval of the final manuscript. KH contributed to the conception of the work, and assisted in grant funding, design of the methods and manuscript preparation. PM assisted in obtaining data and analysis, revised the manuscript and approved the final manuscript version. DS assisted in grant funding submission, data analysis and interpretation of the work, revised the manuscript and approved the final manuscript version.
Funding Financial support for this study was provided by Australian and New Zealand College of Anaesthetists (ANZCA) grant 2014.14 and additional support for YO's CHE4164 Integrated Industrial Project scholarship was provided by GSK Australia. A priori confidentiality agreements were signed between all authors and GSK, mandating that no precise details of any particular physical or chemical processes would be divulged in the public domain, and that GSK could not delay/prevent any manuscript submission beyond a reasonable timeframe. A similar informal agreement was also reached with Baxter, Australia, that would allow manuscript submission in a timely manner by the non-industry aligned authors. On 1 September 2015, GSK sold its opiate facilities in Australia to Sun Pharmaceutical Industries. Prior to this sale, GSK ceased production of morphine sulfate, but continues to manufacture less-refined technical morphine (95% pure by dry weight). We have kept the use of the term ‘GSK’ in this manuscript as they were the company involved in the study.
Competing interests FMG has received research grants and honorariums from ANZCA, SMA has received research grants and honorariums from ANZCA, YO has received research grants and honorariums from GSK Australia, EN worked for GSK Australia and now for SunPharma, KH has received research grants and honorariums from GSK Australia, DS has received research grants and honorariums from ANZCA and PM works for Baxter Australia.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement Data will not be made available due to the confidential nature of the original source data (ie, the preparation of morphine).
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