Breaking Lock-ins to Enable a Green Pharmacy.

Environmentally hazardous pharmaceuticals continue to be produced, used, and released to the environment, despite growing recognition of the need for greener drug design. This study applies a "lock-in" analytical framework to examine how various interacting social, economic, political, and technological factors prevent the effective implementation of concepts such as "benign by design" in drug development. Using a combination of qualitative and quantitative methods, including analysis of US and European clinical trial records, we identify two critical lock-ins: (1) misaligned timing of resources and expertise among key actors that prevents early integration of environmental safety and sustainability considerations in drug design, and (2) incentive structures that promote new drug development over the redesign of existing pharmaceuticals. Notably, this analysis identifies barriers to greening both future and existing drugs on the market. Building on Meadows' framework for effective interventions in complex systems, we propose a strategic approach for breaking lock-ins and present specific recommendations for key stakeholder groups including policymakers, academia, small biotech, big pharma, and financial institutions. Addressing these lock-ins is essential to unlocking the full potential of green innovation in pharmaceutical development, while providing for patient access to essential medicines.