OBJECTIVE: To estimate the global journey of a generic clonazepam pill to map steps of production, distribution, and disposal. DATA SOURCES: PubMed; Google Scholar; industry and market reports; gray literature; pharmaceutical databases (eg, PharmaCompass); export records; pharmacies in Hamilton, Ont; industry professionals and leaders such as pharmaceutical company vice presidents, professors, a supply chain insurance company, and sustainable procurement consulting companies; and an international not-for-profit company. STUDY SELECTION: Data related to clonazepam's standard pharmaceutical production process, life cycle system boundaries, and most probable production locations were included in this review. SYNTHESIS: This study depicts the estimated journey of a clonazepam pill's production and distribution, with the prescription being filled in Vancouver, BC. It begins with the extraction of salts to produce the active pharmaceutical ingredient. The main centres for clonazepam's active pharmaceutical ingredient and excipient salt extraction and production are in India and China. Quality testing and stocking occur elsewhere, such as within the European Union. The product is then shipped back to India for the next manufacturing stages. Excipients are shipped from China to India and are incorporated into formulation and tableting. The product is then sent to global markets for the final stages of pill formation and regional distribution. After shipment through Europe and Asia, the journey continues through several locations within the United States, specifically New Jersey, for the final stages of manufacturing. Once manufacturing is finalized in New Jersey, the pill is shipped to and repackaged in Tennessee for distribution and then sent to Canadian industry clusters, typically within the greater Toronto area in Ontario. Pills are then shipped to pharmacies and hospitals in Vancouver, BC, for consumer use. The total distance travelled in this scenario is approximately 63,162 km, not including the entire process of producing and shipping excipients or local retailer shipments. CONCLUSION: Health care prescribing practices have tangible environmental impacts and manufacturers should continue to invest in operational streamlining to reduce greenhouse gas emissions.
