HOUSEHOLD PHARMACEUTICAL DISPOSAL PRACTICES

 

Pharmaceutical products are major sources of pollution all over the world. The consumption and production of pharmaceutical products increased due to demographic explosion, changing lifestyle & epidemiology, increasing chronic health issues, availability of low priced generic medicines, evolution in clinical practices (OECD 2022). Irrational consumption and disposal behaviours of the public lead to pharmaceutical pollution (Vatovec et al 2016, 2017). 

The  household pharmaceutical waste is 3% to 50%  in Organisation for Economic Co-operation and Development (OECD 2022) countries. The unused pharmaceutical products  are kept at households until they meet their expiry period before its disposal. 

Non-adherence due to side effects and early recovery  are the some of the  reasons for unused medicines in the households. Study shows that , more than half of the respondents  disposed-off this unused  medicines with household garbage. 

Others flush the unused medicines into the sink, water bodies, or use as plant fertilisers. Some people believe that waste water treatment removes all the pharmaceutical contents before reaching any waterbody (Bhayana et al 2016; Monga et al 2020)

There are no proper guidelines for disposing of household  pharmaceutical waste. People are not  aware of the  environmental impacts due to unethical disposal practices. In India, the Solid Waste Management (SWM) Rules, 2016 provide guidelines for house­hold waste management. 

According to the SWM Rules 2016, the waste generator is responsible for segregating waste into three separate streams: biodegradable, non-biodegradable, and domestic hazardous wastes in suitable bins. Biodegradable wastes shall be stored in bins painted green, recyclable wastes in bins painted white and other wastes in bins coloured black.

According to SWM Rules 2016, it is the duty of local authorities to  transport the non-biodegradable wastes to the respective processing facility, material recovery facilities, or secondary storage facility. It mentions about the establishment of waste deposition centres for domestic hazardous waste. 

According to rule, one centre is set up for an area of 20 square kilometres or less. The centres shall notify the timings of receiving domestic hazardous waste, treatment, storage, and disposal facilities (TSDFs) function across the country for the scientific and systematic management of hazardous waste.

 According to the National Annual Inventory report of Hazardous Waste Generating Industries and Hazardous Waste Management in India 2020–21, only Madhya Pradesh and Tamil Nadu have established deposition centres. 

There are only 29 common TSDFs and 920 captive facilities with incinerators (National Inventory on Generation and Management of Hazardous and Other Wastes 2020–21) . 

None of the legislations cover the need for the proper disposal of medicines. In accordance with the SWM rules, expired medicines, used needles, contaminated gauges, etc, generated at the household level come under the “domestic hazardous waste” category, along with discarded paint drums, pesticide cans, compact fluorescent lamps (CFL), and tube lights.

Drug take-back systems, are globally practised for medicine waste disposal from households, but SWM rules does not mention anything about it. The lack of  infrastructure & hazardous waste processing technology worsening the situations. Ecopharmacovigilance (EPV) is seen as an alternative, which involves activities associated with detecting, evaluating, understanding, and preventing adverse effects of pharmaceuticals in the environment . 

In India, research regarding the presence of pharmaceutical compounds in the environment is poor. Various medicines like non-steroidal anti-inflammatory drugs (NSAIDs), statins, antihypertensives, stimulants, anticonvulsants, antibacterials, and antibiotics were found in concentration even more than human therapeutic blood plasma concentrations (Sharma et al 2019; Sackaria and Elango 2020). 

The higher concentrations of these medicines in Indian rivers are a result of higher usage & the lack of efficient sewage treatment. Because, easily degradable medicines, like acetylsalicylic acid, which can be  removed by modern sewage set-ups, were also detected in the Indian rivers (Shanmugam et al 2014). 

Ecopharmacovigilance insists that, pollution must be controlled at the source. As, households are the major sources of medicinal waste, initiatives must be taken to control inappropriate disposal behaviours.

STRATEGIES FOR ACTIONS

Strategies such as fostering environmental consciousness and behaviour, policy-framing and implementation, targeted continuous EPV, and integration of circular economy principles. 

Introducing the new practices in organizations, services, and systems requires in individual and collective human behaviour (Michie et al 2011). A medicine take back system cannot be operated effectively without the active participation of the residents in it (Lv et al 2021).  Mentioning the disposal information along with the other important labelling similar to the United States (US) “DailyMed”, can enable the consumers to take informed decision.

Studies shows that there is no significant direct positive effect of the  awareness of public environment on the proper return behaviour (Lv et al 2021; Manocha et al 2020). But, knowledge about the disposal practices & the personal norms of an individual, can influence the proper return behaviour. 

If the collection point set-up is not convenient to the individual, it will affect the disposal behaviour of those who are highly committed for protection of environment. (Foon et al 2020). 

There is a need to combine the strategies, like increasing the accessibility of the collection points, incentivisation, guidance, and awareness to promote public behaviour towards medicine return. 

POLICY FRAMING & IMPLEMENTATION

In the wake of increasing environmental problems, governments must promote sustainable practices rather than relying on market mechanisms to make these transformations (Khodke et al 2021). 

The creation of extended producer responsibility (EPR) clause with proper monitoring of the free ride by e-pharmacies, online sales, and postal deliveries.  Marketplaces for the redistribution shall be encouraged. 

According to OECD there is a need of a national policy & strategy which includes, source-directed, user-orientated, and end-of-pipe measures targeting stakeholders throughout the life cycle of pharmaceuticals. It should be using a combination of voluntary, economic, and regulatory instruments. Prioritisation of improving disease prevention, precision medicine, & the packaging. 

CIRCULAR ECONOMY PRINCIPLE 

A circular economy entails markets that give incentives to reusing products, rather than scrapping them and then extracting new resources. It aims to detangle economy and ecology. It means keeping the end-of-use medicines as long as possible in the economic and social cycle of use (Viegas et al 2019). 

Various waste practices have been proven to endorse the philosophy of circular economy, which includes drug donations, return schemes for medication reuse, recovery of the active pharmaceutical ingredient and safe disposal.

During the COVID-19 pandemic, the National Health Service (NHS) in the United Kingdom (UK) had released guidelines for re-dispensing the medications in an attempt to manage medicine shortages and deficiencies during that time. Such guidelines can help the pharmacist re-dispense the medications, which can help reduce the pharmacy waste (Alshemari et al 2020).

Reverse logistics, which is considered as a limited version of circular economy, involves the collection of goods from end-consumers, sorting of the goods received, disposal of goods, and retrieval of components at various stages in the supply chain remanufacturing processes (Viegas et al 2019).

The US Drug Enforcement Administration (DEA) periodically hosts National Prescription Drug Take-Back events where temporary collection sites are set up in communities nationwide for safe disposal of prescription drugs.

Meds Disposal awareness campaign in Europe, facilitate reverse logistics of unused medicines. 

The reverse logistics strategy in the context of pharmaceutical  could be practical in developing countries as well. Several factors, including the management, collaboration, information technology, infrastructure, political, financial and economic factors, are critical for reverse logistics implementation (de Campos et al 2021).

TARGETED CONTINUOUS EPV

Targeted EPV has been proposed as an optimised management strategy for controlling the pharmaceutical pollution. It is defined as the science and activities associated with the targeted detection, evaluation, understanding, and prevention of adverse effects of high-priority hazardous pharmaceuticals in the environment. 

According to the United Nations, Department of Economics & Social Affairs World Urbanization Prospects (2018), the world’s urban population is expected to concentrate in just a few countries. Together, India, Nigeria, and China will account for about 3% of the projected growth of the world’s urban population between 2018 and 2050.  

By 2050, it is projected that India will have an additional 416 million urban dwellers. There is a need to prioritise compounds considering the level of risk that it can cause to the environment. Various scientific methods are available for prioritisation procedures. Regulations must be made in accordance with the contextually relevant or high-risk compounds (Petrović et al 2013).

It identifies targeted-monitoring, reporting & management of emission sources along with the legislation and educational strategies for its successful implementation.