Household disposal of pharmaceuticals and perception of risk to the environment

Modeling Predictors of Medication Waste Reduction Intention in Algeria: Extending the Theory of Planned Behavior

COVID-19 caused an increase in the demand for medications, which led to an increase in pharmaceutical waste and there is no doubt that this contributes to environmental pollution. Hence, it became necessary to search for how to protect and improve the environment by encouraging the behavior of medication waste reduction. Accordingly, this study aims to investigate the factors affecting intentions to reduce medication waste. Considering this, we develop an extended theory of planned behavior (TPB) framework by incorporating the constructs of moral obligation, environmental awareness, and medication waste risk perception. Using the convenience sampling method and based on a self-administered questionnaire, a total of 225 usable responses were collected in five Algerian cities. The results showed that positive attitudes (β = 0.316, p < 0.001), moral obligation (β = 0.291, p < 0.001), environmental awareness (β = 0.227, p < 0.001), perceived behavior control (PBC) (β = 0.151, p = 0.001), greater perceived risks (β = 0.127, p < 0.001), and subjective norm (β = 0.096, p < 0.05) significantly and positively influence the medication waste minimization intention. Furthermore, our analyses revealed that the extended TPB model explained 73.40% of the intention variance. In conclusion, we have explored the intentions, and there may be a gap between intent and actual behavior. Therefore, we recommend future studies to examine the factors affecting the actual behavior of medication waste reduction and to investigate environmental ethics and religious commitment as predictors of waste reduction intentions.

End-of-life management strategies of pharmaceuticals in Portuguese households

The end of life of pharmaceutical products through environmentally unsafe routes is a growing concern in our society. However, the studies reported so far, apart from being limited in number, do not reflect the current management practices for the end-of-life management of pharmaceuticals. Published work lacks an in-depth analysis in focusing on the pharmaceutical waste in households. The present work focused on (1) performing a state-of-the art overview to compare worldwide studies and the results and (2) implementing a comprehensive survey in Portugal (n = 454 respondents). The results showed that the delivery to pharmacies was used by the majority of the respondents (72%), indicating a good awareness of pharmaceutical waste management issues, when compared to the reviewed studies. Statistically significant variables for the destination of end-of-use pharmaceuticals include gender, age and distance from the residence to the pharmacy (p < 0.05). Most participants believe that educating the population on existing structures of medication and packaging management is of the utmost importance to improve the national managing system. This is the first study conducted in Portugal; it includes statistical analysis of the data and reflects on the practices that should be adopted to reduce incorrect pharmaceutical waste disposal. These findings call upon the strategies to strengthen the pharmaceutical waste management programme.

Judging Pharmaceutical Environmental Risk by its Cover? The Effects of Prescription Medication and Disease Severity on Environmental Risk Perception

Recent wastewater analyses performed in care homes for the elderly showed high levels of water pollution resulting from pharmaceutical waste. The way people perceive the environmental risk of pharmaceuticals can contribute to reversing this problem, but the factors that influence risk perception remain relatively unknown. The aims of the study are two-fold. We first focused on exploring the levels of knowledge regarding environment/water pollution due to pharmaceutical residues from the groups responsible for prescribing (health professionals), handling (staff), and consuming pharmaceuticals (residents) in care homes for the elderly. Second, we assessed the environmental risk perception of pharmaceuticals based on two main factors: prescription medication (nonprescribed versus prescribed) and disease severity (milder versus severe disease), accounting for their level of knowledge (deficit versus sufficiency of knowledge). The study was designed based on correlational research. Data were collected in homes for the elderly located in three Southwestern European countries (N = 300), using self-report surveys. Current knowledge was perceived to be low and the need to know more was perceived to be high, across all groups. As hypothesized, results indicated that to assess the environmental risk, participants made use of information that was unrelated to pharmaceutical persistence, bioaccumulation, and toxicity (PBT). Prescribed pharmaceuticals and/or medication used to treat severe diseases were perceived as being more hazardous for the environment. Simple main effects analysis comparing between knowledge levels confirmed that this effect occurred mostly when participants had knowledge deficit for disease severity but not for prescription medication. These misconceptions might discourage taking an active role in reducing the impact of pharmaceutical residues in the environment.

Household Pharmaceutical Waste Management Practices in the Johannesburg Area, South Africa

Pharmaceutical wastes are expected to increase given the increasing population growth rates and rapidly rising economic burden of human diseases. This challenge calls for appropriate measures for the management of such hazardous wastes. The purpose of this survey was to document and investigate existing practices for the handling, storage, and disposal of household pharmaceutical wastes (HPWs) in the Johannesburg area. Primary data were collected via online surveys with self-administered questionnaires completed by respondents. The research found that 77% (n = 286) of respondents claimed some knowledge about HPWs. Types of medicines that contributed to HPWs included painkillers or analgesics (73%, n = 270) and drugs for treating colds and flu-related illnesses (52%; n = 193). Although there were a few exceptions, the respondents generally exhibited strong disagreements with environmentally unfriendly and health-threatening disposal practices. Moreover, most participants were willing to return expired medicines to pharmacies (40.7%, n = 151), whereas only 8.6% (n = 32) opposed this solution. Awareness levels tended to vary with employment status, educational qualifications, and place of residence. However, place of residence and household size did not correlate with types of pharmaceutical waste. Additionally, the study found that education attainments significantly influenced the willingness of respondents to return pharmaceutical wastes. Finally, there were no significant differences amongst respondents in terms of waste disposal practices. Altogether, the findings suggest the need for targeted efforts to bring about sustainable waste management at a household level.

Low-Cost and Eco-Friendly Hydroxyapatite Nanoparticles Derived from Eggshell Waste for Cephalexin Removal

This work describes the hydroxyapatite nanoparticle (HAP) preparation from eggshell waste and their application as an adsorbent for Cephalexin (Ceph) antibiotic removal from aqueous solutions. Chemical precipitation with phosphoric acid was used to evaluate the feasibility of calcium oxide for HAP preparation. The structural properties of HAP were characterized by X-ray diffraction, which revealed the formation of the hydroxyapatite crystalline phase formation. In addition, transmitting electron spectroscopy showed an irregular shape with a variation in size. The impact of various experimental conditions on the removal efficiency such as the solution’s pH, contact time, HAP mass, solution temperature, and Ceph concentration were studied. Experimental data showed that HAP could remove most Ceph species from aqueous solutions within 1 h at pH = 7 with 70.70% adsorption efficiency utilizing 50 mg of the HAP. The removal process of Ceph species by HAP was kinetically investigated using various kinetic models, and the results showed the suitability of the pseudo-second-order kinetic model for the adsorption process description. Moreover, the removal process was thermodynamically investigated; the results showed that the removal was spontaneous endothermic and related to the randomness increase. The data confirmed that HAP had high efficiency in removing Ceph antibiotics from an aqueous solution.

Photocatalytic Degradation of Cefixime Trihydrate by Bismuth Ferrite Nanoparticles

The present work was carried out to synthesize bismuth ferrite (BFO) nanoparticles by combustion synthesis, and to evaluate the photocatalytic activity of synthesized bismuth ferrite nanoparticles against cefixime trihydrate. BFO nanoparticles were successfully synthesized using bismuth (III) nitrate and iron (III) nitrate by a combustion synthesis method employing different types of fuels such as maltose, succinic acid, cinnamic acid, and lactose. The effects of the different types of fuels on the morphology and size of the bismuth ferrite nanoparticles were investigated. Characterization of the as-obtained bismuth ferrite nanoparticles was carried out by different techniques such as X-ray diffraction (XRD), scanning electron microscopy (SEM), Energy-Dispersive Spectroscopy (EDS), N₂-sorption analysis, Fourier-transform infrared spectroscopy (FT-IR), and ultraviolet-visible (UV-vis) spectroscopy. Photoluminescence studies were also carried out for the various bismuth ferrite nanoparticles obtained. Degradation of cefixime trihydrate was investigated under sunlight to evaluate the photocatalytic properties of the bismuth ferrite nanoparticles, and it was found that the bismuth ferrite nanoparticles followed first-order degradation kinetics in solar irradiation in the degradation of antibiotic, cefixime trihydrate.

Attitudes and Considerations towards Pharmaceuticals-Related Environmental Issues among Finnish Population

A number of policy recommendations identify the general public as a key participant in environmentally sustainable pharmaceutical policies. However, research into pharmaceuticals-related environmental issues from the population perspective is scarce. We studied the awareness among Finnish adults (n = 2030) of pharmaceutical residues in Finnish waterways, their perceived environmental sources, views on pharmaceuticals-related environmental issues, and their association with background characteristics. Of the respondents, 89.5% were aware of the presence of pharmaceuticals in Finnish waterways. Wastewaters from the pharmaceutical industry were most frequently, and pharmaceuticals excreted by humans least frequently, considered a major environmental source of pharmaceuticals. The vast majority of the respondents were worried about the environmental and health impact of pharmaceutical residues and emphasized issues such as the importance of environmentally sustainable actions by pharmaceutical companies and the recyclability of the pharmaceutical packaging materials. Age, education, use of prescription medicines, and environmental attitude were associated with awareness of pharmaceutical residues, while gender, age, education level, and environmental attitude were associated most frequently with pharmaceuticals-related environmental considerations. These results indicate a need for improved communication about the environmental effects of pharmaceuticals and the significance of different pharmaceutical emission sources in order to promote a more environmentally friendly, effective pharmaceutical policy.

Assessment on the Impact on Human Health, Environment, Water and Soil by Disposing Household Expired Drugs: A Cross-Sectional Study in China

Background

The household expired drugs disposal has been a huge public issue in many countries, including China, which may affect various side and toxic effects on human health and environment, water resources, and soil too. This paper explores the knowledge, attitude, and practice of Guangzhou city residents regarding household expired drugs and their effect on human health and provided the scientific pieces of evidence to carry out the long-term recovery mechanism for expired medicines.

Methods

An observational, cross-sectional study was conducted using a self-structured questionnaire. Descriptive analysis, including univariate and unconditional logistic regression models, was carried out to analyze the data.

Results

A total of 613 community residents with a 99.4% response rate enrolled for the study. More than half 60.2% of residents stated that expired drugs pollute the environment, soil, and water resources, where 81.2% of respondents knew that it would produce side effects or toxic effects. However, still, 71.6% of respondents disposed of directly into the trash bin or sink, and, only 24.8% had good practice that they use a designed recycling bin. Likewise, only 8.3% of respondents placed expired drugs into collection points nearly 3-5 times in a year, while 65.1% of participants never disposed of in the collection point, which found a worse practice.

Conclusion

Overall, the knowledge, attitude, and practice of Guangzhou residents regarding household expired drugs disposal were not ideal. To improve the resident's awareness about family expired drugs disposal, ensure the financial support for the recycling process, establish an accessible and acceptable recycling point, and introduce relevant laws and regulations for the long-term mechanism.

Household discharge of chemical products and its classification based on anaerobic biodegradability

Synthetic household chemical products (HCP) are used in various household activities. An average urban household was estimated to consume ~ 3 kg HCP per month while discarding 212-387 mg/L HCP in sewage comprising > 265 different chemical compounds. The high sorption properties of HCP and their antimicrobial resistance lead to their long-term persistence in the environment. The intrusion of HCPs and their breakdown products into food chain causes detrimental effects on health and ecology. HCPs comprise mostly of a mixture of xenobiotics, organic and inorganic compounds resulting in an impaired biodegradation. Yet, the biodegradability of HCPs is seldom assessed. Therefore, this research proposes a modified Gompertz model approach to analyze BMP data in order to classify commercially available HCPs into seven groups based on the observed levels of recalcitrance and is in turn coined "Anaerobic Biodegradability Index" (ABI, beginning from ABI-VI to ABI-0 wherein ABI-VI represents the highest degradability and ABI-0 the least). This approach emulates "Energy-Star" ratings of electrical appliances classified based on electrical efficiency. Results of such a classification indicated that HCPs containing ≥ 10% anionic surfactants such as laundry detergents, handwash gel, dishwasher chemicals, and creosote surface cleaner, exhibit lowered anaerobic degradability and were therefore categorized between ABI-0 and ABI-II. Whereas the highly degradable HCP such as toothpaste, shower gel, and hair shampoo were categorized in ABI-V and ABI-VI categories. We perceive that the weightages and concentrations can be used in the future to define the capability of various wastewater treatment systems and their tolerance to various ABI classes.

Intentions to "Reuse" Medication in the Future Modelled and Measured Using the Theory of Planned Behavior

BACKGROUND

A range of pro-environmental behaviors are recognized, promoted, and investigated, but urgent action is also needed to tackle the direct and indirect environmental impact of medication waste. One solution is to reissue medicines, returned unused to pharmacies (i.e., reuse medicines). Yet, if medicines reuse is to be formally introduced in the UK, it is imperative also to understand people's willingness to take part in such a scheme and importantly, the underpinning drivers. This study aimed to develop, validate, and evaluate a Theory of Planned Behavior model aimed at predicting medicines reuse behavioral intentions.

METHODS

The behavior of interest, medicines reuse, was defined according to its Target, Action, Context, and Time. Then themes from an existing qualitative study were used in order to draft, validate and pilot a Theory of Planned Behavior-based questionnaire before its completion by a representative sample (n = 1003) of participants from across the UK.

RESULTS

The majority expressed pro-medicines reuse intentions. The three direct measures accounted for 73.4% of the variance in relation to people's intention to reuse medicines in the future, which was statistically significant at p < 0.001. People's specific beliefs about medicines reuse and how they evaluate other people's expectations of them had a substantial impact on their intentions to reuse medication in the future, mediated in an intricate way via attitudes, subjective norms and perceived behavioral control (PBC).

CONCLUSIONS

This study shows how people could embrace medicines reuse via practical measures that illustrate the safety and quality assurance of reissued medicines, educational interventions that bolster beliefs about the pro-environmental benefits, and norm-based interventions encouraging doctors and pharmacists to endorse the practice. The findings add to the emerging work on medicines reuse and, significantly, provide a theoretical framework to guide policymakers and other organizations looking to decrease the impact of medication waste through medicines reuse schemes.

Understanding the behavioural intention to dispose of unused medicines: an extension of the theory of planned behaviour

This study examined behavioural intention to dispose of unused medicines using a comprehensive model integrating the theory of planned behaviour (TPB), with knowledge as a driver of personal norms; attitudes, personal norms, and perceived busyness as additional drivers of behavioural intention; and perceived convenience as a moderator. The model was tested with data collected from 204 respondents using the partial least squares technique. Knowledge about the proper disposal of unused medicines was recognized as a strong predictor of personal norms and attitudes towards proper disposal of waste medications. The results showed that attitudes, personal norms, perceived busyness, and perceived behavioural control have significant effects on intention to dispose of unused medicines. Furthermore, perceived convenience moderates the impacts of attitude, personal norms, and perceived behavioural control on intention to dispose of unused medicines. The extended TPB explained 55.7% of the variance of intention to dispose of unused medicines properly. Our results indicate the importance of integrating additional variables into the TPB to enhance its explanatory power in predicting behavioural intention. The results suggest to governments that in order to implement planned programs for proper collection and destruction of waste medication, a plan is needed to enhance public knowledge on the impacts of improper medication waste disposal on the environment, and also that collection points should become accessible for anyone.

What's in Your Body of Water? A Pilot Study Using Metaphoric Framing to Reduce the Psychological Distance in Pharmaceutical Pollution Risk Communication

Aquatic pharmaceutical pollution poses ecotoxicological risks to the environment and human health. Consumer pharmaceutical use and disposal behaviors represent a significant source of pharmaceutical compounds in surface waters, and communication strategies are needed to promote pro-environmental behaviors to reduce pharmaceutical pollution. Designing effective risk communication campaigns requires an understanding of public perceptions of aquatic pharmaceutical pollution. The purpose of this mixed-methods pilot study was to test the efficacy of using theories from cognitive linguistics and psychology (conceptual metaphor theory and construal level theory of psychological distance, respectively) in using metaphors in pharmaceutical pollution risk communication. Our methods included a randomized cross-over design in which a convenience sample of university students (n = 20) viewed visual representations of pharmaceutical pollution risks (metaphor based and non-metaphor). We used cognitive interviewing methods to assess metaphor use on participants understanding of pharmaceutical pollution risk, concern about this risk, and willingness to act. Results indicate that participants preferred the metaphorically-framed visual, and that the use of metaphor significantly reduced participants' perceived social and geographic distance of pharmaceutical pollution risk, suggesting a relationship between metaphoric framing and psychological distance warranting additional research. Theoretical and practical implications of metaphor use in risk communications are discussed.

Consumer willingness to pay for a pharmaceutical disposal program in Serbia: A double hurdle modeling approach

Proper collection and disposal of pharmaceutical waste from households can reduce the negative influence of medicines on the environment. The aim of this paper is to examine the current methods of disposal of unused medicines from households, as well as the willingness of Serbian residents to participate and bear the costs of an organized collection program. Moreover, this research aims to define factors contributing to an individual's willingness to participate and pay for a medicine collection program. The survey included randomly selected patients older than 18 years visiting private pharmacies in the four largest Serbian cities. The questionnaire included information regarding the presence of unwanted medicines within the household, general medicine disposal practices, the likelihood to participate in a medicine take-back program, willingness to pay for a medicine disposal program (per prescription and per visit), importance to the environment, and demographic variables from participants. Approximately 80% of surveyed respondents are very or somewhat likely to participate, however less than half of the respondents are willing to pay for the collection of their unused medicines. The factors that influenced willingness to participate are environmental awareness and income, while the factors affecting willingness to pay, are previously received advice about proper disposal, education level, number of unwanted medicines in the household and gender. The majority of Serbian people dispose unused medicines improperly, mostly into household garbage. Well-organized and easily accessible collection programs are essential in order to enable the general public to return unused medicines for proper disposal.

Pharmaceuticals residues and xenobiotics contaminants: Occurrence, analytical techniques and sustainable alternatives for wastewater treatment

Emerging contaminants are increasingly present in the environment, and their appearance on both the environment and health of living beings are still poorly understood by society. Conventional sewage treatment facilities that are under validity and were designed years ago are not developed to remove pharmaceutical compounds, their main focus is organic and bacteriological removal. Pharmaceutical residues are associated directly with quantitative production aspects as well as inadequate waste management policies. Persistent classes of emerging compounds such as xenobiotics present molecules whose physicochemical properties such as small molecular size, ionizability, water solubility, lipophilicity, polarity and volatility make degradability, identification and quantification of these complex compounds difficult. Based on research results showing that there is a possibility of risk to human and environmental health the presence of these compounds in the environment this article aimed to review the main pharmaceutical and xenobiotic residues present in the environment, as well as to present the most common methodologies used. The most commonly used analytical methods for identifying these compounds were HPLC and Gas Chromatography coupled with mass spectrometry with potential for characterize complex substances in the environment with low concentrations. An alternative and low-cost technology for emerging compound treatment demonstrated in the literature with a satisfactory performance for several types of sewage such as domestic sewage, wastewater and agroindustrial, was the Wetlands Constructed. The study was able to identify the main compounds that are being found in the environment and identify the most used analytical methods to identify and quantify these compounds, bringing some alternatives combining technologies for the treatment of compounds. Environmental contamination is eminent, since the production of emerging compounds aims to increase along with technological development. This demonstrates the need to explore and aggregate sewage treatment technologies to reduce or prevent the deposition of these compounds into the environment.

Estoque e descarte de medicamentos no domicílio: uma revisão sistemática

Resumo Este estudo teve como objetivo analisar a evidência científica nacional e internacional existente sobre o motivo do estoque e a forma de descarte dos medicamentos no domicílio. Realizou-se uma revisão sistemática da literatura de 2001 a 2016 nas bases de dados PubMed, Lilacs e Elsevier’s Scopus Database, utilizando os seguintes unitermos: "Disposal of medicines in household", "Disposal of expired drugs", "Residential expired drugs", "Management of expired medications in household". Foram selecionados 33 estudos originais após aplicação dos critérios de inclusão e exclusão. Os estudos analisados demonstraram que os principais motivos de estoque no domicílio foram: automedicação; guarda para uso futuro e sobras de tratamentos anteriores. E quanto ao descarte dos medicamentos, prevalecem práticas inadequadas, como descarte no lixo comum e na rede de esgoto. Alguns países têm adotado programas de orientação sobre o armazenamento e o descarte correto, no entanto, foi apenas encontrado um estudo que descreve um programa nacional gratuito, para orientar essas práticas. A partir das evidências cientificas verificou-se a importância do incentivo para a elaboração e a implementação de políticas públicas voltadas para o uso e descarte adequado de medicamentos no domicílio.

When is a medicine unwanted, how is it disposed, and how might safe disposal be promoted? Insights from the Australian population

Objective The aim of the present study was to explore disposal practices of unwanted medicines in a representative sample of Australian adults, compare this with previous household waste surveys and explore awareness of the National Return and Disposal of Unwanted Medicines (RUM) Project. Methods A 10-min online survey was developed, piloted and conducted with an existing research panel of adult individuals. Survey questions recorded demographics, the presence of unwanted medicines in the home, medicine disposal practices and concerns about unwanted medicines. Descriptive statistical analyses and rank-ordered logit regression were conducted. Results Sixty per cent of 4302 respondents reported having unwanted medicines in their household. Medicines were primarily kept just in case they were needed again and one-third of these medicines were expired. Two-thirds of respondents disposed of medicines with the household garbage and approximately one-quarter poured medicines down the drain. Only 17.6% of respondents had heard of the RUM Project, although, once informed, 91.7% stated that they would use it. Respondents ranked the risk of unintended ingestion as the most important public health message for future social marketing campaigns. Conclusions Respondents were largely unaware of the RUM Project, yet were willing to use it once informed. Limited awareness could lead to environmental or public health risks, and targeted information campaigns are needed. What is known about the topic? There is a growing international evidence base on how people dispose of unwanted medicines and the negative consequences, particularly the environmental effects of inappropriate disposal. Although insight into variation in disposal methods is increasing, knowledge of how people perceive risks and awareness of inappropriate disposal methods is more limited. What does this paper add? This study provides evidence of inappropriate medicines disposal and potential stockpiling of medicines in Australian households that could contribute to environmental and/or public health risks. It also reveals possible trends towards a higher frequency of inappropriate disposal practices in the Australian context. Insights into respondents' perceptions of associated risks and awareness of a national scheme for appropriate disposal of medicines have not previously been reported. What are the implications for practitioners? The findings of the present study provide important insights for all health professionals as stakeholders in the quality use of medicines. It is important for those health professionals who assist consumers to manage their medicines to have strategies in place that routinely identify potential stockpiling and inform consumers about appropriate methods of medicines disposal. Although the findings of this study are specific to the Australian context, they may usefully inform policy, public health campaigns and the individual practices of health professionals and other stakeholders in promoting the quality use of medicines nationally and internationally.

Investigation of medicines consumption and disposal in Brazil: A study case in a developing country

The incorrect disposal of medicines can be harmful to the environment. Here, we aim to understand the consumption and disposal of medicines in Brazil using online forms. 64% of the respondents have the habit to self-medicate. 66% of respondents dispose the disused or expired medicines in the garbage. 71.9% of respondents never receive any information about correct disposal of medicines. 95.2% of respondents believe that residues of medicines can be harmful to the environment. Environmental education can provide information to the population and help to mitigate pharmaceuticals pollution.

Safe Medication Disposal

Safe disposal of expired or unused medications is essential for individual and environmental safety, yet many patients report not having received education on proper medication disposal. Unused medications in homes and improper medication disposal create various risks including intentional or accidental misuse, overdose, addiction in humans, as well as toxic effects in pets. As part of their community health clinical experience, senior nursing students from the University of Pennsylvania School of Nursing visited patients of a large home care and hospice agency in a Philadelphia suburb throughout the semester. A survey conducted with a small number (N = 15) of home care patients suggested the majority of patients had inadequate knowledge about safe medication disposal. The nursing students created and presented a tip sheet on safe medication disposal and a list of local prescription medication disposal sites to home care patients. They also obtained and provided medication disposal bags for patients and caregivers who were unable to get to medication disposal sites.

Detection of Antibiotics in Drinking Water Treatment Plants in Baghdad City, Iraq

Persistence of antibiotics in the aquatic environment has raised concerns regarding their potential influence on potable water quality and human health. This study analyzes the presence of antibiotics in potable water from two treatment plants in Baghdad City. The collected samples were separated using a solid-phase extraction method with hydrophilic-lipophilic balance (HLB) cartridge before being analyzed. The detected antibiotics in the raw and finished drinking water were analyzed and assessed using high-performance liquid chromatography (HPLC), with fluorometric detector and UV detector. The results confirmed that different antibiotics including fluoroquinolones andB-lactams were detected in the raw and finished water. The most frequently detected antibiotics were ciprofloxacin with highest concentration of 1.270 μg L−1in the raw water of Al-Wihda plant, whereas the highest concentration of levofloxacin was 0.177 μg L−1, while amoxicillin was not detected in this plant. In contrast, ciprofloxacin was found in both raw water and finished water of Al-Rasheed plant and recorded highest concentration of 1.344 and 1.312 μg L−1, respectively. Moreover, the residual amount of levofloxacin in the raw water was up to 0.414 μg L−1, whereas amoxicillin was shown to be the most detectable drug in the raw water of Al-Rasheed plant, with a concentration of 1.50 μg L−1. The results of this study revealed the existence of antibiotic drugs in raw and finished water and should be included in the Iraqi standard for drinking water quality assessment.

Number of Unused Medications at the Time of Last Admission: A Prospective Observational Study in a Single Palliative Care Unit

BACKGROUND:

Unused medications (UM) are an important issue, with the waste associated with UM a burden to the health-care system. The aims of this study were to clarify the amount and costs of UM in patients with advanced cancer at the time of their last admission to a palliative care unit and to explore the factors contributing to the cost of UM and how patients dealt with UM.

METHODS:

A prospective observational study was conducted in single palliative care unit. Unused medications were classified into 6 categories and the number and cost of UM by category calculated per patient. Patients were classified into 2 cost groups (high and low) based on the total cost of UM, and the number and cost of UM by category were compared between these 2 groups.

RESULTS:

Of 194 consecutive hospitalized patients, data were analyzed for 90. The mean number and cost of UM per patient was 440 and US$301, respectively. Opioids accounted for 47% of the cost of UM. Comparing costs by UM category, the proportion of opioids (51% vs 21%; P < .0001) and oral anticancer drugs (14% vs 3%; P = .02) was higher in the high- than in the low-cost group.

CONCLUSION:

Based on the results of the present study, the estimated annual waste cost of UM for patients with cancer who died in Japan was approximately US$110 million. Interventions to educate patients regarding UM and to eliminate barriers to opioid use may help reduce the cost of UM, particularly opioids and anticancer drugs.

Evaluation of iron loading in four types of hepatopancreatic cells of the mangrove crab Ucides cordatus using ferrocene derivatives and iron supplements

The mangrove crab Ucides cordatus is a bioindicator of aquatic contamination. In this work, the iron availability and redox activity of saccharide-coated mineral iron supplements (for both human and veterinary use) and ferrocene derivatives in Saline Ucides Buffer (SUB) medium were assessed. The transport of these metallodrugs by four different hepatopancreatic cell types (embryonic (E), resorptive (R), fibrillar (F), and blister (B)) of U. cordatus were measured. Organic coated iron minerals (iron supplements) were stable against strong chelators (calcein and transferrin). Ascorbic acid efficiently mediated the release of iron only from ferrocene compounds, leading to redox-active species. Ferrous iron and iron supplements were efficient in loading iron to all hepatopancreatic cell types. In contrast, ferrocene derivatives were loaded only in F and B cell types. Acute exposition to the iron compounds resulted in cell viability of 70-95%, and to intracellular iron levels as high as 0.40 μmol L^-1 depending upon the compound and the cell line. The easiness that iron from iron metallodrugs was loaded/transported into U. cordatus hepatopancreatic cells reinforces a cautionary approach to the widespread disposal and use of highly bioavailable iron species as far as the long-term environmental welfare is concerned.

RETRACTED: Public environmental awareness of water pollution from urban growth: The case of Zarjub and Goharrud rivers in Rasht, Iran

This article has been retracted: please see Elsevier Policy on Article Withdrawal (https://www.elsevier.com/about/our-business/policies/article-withdrawal). This article has been retracted at the request of the Editors-in-Chief. After a thorough investigation, the Editors have concluded that the acceptance of this article was based upon the positive advice of three illegitimate reviewer reports. The reports were submitted from email accounts which were provided by the corresponding author C.A. Damalas as suggested reviewers during the submission of the article. Although purportedly real reviewer accounts, the Editors have concluded that these were not of appropriate, independent reviewers. This manipulation of the peer-review process represents a clear violation of the fundamentals of peer review, our publishing policies, and publishing ethics standards. Apologies are offered to the reviewers whose identity was assumed and to the readers of the journal that this deception was not detected during the submission process.

Pharmacopollution and Household Waste Medicine (HWM): how reverse logistics is environmentally important to Brazil

Pharmacopollution is a public health and environmental outcome of some active pharmaceutical ingredients (API) and endocrine-disrupting compounds (EDC) dispersed through water and/or soil. Its most important sources are the pharmaceutical industry, healthcare facilities (e.g., hospitals), livestock, aquaculture, and households (patients' excretion and littering). The last source is the focus of this article. Research questions are "What is the Household Waste Medicine (HWM) phenomenon?", "How HWM and pharmacopollution are related?", and "Why is a reverse logistic system necessary for HWM in Brazil?" This article followed the seven steps proposed by Rother (2007) for a systematic review based on the Cochrane Handbook and the National Health Service (NHS) Center for Reviews Dissemination (CDR) Report. The HWM phenomenon brings many environmental, public health, and, social challenges. The insufficient data is a real challenge to assessing potential human health risks and API concentrations. Therefore, the hazard of long-term exposure to low concentrations of pharmacopollutants and the combined effects of API mixtures is still uncertain. HWM are strongly related to pharmacopollution, as this review shows. The Brazilian HWM case is remarkable because it is the fourth pharmaceutical market (US$ 65,971 billion), with a wide number of private pharmacies and drugstores (3.3: 10,000 pharmacy/inhabitants), self-medication habits, and no national take-back program. The HWM generation is estimated in 56.6 g/per capita, or 10,800 t/year. The absence of a reverse logistics for HWM can lead to serious environmental and public health challenges. The sector agreement for HWM is currently under public consultation.

Patients' Knowledge and Attitude toward the Disposal of Medications

BACKGROUND

Safe disposal of medications is of high concern as malpractice may lead to harmful consequences such as undesirable effects, prescription drug abuse, overstocking, self-medication, accidental overdose, and even death. There is a lack of uniform and nationwide guidance on how patients should safely dispose their leftover medications. This study aims to assess patients' knowledge and attitude regarding the disposal of medications.

METHOD

This research is a cross-sectional study. A self-administered questionnaire was used to collect data from various outpatient pharmaceutical services in King Abdulaziz Medical City (KAMC), Jeddah.

RESULTS

The study revealed that 73% of the respondents throw the medications in the trash, 14% return the medications to a pharmacy, 5% never dispose them, and 3% donate the medications to a friend or charity centers. More than 80% of the respondents never received any information or advice from healthcare providers about safe and proper disposal of medications.

CONCLUSION

Our findings suggest that there is an immediate requirement for the establishment of collaborative and uniform guidelines for the safe disposal of leftover medications. A policy for drug donation needs to be included in routine patient education as well as educational and collective programs for the public.

Waiter, there is a drug in my soup - using Leximancer® to explore antecedents to pro-environmental behaviours in the hospital pharmacy workplace

OBJECTIVE/S

The aim of this study was to explore Queensland hospital pharmacists' and pharmacy technicians' knowledge and understanding of the impact of pharmaceuticals on the environment and the handling of pharmaceutical waste.

METHODS

This study followed a mixed methods research design. Purposive sampling techniques were used to recruit 64 hospital pharmacists and pharmacy technicians working in five public and private hospitals, in metropolitan and regional Queensland, Australia. Both quantitative and qualitative data were collected. Qualitative data were analysed using both the text analytics using descriptive statistics.

KEY FINDINGS

Lack of environmental knowledge regarding the impact of pharmaceuticals on the environment and lack of understanding of systems thinking concepts (that all living things are part of the one environment or system, and therefore any negative impacts on the environment will ultimately have negative impacts on human health) were the key findings of this research. Interviewees expressed concern, but most expressed minimal personal concern, about the impact of pharmaceuticals entering the environment. Most interviewees were unsure as to best practice methods for the disposal of pharmaceutical waste, and by complying with hospital policy assumed appropriate disposal occurred.

CONCLUSION

Before the pharmacy profession can take up a leadership role in the more sustainable use of pharmaceuticals, pharmacists and pharmacy technicians require environmental information regarding the negative impacts of pharmaceuticals on the environment, and education on systems thinking to enable them to understand that any negative impacts on the environment will ultimately have negative impacts on human health.

A Novel Liquid-Liquid Extraction for the Determination of Sertraline in Tap Water and Waste Water at Trace Levels by GC-MS

A simple, green and fast analytical method was developed for the determination of sertraline in tap and waste water samples at trace levels by using supportive liquid-liquid extraction with gas chromatography-mass spectrometry. Different parameters affecting extraction efficiency such as types and volumes of extraction and supporter solvents, extraction period, salt type and amount were optimized to get lower detection limits. Ethyl acetate was selected as optimum extraction solvent. In order to improve the precision, anthracene-D10 was used as an internal standard. The calibration plot of sertraline was linear from 1.0 to 1000 ng/mL with a correlation coefficient of 0.999. The limit of detection value under the optimum conditions was found to be 0.43 ng/mL. In real sample measurements, spiking experiments were performed to check the reliability of the method for these matrices. The spiking experiments yielded satisfactory recoveries of 91.19 ± 2.48%, 90.48 ± 5.19% and 95.46 ± 6.56% for 100, 250 and 500 ng/mL sertraline for tap water, and 85.80 ± 2.15% and 92.43 ± 4.02% for 250 and 500 ng/mL sertraline for waste water.

Endocrine disrupting compounds in drinking water supply system and human health risk implication

To date, experimental and epidemiological evidence of endocrine disrupting compounds (EDCs) adversely affecting human and animal populations has been widely debated. Notably, human health risk assessment is required for risk mitigation. The lack of human health risk assessment and management may thus unreliably regulate the quality of water resources and efficiency of treatment processes. Therefore, drinking water supply systems (DWSSs) may be still unwarranted in assuring safe access to potable drinking water. Drinking water supply, such as tap water, is an additional and crucial route of human exposure to the health risks associated with EDCs. A holistic system, incorporating continuous research in DWSS monitoring and management using multi-barrier approach, is proposed as a preventive measure to reduce human exposure to the risks associated with EDCs through drinking water consumption. The occurrence of EDCs in DWSSs and corresponding human health risk implications are analyzed using the Needs, Approaches, Benefits, and Challenges (NABC) method. Therefore, this review may act as a supportive tool in protecting human health and environmental quality from EDCs, which is essential for decision-making regarding environmental monitoring and management purposes. Subsequently, the public could have sustainable access to safer and more reliable drinking water.

How do people conceptualise the reuse of medicines? An interview study

Objectives

To capture people's beliefs about medicines reuse and to map the determinants of intentions to reuse medicines in the future.

Methods

Participants were recruited through an advert placed in the university's community newsletter reaching 15 000 households. Adults wishing to participate were interviewed using convenience sampling, with recruitment continuing until data saturation. Participants were interviewed face‐to‐face by two researchers using a semi‐structured interview schedule based on the theory of planned behaviour (TPB). Interview transcripts were analysed by thematic analysis, with the themes classified according to the TPB. The University's research ethics committee approval was obtained.

Key findings

Nineteen participants were interviewed. The potential economic and environmental benefits of medicines reuse were juxtaposed with stability and safety worries. Participants trusted pharmacists to quality‐assure returned medicines, but wondered if they had the time and storage space to dedicate to medicines reuse. Environmentalists were seen as the main proponents of medicines reuse with drug manufacturers, some taxpayers and parents seen as the main opponents. The physical characteristics of reused medicines, and quality assurance and logistics of reuse processes were seen to enable/obstruct engagement in medicines reuse. A working definition of medicines reuse as a behaviour was developed.

Conclusions

People could potentially agree to reuse medicines if their concerns are addressed and the process is well defined and managed. This is a qualitative study with a small number of participants meaning the results may not be generalisable. The themes generated will enable a structured questionnaire to be developed for quantifying broader views.

Behaviours, thoughts and perceptions around mealtime insulin usage and wastage among people with type 1 and type 2 diabetes mellitus: A cross-sectional survey study

AIMS

People with diabetes who use mealtime insulin (MTI) were surveyed about insulin wastage and injection habits when insufficient insulin remains in a disposable prefilled pen/cartridge to administer a full dose in a single injection.

METHODS

Cross-sectional, online, self-reported survey of MTI usage/wastage behaviour in 400 adults with type 1 (n=120) or type 2 (n=280) diabetes mellitus administering >20units/day of MTI via 100units/ml prefilled pens/cartridges for ⩾1month, conducted in France, Germany, Italy and UK.

RESULTS

Participants' mean±standard deviation age was 54.5±12.2years, body mass index was 29.9±7.2kg/m² and duration of MTI therapy was 8.6±7.8years. They administered 3.7±5.9 injections/day with meals, using 11.3±18.0 prefilled pens/cartridges per month. Overall, 63.5% split the dose across two prefilled pens/cartridges (i.e. administered two injections to obtain a full dose), 15.0% used just what remained in their current pen (i.e. took a lower-than-prescribed dose) and 36.3% discarded prefilled pens/cartridges still containing insulin (i.e. took full dose with new pen). The latter participants discarded a mean 5.5±8.2 prefilled pens/cartridges monthly still containing insulin, each containing 8.6±8.7 units of insulin. Participants who wasted insulin considered it frustrating, time-consuming and painful to inject twice.

CONCLUSIONS

Patients taking >20units/day MTI can find transitions between insulin pens challenging. This study highlights the need to identify ways of improving transitions between pens to make transitions easier for insulin users, which could potentially improve adherence to prescribed doses and reduce waste.

Disposal practices of unused and expired pharmaceuticals among general public in Kabul

BACKGROUND

Most of the medicine users remain unaware about the disposal of unused or expired medicines. The aim of this study was to know the disposal practices of unused and expired medicines among the general public in Kabul.

METHODS

This was a descriptive, cross-sectional survey, conducted through face-to-face interviews using prevalidated structured questionnaire. Returned questionnaires were double-checked for accuracy. Statistical Package for Social Science (SPSS) version 23 was used for statistical analysis.

RESULTS

Total of 301 valid questionnaires were returned with a response rate of 100% in which 73.4% men and 26.6% women participated. More than half of the respondents were university graduates. Interestingly, 83.4% of the interviewees purchased medicines on the prescription of which 47.2% were university graduates, while 14.6% purchased medicine over the counter. Among the respondents, 46.5/100 purchased antibiotics and the remaining purchased NSAIDs, anti-hypertensive and anti-diabetic medicines. Significantly, 97/100 checked the expiry date of medicine before buying. Majority (95.3%) of the respondents' stored medicines at home. 77.7% of the respondents discarded the expired medicines in household trash. Majority of respondents held government responsible for creation of awareness for proper medicine disposal. Almost entire sample (98%) felt that improper disposal of unused and expired medicines can affect the environment and health.

CONCLUSION

Gaps exist in practices, therefore robust, safe and cost-effective pharmaceutical waste management program supported with media campaign is needed. Healthcare practitioners and community pharmacists should offer training to educate customers on standard medicine disposal practices.

Disposal of Unused Drugs: Knowledge and Behavior Among People Around the World

The purpose of this systematic review was to determine the practice of medication disposal around the world and get insight into possible association between environmental awareness and people's behavior regarding this issue. A literature search (2005-2015) was performed to identify reports with quantitative data on disposal practices published in peer-reviewed literature. The most common method for disposal of unused medications in households is disposal in the garbage (Kuwait, United Kingdom, Lithuania, Qatar, Serbia, Ghana, Bangladesh, Malta and Saudi Arabia). The practice of flushing drugs into the sewage system still takes place in New Zealand, USA and Bangladesh. Only in Sweden and Germany, practice of returning drugs to pharmacy was practiced to a larger extent. The environmental impact of improper medication disposal is expected in countries with poorly functioning waste management schemes (Middle Eastern, Asian and African countries). Lack of the adequate information and clear instructions on proper manners of drug disposal was reported in many surveyed countries (USA, New Zealand, Bangladesh, Malta and Ireland). Clear and definite connection between knowledge about environmental detrimental effects of improper drug disposal and the preference towards disposal methods could not be established. Many respondents were generally concerned with issues of inadequate medicines discarding but the behavior regarding disposal of unused drugs often did not equate the awareness (Serbia, USA, Kuwait, Malta and UK). The current data emphasizes the global issue of improper medicine disposal, prevalent in environmentally-aware people.

Streptomycin affects the growth and photochemical activity of the alga Chlorella vulgaris

Antibiotics are increasingly being used in human and veterinary medicine, as well as pest control in agriculture. Recently, their emergence in the aquatic environment has become a global concern. The aim of this study was to evaluate the effect of streptomycin on growth and photosynthetic activity of Chlorella vulgaris after 72h exposure. We found that growth, photosynthetic activity and the content of the D1 protein of photosystem II decreased. Analysis of chlorophyll a fluorescence emission shows a reduction in the energy transfer between the antenna complex and reaction center. Also the activity of the oxygen evolution complex and electron flow between QA and QB were significantly reduced; in contrast, we found an increase in the reduction rate of the acceptor side of photosystem I. The foregoing can be attributed to the inhibition of the synthesis of the D1 protein and perhaps other coded chloroplast proteins that are part of the electron transport chain which are essential for the transformation of solar energy in the photosystems. We conclude that micromolar concentrations of streptomycin can affect growth and photosynthetic activity of Chlorella vulgaris. The accumulation of antibiotics in the environment can become an ecological problem for primary producers in the aquatic environment.

Psychotropic drugs in mixture alter swimming behaviour of Japanese medaka (Oryzias latipes) larvae above environmental concentrations

Psychiatric pharmaceuticals, such as anxiolytics, sedatives, hypnotics and antidepressors, are among the most prescribed active substances in the world. The occurrence of these compounds in the environment, as well as the adverse effects they can have on non-target organisms, justifies the growing concern about these emerging environmental pollutants. This study aims to analyse the effects of six psychotropic drugs, valproate, cyamemazine, citalopram, sertraline, fluoxetine and oxazepam, on the survival and locomotion of Japanese medaka Oryzias latipes larvae. Newly hatched Japanese medaka were exposed to individual compounds for 72 h, at concentrations ranging from 10 μg L(-1) to 10 mg L(-1). Lethal concentrations 50 % (LC50) were estimated at 840, 841 and 9,136 μg L(-1) for fluoxetine, sertraline and citalopram, respectively, while other compounds did not induce any significant increase in mortality. Analysis of the swimming behaviour of larvae, including total distance moved, mobility and location, provided an estimated lowest observed effect concentration (LOEC) of 10 μg L(-1) for citalopram and oxazepam, 12.2 μg L(-1) for cyamemazine, 100 μg L(-1) for fluoxetine, 1,000 μg L(-1) for sertraline and >10,000 μg L(-1) for valproate. Realistic environmental mixture of the six psychotropic compounds induced disruption of larval locomotor behaviour at concentrations about 10- to 100-fold greater than environmental concentrations.

Marine environmental contamination: public awareness, concern and perceived effectiveness in five European countries

Given the potential of Perceived Consumer Effectiveness (PCE) in shaping pro-environmental behavior, the relationships between PCE, awareness of causes of contaminants in the marine environment, and concern about marine environmental contamination were investigated using Structural Equation Modeling (SEM). PCE is the belief that an individual has in being able to make a difference when acting alone. A web-based survey was performed in one western European country (Belgium), one northern European country (Ireland) and three southern European countries (Italy, Portugal and Spain), resulting in a total sample size of 2824 participants. The analyses confirm that European citizens are concerned about marine environmental problems. Participants from the southern countries reported the highest concern. In addition, the study participants did not have a strong belief in themselves in being capable of making a difference in tackling marine environmental problems. However, a higher awareness, which was associated with a higher degree of concern, enhanced the belief that an individual can make a difference in tackling marine environmental problems, though only when a concrete action was proposed. Consequently, information campaigns focusing on pro-environmental behavior are recommended to raise public awareness about marine environmental problems and at the same time explicitly refer to concrete possible actions. The findings indicate that when only awareness and concern are raised without mentioning a concrete action, PCE might even decrease and render the communication effort ineffective.

Pharmaceutical Residues in Sewage Treatment Works and their Fate in the Receiving Environment

Pharmaceuticals are increasingly used in large amounts in human (and veterinary) medicine around the world. They reach the aquatic environment mainly through sewage treatment systems and can reach μg l−1 levels. The continual input of pharmaceuticals to the aquatic environment, via sewage, can also impart a persistent quality to compounds that otherwise possess no inherent environmental stability. While the literature contains increasing numbers of studies detailing fate, effects and behaviour in the environment, the subject is still not fully understood for all the different therapeutic classes. The toxicological significance for non-target (especially aquatic) organisms is poorly understood. The use/release of antibiotics and natural/synthetic steroids to the environment has generated most of the concern to date, but a plethora of other drugs are increasingly attracting attention, as their biological activity alone may support ecotoxicity assessments of those compounds with high production volumes (or toxicity), especially in view of the increasing importance of freshwater resources. Pharmaceuticals display a variety of removal efficiencies during wastewater treatment and their fate and behaviour are not determined by their physicochemical properties alone. Despite the fact that many drugs have high sorption potentials, partitioning to the solid phase was determined to be an unlikely removal pathway for the majority of compounds. The partitioning behaviour of these compounds both in sewage treatment and the aquatic environment is likely to be dictated by a number of physicochemical parameters. Findings also indicate that the costs of using tertiary treatment options (mainly based on drinking water treatment) to remove drugs from wastewater effluent are likely to be prohibitively expensive, and potentially undesirable, due sustainability implications. While adjusting existing treatment parameters may increase the removal efficiencies of pharmaceuticals, any changes to sewage treatment parameters would need to be offset against the economic and environmental costs. Likewise, any regulations on drug use must be balanced against health benefits. If receiving waters are used for potable supplies, the presence of these compounds may (although it is unlikely) represent a potential hazard to human health, especially in areas without advanced water treatment. The focus for future research should therefore be on proper and sufficient science for establishing the occurrence, exposure and effects of pharmaceuticals in the environment, so that sound decisions can be made regarding human and ecological health.

Iron metallodrugs: stability, redox activity and toxicity against Artemia salina

Iron metallodrugs comprise mineral supplements, anti-hypertensive agents and, more recently, magnetic nanomaterials, with both therapeutic and diagnostic roles. As biologically-active metal compounds, concern has been raised regarding the impact of these compounds when emitted to the environment and associated ecotoxicological effects for the fauna. In this work we assessed the relative stability of several iron compounds (supplements based on glucoheptonate, dextran or glycinate, as well as 3,5,5-trimethylhexanoyl (TMH) derivatives of ferrocene) against high affinity models of biological binding, calcein and aprotransferrin, via a fluorimetric method. Also, the redox-activity of each compound was determined in a physiologically relevant medium. Toxicity toward Artemia salina at different developmental stages was measured, as well as the amount of lipid peroxidation. Our results show that polymer-coated iron metallodrugs are stable, non-redox-active and non-toxic at the concentrations studied (up to 300 µM). However, TMH derivatives of ferrocene were less stable and more redox-active than the parent compound, and TMH-ferrocene displayed toxicity and lipid peroxidation to A. salina, unlike the other compounds. Our results indicate that iron metallodrugs based on polymer coating do not present direct toxicity at low levels of emission; however other iron species (eg. metallocenes), may be deleterious for aquatic organisms. We suggest that ecotoxicity depends more on metal speciation than on the total amount of metal present in the metallodrugs. Future studies with discarded metallodrugs should consider the chemical speciation of the metal present in the composition of the drug.

Household hazardous waste management: a review

This paper deals with the waste stream of household hazardous waste (HHW) presenting existing management systems, legislation overview and other relevant quantitative and qualitative information. European Union legislation and international management schemes are summarized and presented in a concise manner by the use of diagrams in order to provide crucial information on HHW. Furthermore, sources and types, numerical figures about generation, collection and relevant management costs are within the scope of the present paper. The review shows that the term used to refer to hazardous waste generated in households is not clearly defined in legislation, while there is absence of specific acts regulating the management of HHW. The lack of obligation to segregate HHW from the household waste and the different terminology used makes it difficult to determine the quantities and composition of this waste stream, while its generation amount is relatively small and, therefore, is commonly overlooked in waste statistics. The paper aims to cover the gap in the related literature on a subject that is included within the crucial waste management challenges at world level, considering that HHW can also have impact on other waste streams by altering the redox conditions or causing direct reactions with other non hazardous waste substances.

Environmental Risk Assessment (ERA) of diclofenac and ibuprofen: a public health perspective

Non-steroidal anti-inflammatory drugs (NSAIDs) have been widely used in human and veterinary medicine, representing potential aquatic environmental contamination. This study aimed to perform an Environmental Risk Assessment (ERA) of NSAIDs diclofenac (Dic) and ibuprofen (Ibu) in cities of the state of Paraná, Brazil, over the course of three years, by using available data from the Brazilian Public Health System. The environmental risk (ER) was assessed by employing the European Medicines Agency (EMeA) approach, and predicted environmental concentrations (PECs) were calculated. The refined PECs considered the drug metabolism and the excretion data, and also the sewage treatment plant removal rates of biological filters and activated sludge processes to define environmental scenarios. References to the predicted no effect concentration (PNEC) for these pharmaceuticals were considered, and the PEC/PNEC ratio was calculated; ratio values ⩾ 1 suggested an ER. Environmental risk was conducted on several cities, and the lack of an adequate sanitation system in the majority of Paraná cities forecasts a significant concern with the exposure to possible environmental damages in those cities. The high PEC/PNEC ratios in several cities showed that current usage patterns of these drugs constitute an environmental issue in need of resolution by health and environmental authorities.

Emerging contaminants of public health significance as water quality indicator compounds in the urban water cycle

The contamination of the urban water cycle (UWC) with a wide array of emerging organic compounds (EOCs) increases with urbanization and population density. To produce drinking water from the UWC requires close examination of their sources, occurrence, pathways, and health effects and the efficacy of wastewater treatment and natural attenuation processes that may occur in surface water bodies and groundwater. This paper researches in details the structure of the UWC and investigates the routes by which the water cycle is increasingly contaminated with compounds generated from various anthropogenic activities. Along with a thorough survey of chemicals representing compound classes such as hormones, antibiotics, surfactants, endocrine disruptors, human and veterinary pharmaceuticals, X-ray contrast media, pesticides and metabolites, disinfection-by-products, algal toxins and taste-and-odor compounds, this paper provides a comprehensive and holistic review of the occurrence, fate, transport and potential health impact of the emerging organic contaminants of the UWC. This study also illustrates the widespread distribution of the emerging organic contaminants in the different aortas of the ecosystem and focuses on future research needs.

Nissen L, Barter N, McIntosh M. The global public health issue of pharmaceutical waste: what role for pharmacists?

Purpose

– Pharmaceuticals have played an important role in improving the quality of life of the human population in modern times. However, it must also be acknowledged that both the production and use of pharmaceuticals have a significant, negative impact on the environment and consequently, a negative impact on the health of humans and wildlife. This negative impact is due to the embedded carbon in pharmaceuticals' manufacture and distribution and the waste generated in their manufacture, consumption and disposal. Pharmaceutical waste is comprised of contaminated waste (unwanted pharmaceuticals and their original containers) and non-contaminated waste (non-hazardous packaging waste). The paper aims to discuss these issues.

Design/methodology/approach

– The article is a literature review.

Findings

– The article identified a gap in the literature around pharmacist attitudes and behaviour toward the environmentally responsible handling of pharmaceutical waste.

Originality/value

– Pharmacists, with their professional commitment to the quality use of medicines and their active participation in the medicines management pathway, already play an important role in the more sustainable use of pharmaceuticals. Even so, they have the potential to play an even greater role with the environmentally responsible disposal of pharmaceutical waste (including packaging waste) and the education of other health professionals and the general public on this topic.

Public practice regarding disposal of unused medicines in Ireland

BACKGROUND

Over recent years, a global increase in the use of pharmaceutical products has been observed. EU directives state that "Member states shall ensure that appropriate collection systems are in place for medicinal products that are unused or have expired" (Directive 2001/83/EC and Directive 2004/27/EC).

OBJECTIVES

There is no published data on how people in Ireland dispose of unused medicines; therefore the purpose of this study is to establish baseline information on storage and disposal of medicines.

DESIGN

Data was collected over two 2-week periods a year apart. People in the streets of Galway and Cork were approached randomly and invited to participate by filling out a questionnaire.

RESULTS

The questionnaire was completed by 398 individuals (207 in Galway and 191 in Cork). Unused medicines were kept in the home by 88% of the respondents. The most cited reason for keeping unused medicines was "in case they are needed later" (68%). Of the respondents who had disposed of medicine in the past, 72% had done so inappropriately. Environmentally inappropriate disposal methods were through general waste disposal and via the sewage system. Interestingly, of the people who had received advice on disposal practices from a healthcare professional, 75% disposed of their medicine appropriately.

CONCLUSIONS

There is little awareness among members of the public regarding appropriate ways to dispose of unused medicines. Our findings suggest that effective communication and established protocols will promote appropriate disposal practices.

Sonochemical degradation of the persistent pharmaceutical carbamazepine

The objective of this work was to evaluate the potential of a sonochemical oxidation process for the degradation of carbamazepine (CBZ). Several factors, such as electrical power, treatment time, pH and initial concentration of CBZ were investigated. Using a 2(4) factorial matrix, the best performance for CBZ degradation (90.1% of removal) was obtained with an electrical power of 40 W, a treatment time of 120 min and an initial pH of 10.0 imposed in the presence of 6.0 mg L(-1) of CBZ. The treatment time and the calorimetric power were the most influential parameters on the degradation rate of CBZ. Subsequently, the optimal experimental parameters for CBZ degradation were investigated using central composite design. The sonochemical oxidation process, applied under optimal operating conditions (at an electrical power of 43 W for 116 min), oxidized 86 and 90% of the initial CBZ concentration of 5.62 mg L(-1) and 8.05 μg L(-1), respectively. During the sonochemical process, CBZ was primarily transformed into anthranilic acid and acridine.

Consumer-perceived risks and choices about pharmaceuticals in the environment: a cross-sectional study

BACKGROUND

There is increasing concern that pollution from pharmaceuticals used in human medicine and agriculture can be a threat to the environment. Little is known, however, if people are aware that pharmaceuticals may have a detrimental influence on the environment. The present study examines people's risk perception and choices in regard to environmental risks of pharmaceuticals used in human medicine and for agricultural purposes.

METHODS

A representative sample of the U.S. population (N = 640) was surveyed. Respondents completed a hypothetical choice task that involved tradeoffs between human and environmental health. In addition, it was examined how much people would support an environment policy related to drug regulation.

RESULTS

For agricultural pharmaceuticals, respondents reported a high level of satisfaction for a policy requiring farms to limit their use of antibiotics. In the domain of pharmaceuticals used in human medicine, we found that people were willing to consider environmental consequences when choosing a drug, but only when choices were made about treatment options for a rather harmless disease. In contrast, when decisions were made about treatment options for a severe disease, the drug's effectiveness was the most important criterion.

CONCLUSIONS

It can be concluded that the environmental impact of a drug will be hardly considered in decisions about pharmaceuticals for severe diseases like cancer, and this may be due to the fact that these decisions are predominantly affective in nature. However, for less severe health risks, people are willing to balance health and environmental considerations.