Pharmaceutical pollution sources and solutions: Survey of human and veterinary medication purchasing, use, and disposal

A Cross-Sectional Study to Assess the Knowledge of Pharmacy Students About Drug Pollution in Spain

The presence of pharmaceuticals in the environment is an issue of growing concern. The European Commission adopted the "European Union Strategic Approach to Pharmaceuticals in the Environment", which focuses on actions to reduce the risk of pharmaceuticals in the environment, including how environmental aspects can become part of medical training programs.

OBJECTIVE

Obtain data from pharmacy students about pharmaceutical pollution to provide information about the training needs that may help develop new actions related to the training and dissemination of this issue.

METHODS

A total of 1614 pharmacy students from 5 Schools of Pharmacy in Spain completed a self-administered questionnaire consisting of 24 questions: 13 about knowledge, 8 related to attitude, and 3 to opinion.

RESULTS

Around 75% of students reported that they did not know "One Health" or "emerging pollutant" concepts and around 88% declared that they did not know that diclofenac caused a catastrophic vulture decline in Asia. The importance of this topic and their attitude to acquiring new knowledge was evaluated higher than 8 points out of 10, while received training during their studies was a score of 2.8 points out of 10.

CONCLUSION

The knowledge about key concepts was relatively poor. In fact, they judged training about pharmaceuticals in the environment during their pharmacy studies was very scarce. However, students consider drug pollution to be a very important issue and have a very good attitude toward acquiring knowledge about it.

A novel electrochemical sensor for the detection of metronidazole residues in food samples

The widespread use and misuse of antibiotics in pharmaceuticals and animal farming has resulted in their accumulation in food sources and the environment, posing significant threats to human health, the environment, and the global economy. In this study, we have developed a hypersensitive, and ultra-selective electrochemical sensor, the first of its kind, by integrating a thermally annealed gold-silver alloy nanoporous matrix (TA-Au-Ag-ANpM) with reduced graphene oxide (r-GO) and poly(glycine) at the surface of a glassy carbon electrode (GCE). This sensor aims to detect life-threatening metronidazole (MTZ) residues in food samples. TA-Au-Ag-ANpM/r-GO/poly(glycine)/GCE was thoroughly characterized using a range of analytical techniques, including UV-Vis, FT-IR, XRD, SEM, and EDX. Furthermore, its electrochemical properties were investigated by cyclic voltammetry (CV), square wave voltammetry (SWV), and electrochemical impedance spectroscopy (EIS). The sensor exhibited outstanding performance, with a broad linear range of 2.0 pM-410 μM. The limits of detection (LOD) and quantification (LOQ) were determined to be 0.0312 pM and 0.104 pM, respectively. The TA-Au-Ag-ANpM/r-GO/poly(glycine)/GCE exhibited exceptional reproducibility, repeatability, stability, and resistance to interferences. Moreover, the sensor demonstrated outstanding performance in detecting MTZ residues in milk powder, pork, and chicken meat samples, achieving very good recoveries (96.9%-101.4%) with a relative standard deviation (RSD) below 5%. This performance highlights the potential for practical applications in food safety and quality monitoring. Therefore, the developed sensor contributes to the advancement of electrochemical sensing technology and its application in ensuring food safety and integrity by combating antibiotic residues.

Guidance provided by pharmacists to customers regarding to destination of unused household medications: disposal of household medications

BACKGROUND

Discarding pharmaceuticals in the garbage or into the sewage system are still the most common methods in many countries. This study aims to investigate the guidance provided by pharmacists to customers on the disposal of unused and expired household medications in São Paulo State, Brazil.

METHOD

The study population consisted of 630 pharmacists from the State of São Paulo, who work in community pharmacies. They answered an online questionnaire with questions composed in three blocks: demographic, work, and academic information on the pharmacist; guidance about the disposal of household medications; and knowledge regarding the reverse logistics of these medications. An invitation to participate in the questionnaire was made via WhatsApp, individually and collectively. Inferential statistics were performed using the chi-square test and were considered significant when p < 0.05%.

RESULTS

Among the participating pharmacists, the majority were women under 60 years old,56 (8.89%) stated that they never orient the customer regarding the disposal of unused and expired household medications, while 574 (91,12%) indicated that they almost provide guidance. The frequency with which they provided guidance was influenced by the number of years since graduation (p = 0.0047), the time they had worked in pharmacies and drugstores (p = 0.0007), and whether or not they had a graduate degree (p = 0.0181). Regarding the disposal of medications, among the 643 responses provided by the pharmacists,516 (80.25%) indicated that they oriented customers to return them to a pharmacy.

CONCLUSION

A small number of pharmacists always orient customers on the proper disposal that should be followed for unused and expired household medications, prioritizing their return to a pharmacy. In general, these pharmacists have longer periods of work experience and higher academic qualifications. Thus, it is important to increase knowledge through professional training and further education programs.

Enhancing environmental sustainability through a household pharmaceuticals take-back program in Jordan

Most homes have unwanted, discarded, unused, or expired pharmaceuticals. These pharmaceuticals can pose health risks if they are not properly disposed of. Active pharmaceutical ingredients have been detected in water resources at an alarming level globally and recently in Jordanian waters. Unfortunately, no programs or regulations are addressing this problem in Jordan. This study aims to provide a comprehensive evaluation of the stakeholders' potential involvement in establishing a pharmaceutical take-back program in Jordan. The study was designed to determine the focal points of establishing a pharmaceutical take-back program using a qualitative cross-sectional approach and using a force field analysis to put together a plan for a successful program in Jordan. The study conducted three surveys using structured questionnaires and interviews with officials to evaluate the attitude toward the pharmaceutical take-back program, awareness of environmental impacts, and current conditions of household pharmaceuticals in Jordan. The questionnaires were assigned to the public, pharmaceutical manufacturers, and pharmaceutical warehouses. The interviews were conducted with the Ministry of Environment, pharmaceutical manufacturers, and pharmaceutical warehouses. Most of the pharmaceutical producers (85% manufacturers and 94% warehouses) refused to participate voluntarily in the program due to the extra cost incurred. On the other hand, the public and the Ministry of Environment were supportive of establishing the program. The study revealed that there is a lack of awareness among the public toward household pharmaceuticals. About 77% of the public questionnaire respondents reported they had not received any information on how to dispose safely of their unwanted pharmaceuticals. Also, about 61% reported that they have concerns that household pharmaceuticals might contaminate the water resources in Jordan. Following the questionnaires' analysis, the study determined the main forces against establishing a pharmaceutical take-back program as the unwillingness of producers to participate, weak logistic support, lack of public awareness, and low public participation. A force field analysis (FFA) was conducted based on the forces determined from the questionnaires. Accordingly, the study recommends developing a comprehensive legislation and regulatory framework for household pharmaceuticals' recovery, establishing a monitoring entity, securing funds, and implementing a long-term awareness and education plan to support the establishment of a pharmaceutical take-back program in Jordan.

Veterinary pharmaceutical as emerging contaminants in wastewater and surface water: An overview

Veterinary pharmaceuticals have become of interest due to their indiscriminate use. Thus, this paper compiles studies on detection in surface and wastewater, and the treatment applied for their removal. Additionally, a case study was performed to evaluate its commercialization, as the ecological risk assessment for the most relevant compounds. 241 compounds were detected. The highest concentrations were found for antibiotics such as oxytetracycline, amoxicillin, and monensin, with values up to 3732.4 µg/L. Biological treatments have been mainly reported, obtaining removal greater than 80% for sulfadiazine, sulfamethazine, sulfamethoxazole, enrofloxacin, and oxytetracycline. Considering the case study, enrofloxacin and oxytetracycline were widely commercialized. Finally, there was a low risk for the species exposed to enrofloxacin, in contrast, the species exposed to oxytetracycline presented a high risk of long-term mortality. Concluding that veterinary compounds have emerged as a significant concern regarding water source contamination, owing to their potential adverse effects on aquatic biota and even human. This is particularly relevant because many water bodies that receive wastewater are utilized for drinking water purposes. Consequently, the development of comprehensive, full-scale systems for efficient antibiotic removal before their introduction into water sources becomes imperative. Equally important is the need to reconsider their extensive use altogether.

Expiry of veterinary medicines in supply outlets in Central Uganda: prevalence, management and associated factors

BACKGROUND

Animal diseases are a danger to livestock, businesses, and public health. This is why the public and private sectors in Africa have invested immensely in the manufacture and distribution of veterinary drugs. However, veterinary drug supply chain actors still suffer losses as a result of expiration. Besides, the way expired products are managed might pose risks to human, animal, and environmental health. This study investigated the prevalence, management of, and factors associated with the expiry of veterinary medicines in supply outlets in Central Uganda.

METHODS

A cross-sectional study was conducted among owners and caretakers of veterinary drug supply outlets. Data were collected using self-administered, semi-structured questionnaires. The level of expiry was computed as "acceptable" (for levels reported as ≤ 5%) and "unacceptable" (for levels reported as ˃5%). Logistic regression was used to assess associations between the level of drug expiry and predictor variables.

RESULTS

A total of 168 owners/caretakers of veterinary drug supply outlets were included in this study. The majority (148/168, 88.1%) of respondents reported having experienced expiries in their outlets. Unacceptable levels of expiry were reported in 38/168 (22.6%) of the outlets. Retail outlets accounted for the majority (34/38, 89.5%) of the unacceptable levels. Powdered drugs accounted for most expiries (106/148, 71.6%). Most expiries were for drugs supplied to outlets on credit (58/124, 46.8%) and those used to treat rare diseases (26/124, 21%). Major reasons for expiry included irrational prescription, inaccurate forecasts, overstocking, dry seasons, and stocking without considering stock-at-hand. Methods of disposal of expired drugs included throwing at pits (74/168, 44.1%); returning drugs to suppliers (51/168, 30.4%); and incineration (33/168, 19.6%). Factors associated with acceptable levels of expiry included the caretaker being female [adjusted OR = 2.9, 95% CI = 1.22-5.08]; having a procurement policy [adjusted OR = 3.9, 95% CI = 1.29-4.81] and practicing first expiry, first out [adjusted OR = 6.07, 95% CI = 4.71-8.70].

CONCLUSIONS

Veterinary drug expiries are common in Uganda, and environmentally unfriendly methods of disposal are widely used. Acquisition and use of inventory tracking technologies that support First-Expiry-First-Out principles as well as proper disposal of expired medicines are recommended.

Patient medication counselling in community pharmacy: evaluation of the quality and content

BACKGROUND

Patient medication counselling (PMC) is a pharmaceutical care service targeted at optimizing patient drug use, safety and improving treatment outcomes. This study assessed the content and quality of PMC from the community pharmacists' (CPs) and pharmacy customers' (PCs) perspectives.

METHODS

A cross-sectional questionnaire-guided survey was conducted in Ibadan, Nigeria, among 125 CPs and 612 PCs. The 35-counselling items validated United States Pharmacopeia Medication Counselling Behaviour Guideline scale with 10-point graded responses (1 = poor to 10 = excellent) was used. Self-reported medication counselling information content provided by CPs and received by PCs was assessed and expressed in median and interquartile ranges. The quality of PMC was evaluated and graded as poor (1-29.9%), unsatisfactory (30-59.9%), satisfactory (60-79.9%) and excellent (80-100%). Associations between demographic variables and overall quality of counselling were determined with Mann-Whitney U and Kruskal-Wallis tests at p < 0.05.

RESULTS

The response rate was 92.5% and 97.6% for PCs and CPs, respectively. The PCs' opinions on the individual content of the PMC provided by the CPs were significantly different from the pharmacists' self-report (p < 0.05). Some of the PMC content included how to take the medicine PC = 6.00 (2.00) vs CP = 8.00 (2.00), information on possible side effects PC = 6.00 (2.00) vs CP = 8.00 (2.00), taking history of allergies and other medications PC = 6.00 (6.00) vs CP = 7.00 (1.00), and how to incorporate drug regimen into daily routine PC = 5.00 (6.00) vs CP = 8.00 (3.00). The quality of PMC purportedly provided by CPs and received by the PCs was satisfactory (75%) and unsatisfactory (55%), respectively. The quality of communication counselling offered by CPs trained in Nigeria (Mean rank = 62.49) was higher than those trained outside Nigeria (Mean rank = 26.40), U = 228.00, p = 0.024. The PC's age, marital status, and highest educational qualification were significantly associated with their opinion on the quality of counselling received.

CONCLUSIONS

Both the community pharmacists and pharmacy customers reported the provision of patient medication counselling on side effects, drug usage, medication history and allergies among others. However, the quality of counselling provided by the pharmacists was satisfactory, but the quality of counselling received by the pharmacy customers was unsatisfactory. Pharmacists may need to engage pharmacy customers more during medication counselling.

Household Pharmaceutical Waste Disposal as a Global Problem-A Review

The negative effect of the pharmaceuticals presence (persistence?) in various components of the environment is a global problem today. These compounds are released into the environment as a result of, inter alia, their use and improper disposal. Therefore, it is important to reduce excessive drug consumption and to develop a system for the collection of unused/expired pharmaceuticals. The effectiveness of actions in this area is inextricably linked with the need to educate society on how to deal properly with unwanted medications. The aim of the study was to show that the inappropriate handling of unused/expired drugs by society is an important problem in waste management systems, and it impacts the state of the environment. Forty-eight scientific articles published between 2012 and 2021 were taken into account that discussed the systems in various countries for the collection of unused/expired pharmaceuticals. This literature review shows that the main method of disposing of unused/expired medications, according to respondents from different countries, is either by disposing of them in household waste or flushing them into the sewage system. This is also the case in countries with systems or programs for the return of redundant drugs, which indicates that these systems are not sufficiently effective. This may be influenced by many factors, including the lack or ineffective education of the society.

Insights into the occurrence, elimination efficiency and ecological risk of antibiotics in rural domestic wastewater treatment facilities along the Yangtze River Basin, China

China is embarking on the treatment of rural domestic wastewater, but little information on the characteristics of antibiotics in the rural domestic wastewater is available. As one of the most important new-emerging pollutants, antibiotic has been explicitly proposed to be controlled and treated since the fifth plenary session of the 19th Central Committee of the Communist Party of China. Thus, the occurrence, elimination efficiency and ecological risk of antibiotics, as well as conventional wastewater quality parameters were investigated in influents and effluents from 41 rural domestic wastewater treatment facilities (RD-WWTFs) along the Yangtze River Basin. Results showed that elimination efficiencies of routinely monitored conventional pollutants in 33 RD-WWTFs (accounting for 80.5%) were effective based on conventional wastewater quality parameters. Of 39 target antibiotics selected, 26 ones were detected in the influents and effluents with a detection frequency (DF) between 2.4% and 100%. No significant decrease of antibiotics was observed in the effluents compared with that in the influents except chlortetracyclin (CTE) and tetracycline (TCs). The composition characteristics of antibiotics showed regional differences. Among the investigated antibiotics, ofloxacin (OFX), doxycycline (DOX), roxithromycin (ROX) and lincomycin (LIN) were the predominant, totally accounted for a median percentage of more than 60% of ΣAB concentrations in both influents and effluents. Ecological risk values of ΣABs showed that 11 effluents presented high risks (26.8%), 18 ones had moderate risks (43.9%), and the rest 12 ones showed low risks (29.3%). Moreover, oxytetracycline (OXY), norfloxacin (NOR), LIN and ROX was the dominant contributors to the ecological risk values. Overall, the elimination effect of antibiotics was limited in RD-WWTFs along the Yangtze River Basin, which was likely to pose potential adverse impacts on aquatic ecosystems.