The global public health issue of pharmaceutical waste: what role for pharmacists?

An observational cross-sectional study of pharmaceutical waste disposal practices in Australian medical imaging departments: A comparison of community versus hospital practice

INTRODUCTION

Pharmaceuticals are used widely in radiography practice but pose an environmental risk. This study explored Australian radiographers' environmental attitude, pharmaceutical waste disposal practices, and knowledge and concern regarding the environmental impact of these pharmaceuticals.

METHODS

This study utilised an anonymous, online questionnaire developed from two validated questionnaires. Participants (n = 150) held current registration with the Medical Radiation Practice Board of Australia and were working eight or more hours per week in a medical imaging practice (public or private).

RESULTS

Participants did not answer all questions, hence percentages reported reflect the number of counts for each question. Most participants (71.4%; 105/147) disposed of contaminated pharmaceutical waste in clinical waste bins with 17.1% (15/146) disposing of it down drains. More hospital radiographers 13.54% (13/96) reported this disposal compared with 2.08% (1/48) of community-based radiographers (Fisher's Exact Test, p = 0.035). There was no difference in disposal of non-contaminated waste between practice settings - general waste bin (68.5%; 100/150), recycling bin (28.8%; 42/146), and clinical waste bin (41.8%; 61/146). Participants lacked knowledge of impacts on the food chain and the health of humans and wildlife. Only 34.7% (48/138) of participants expressed concern regarding the impacts of human excreted pharmaceuticals on the environment compared with 65.8% (98/149) regarding impacts from incorrect disposal. Many (18.4%; 25/136) reported having received no information on correct disposal of pharmaceutical waste.

CONCLUSION

This study highlighted participants' lack of knowledge on how pharmaceuticals enter the natural environment and the subsequent impacts on the environment and on the health of humans, and flora and fauna. They lacked knowledge of correct pharmaceutical waste disposal methods, but most agreed it was their professional responsibility to dispose of waste correctly.

IMPLICATIONS FOR PRACTICE

Improving radiographers' pharmaceutical waste disposal practices through education and professional support will reduce environmental impacts and also provide financial co-benefits if non-contaminated waste is recycled where possible and not incinerated.

Broadening the Perspective on Reducing Pharmaceutical Residues in the Environment

The present study reviews options for reducing harm from pharmaceuticals that are known to cause adverse impacts by their presence in the environment. It reviews recent global and European Union policy development, which could go further in recognizing and addressing the issue in a global context. It considers green chemistry, which can help clean up production processes but holds only long-term promise for creating "green" alternatives. It explores the potential of health promotion and disease prevention, which can contribute significantly to a reduction of the disease burden and thus the need for medicines, both for infectious and for noncommunicable disease. Eco-directed sustainable prescribing practices are reviewed, which have been adopted successfully to reduce the use of harmful pharmaceuticals. We note recent developments in medicines optimization and precision medicine, which hold promise for improving patient outcomes, saving costs, and reducing pharmaceutical use, through individually tailored prescribing whereby the patient codecides their therapy. Waste prevention through reuse or redistribution is beginning to find public support and "take-back" waste disposal schemes set up via extended producer responsibility systems have achieved high returns. Finally, the paper summarizes preferred advanced wastewater technologies, including innovative low-cost, low-energy options. In summary, although end-of-pipe options have a role to play, particularly for highly concentrated wastewaters, solutions further up the medicinal chain and disease prevention interventions, informed by a broad view of health and health care, are needed to pursue a much greater potential reduction of pharmaceuticals in the environment than can be achieved by end-of-pipe solutions alone. Environ Toxicol Chem 2024;43:653-663. © 2023 The Authors. Environmental Toxicology and Chemistry published by Wiley Periodicals LLC on behalf of SETAC.

Pharmacy students' perceptions on environmental sustainability in pharmacy education and practice

Background

Given the negative environmental impacts of pharmaceuticals, including their contribution to healthcare's carbon footprint, pharmacists have a role in responding to the climate and biodiversity crises. Knowledge and education are required to support transitions to environmentally sustainable pharmacy practice (ESPP). The aim of this study was to explore Australian undergraduate pharmacy students' knowledge and attitudes towards environmental sustainability and ESPP curriculum content.

Methods

Participants were surveyed using an anonymous online questionnaire deployed using Qualtrics. The questionnaire comprised of two main sections: the 15-item New Ecological Paradigm (NEP) scale to determine participants' environmental attitude score, and section on students' perceptions and curricular experience of environmentally sustainable practice which was adapted from previously published surveys. The invitation with survey link was disseminated via social media, Australian pharmacy student organisations, and direct approach. Quantitative data were reported descriptively. Qualitative data from responses to open-ended questions were analysed thematically using a reflexive, recursive approach. Incomplete survey responses were excluded from the analysis.

Results

Of the 164 complete responses, 99% had previously received information on environmental sustainability. However, only 10% were knowledgeable about ESPP and only 8.5% were aware of ESPP content in their pharmacy school curriculum. Importantly, 70% of respondents saw ESPP as relevant to their future pharmacy practice, and 94% believed the pharmacy profession has a responsibility to undertake sustainability initiatives in the delivery of pharmaceutical care.

Conclusions

Australian pharmacy students lacked knowledge of ESPP and few reported having curricular exposure to ESPP content in their pharmacy degrees. Therefore, ESPP content is an important area for development in pharmacy curricula.

Ecopharmacology: Knowledge, Attitude, and Medication Disposal Practice Among Pharmacy Students

Background

Ecopharmacology, as a form of drug management for the environment, focuses on the impact of drugs on the environment. Pharmacists, and by extension pharmacy students, are expected to play an important role in ecopharmacology. Therefore, this study was conducted to determine the knowledge and attitude towards ecopharmacology and the practice of disposal of leftover or expired medicines among pharmacy students.

Methods

This was a descriptive cross-sectional study among pharmacy students in Northwestern Ethiopia. The study took place from May 1 to June 15, 2023. A self-administered questionnaire was used for data collection.

Results

Four hundred and forty-five students were included in the study. Only 91 (20%) of the students were aware of the term ecopharmacology, 27% knew that excretion from the human or animal body is the major route by which pharmaceutical agents enter the environment, and 42% were aware of the risk of increased antimicrobial resistance due to antibiotic residues in the environment. In addition, only 27% of respondents reported receiving information about the disposal of pharmaceuticals. The most common method of disposing of medications was throwing them away in household trash (61.8%).

Conclusion

Our results suggest that while most pharmacy students in Ethiopia have a positive attitude toward ecopharmacology, they do not know enough about ecopharmacology and dispose of their medicines poorly. More uniform education in ecopharmacology and pharmaceutical pollution might be warranted in the pharmacy curriculum.

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.

Towards zero waste in pharmacy: Challenges and opportunities in Singapore

Background

In line with zero-waste movement, there is a need for pharmacies to start reducing waste. There is no systematic waste minimization efforts by local pharmacies or studies to evaluate their effectiveness.

Aim

Assess behavioral change factors towards waste minimization at National Cancer Centre Singapore and evaluate effectiveness of recycling effort and patient education campaign.

Methods

Preliminary surveys were carried out among pharmacy staff, patients/caregivers to assess behavioral change factors. Recycling rate of staff and plastic bag consumption levels of patients/caregivers were measured.

Results

46 staff members and 335 patients/caregivers were surveyed. Both populations were optimistic about the suggested green initiatives, 82.6% of staff members viewed recycling as a potential solution to reduce waste and 67.6% of patients and caregivers demonstrated willingness to participate in a Bring Your Own Bag (BYOB) campaign. Recycling efforts improved recycling rates by 53.4% while BYOB campaign resulted in no notable decrease in plastic bag consumption levels.

Conclusion

This study revealed the need for improvements in current waste management practices in local pharmacies, and demonstrated the effectiveness of implementing a recycling effort. BYOB campaign was not shown to be effective. Follow-up studies should be carried out to capture long-term sustainability data. Future efforts should include studies at other non-specialized local pharmacies.

Poor and Unsatisfactory Disposal of Expired and Unused Pharmaceuticals: A Global Issue

Pharmaceuticals are beneficial to humankind and emerged as crucial arms to treat/manage multiple disease pathogenesis in the present era. In analogous, these medicines/ medical devices should be used cautiously as they possess a potential threat to induce multiple undesired effects that may be related to human health or the environment. Daunting effects may arise due to the improper disposal of unused/expired medicines. Hence, to minimize such harm, there should be adequate knowledge and practice among the population regarding the safe disposal of unused/expired medicines or related pharmaceutical devices. The lack of approved information regarding safe disposal of such substances may invite serious concerns like environmental pollution, which may induce immediate health hazards to the present population and upcoming future generations. There are numerous ways to dispose of, or manage the unused and expired pharmaceutical substances. Sharing the medicines among siblings, friends, and family members are never free from serious health risks. Storing the unused and expired medicines in the home increases the risk of intentional or accidental ingestion of such substances and may create a health emergency. Disposing medicines like household and municipal waste may lead to environmental pollution and harm to humans and animals. The present review finds the multiple unsafe ways of disposal of unutilized medications/tools. Furthermore, it also summarizes the disposal pattern of unutilized medications among the few developed and undeveloped nations.

Leftover drug disposal: Customer behavior, pharmacist recommendations, and obstacles to drug take-back box implementation

Production and use of pharmaceuticals in the United States is high and continues to grow. This, combined with poor wastewater removal rates for drugs in excreted waste, and improper pharmaceutical disposal leads to the presence of pharmaceuticals in fresh- and marine waters and wildlife. In the United States, safe drug take-back boxes, or dropboxes, were established in pharmacies after federal legislation passed in 2014, allowing for year-round safe collection of leftover pharmaceuticals. The overarching objective of this work was to identify opportunities for improving access to proper pharmaceutical disposal. We assessed consumer behavior regarding drug disposal choices and knowledge of dropboxes at pharmacies, investigated pharmacist attitudes toward and recommendations about leftover drug disposal, and compared responses at locations with and without dropboxes. We also explored obstacles to dropbox adoption and usage. We found that customer awareness of dropboxes as well as knowledge about risks of improper disposal are low, however awareness was greater at pharmacies with dropboxes. Additionally, pharmacists at dropbox locations were more consistent in their messaging to customers, more likely to recommend proper disposal methods, and more supportive of drug take-back programs. Through a focus group, we learned that further consumer education would overwhelm the capacity of the existing dropboxes. Based on our findings, we recommend solutions to improper disposal focus on legislation mandating dropboxes at pharmacies and pressure on the pharmaceutical industry to fund proper disposal of unused pharmaceuticals.

Enabling Medicine Reuse Using a Digital Time Temperature Humidity Sensor in an Internet of Pharmaceutical Things Concept

Medicinal waste due to improper handling of unwanted medicines creates health and environmental risks. However, the re-dispensing of unused prescribed medicines from patients seems to be accepted by stakeholders when quality and safety requirements are met. Reusing dispensed medicines may help reduce waste, but a comprehensive validation method is not generally available. The design of a novel digital time temperature and humidity indicator based on an Internet of Pharmaceutical Things concept is proposed to facilitate the validation, and a prototype is presented using smart sensors with cloud connectivity acting as the key technology for verifying and enabling the reuse of returned medicines. Deficiency of existing technologies is evaluated based on the results of this development, and recommendations for future research are suggested.