Why regulatory indifference towards pharmaceutical pollution of the environment could be a missed opportunity in public health protection. a holistic view

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.

Disposal Practices of Unused and Leftover Medicines in the Households of Dhaka Metropolis

Background: This fact-finding study aimed to attain an overall idea and knowledge about medicine disposal practices in Dhaka Metropolitan households. Methods: This mixed study (both quantitative and qualitative) was orchestrated to inspect the household leftover medicine disposal pattern's governing status. A cross-sectional survey was conducted following a structured questionnaire and key informant interview with a household person and in-depth interviews with the top pharmaceutical and government officials. Results: Findings disclose that, for most of the key informants, the terms "drug disposal" and "drug pollution" were unknown; more precisely, 67% and 74% of key informants even did not hear these two terms. Almost all (87%) households faced undesired incidents due to the insecure storage of medicines. People disposed of excess and expired medication in regular dustbins (47%), threw out of the window (19%), flushed within commode (4%), burnt in fire (2%), and reused (4%). A good percentage of people (21%) returned unexpired drugs to the pharmacy and bought other medicines on a need basis. A total of 72% wanted a medicine take-back program, and 100% agreed on mass education on this issue. Officials of pharmaceuticals conferred mixed opinion: top-ranked pharmaceuticals will adopt leftover medicine disposal practices; middle and low-ranked pharmaceutical companies are reluctant, merely denied mentioning the less important issue. Conclusions: The absence of mass awareness and standard laws and policies may explain these existing aberrant practices.

Assessing the bioremediation potential of indigenously isolated Klebsiella sp. WAH1 for diclofenac sodium: optimization, toxicity and metabolic pathway studies

Among the various pharmaceutical pollutants, diclofenac sodium (DFS), a widely prescribed non-steroid anti-inflammatory drug is detected in the aquatic environment at concentrations which can be harmful to living organisms. Present study illustrates the isolation and characterization of strain Klebsiella pneumoniae WAH1 from activated sludge and its ability to degrade DFS as sole source of carbon and energy. The growth and degradation capacity of K. pneumoniae WAH1 under different conditions of pH, temperature, rotation speed, and inoculum age were evaluated using optical density and liquid chromatography-mass spectroscopy (LCMS). The results show that K. pneumoniae WAH1 can grow well with DFS as its sole source of carbon and degrade 79.14% of DFS (10 mg L^-1) within 72 h. Based on chemical structure of intermediates detected through LCMS, it is inferred that degradation pathway advanced by hydroxylation, decarboxylation, and dechlorination reactions. Toxicity studies revealed the non-toxic nature of the end-products of DFS degradation after 72 h. The findings suggest that K. pneumoniae WAH1 has an excellent potential for bioremediation of DFS in industrial wastewaters.

Molecularly imprinted polymer-based electrochemical sensors for environmental analysis

The ever-increasing presence of contaminants in environmental waters is an alarming issue, not only because of their harmful effects in the environment but also because of their risk to human health. Pharmaceuticals and pesticides, among other compounds of daily use, such as personal care products or plasticisers, are being released into water bodies. This release mainly occurs through wastewater since the treatments applied in many wastewater treatment plants are not able to completely remove these substances. Therefore, the analysis of these contaminants is essential but this is difficult due to the great variety of contaminating substances. Facing this analytical challenge, electrochemical sensing based on molecularly imprinted polymers (MIPs) has become an interesting field for environmental monitoring. Benefiting from their superior chemical and physical stability, low-cost production, high selectivity and rapid response, MIPs combined with miniaturized electrochemical transducers offer the possibility to detect target analytes in-situ. In most reports, the construction of these sensors include nanomaterials to improve their analytical characteristics, especially their sensitivity. Moreover, these sensors have been successfully applied in real water samples without the need of laborious pre-treatment steps. This review provides a general overview of electrochemical MIP-based sensors that have been reported for the detection of pharmaceuticals, pesticides, heavy metals and other contaminants in water samples in the past decade. Special attention is given to the construction of the sensors, including different functional monomers, sensing platforms and materials employed to achieve the best sensitivity. Additionally, several parameters, such as the limit of detection, the linear concentration range and the type of water samples that were analysed are compiled.

Using a targeted ecopharmacovigilance intervention to control antibiotic pollution in a rural aquatic environment

The "targeted ecopharmacovigilance (EPV)" strategy emphasizes the control of environmental pollution by high-priority hazardous pharmaceuticals from principal pollution sources especially in areas that are high risk as a result of drug administration. We conducted a prospective empirical study to explore the possibility of using a targeted EPV intervention as an optimized management tool for the control of aquatic pollution by antibiotics, a common type of pharmaceutical residue, in a rural area in China. Because of the notably high levels of ofloxacin in the studied aquatic environment and the well-accepted environmental risks posed by fluoroquinolone residues, ofloxacin was selected as the targeted high-priority antibiotic pollutant. Based on the main sources of antibiotic pollution in the studied rural aquatic environment, which had been traced previously, a five-step targeted EPV intervention was designed and conducted from Feb 2018 to Jan 2019. The results showed that the residual levels of ofloxacin in the studied Chinese rural aquatic environment significantly decreased during the targeted EPV intervention. Importantly, the EPV measures targeting ofloxacin were found to effectively reduce the environmental pollution by other non-targeted antibiotics. The data from a survey of 45 participants (42 residents and 3 clinicians) and 12 program committee members revealed that the targeted EPV intervention was acceptable to both participants and organizers and could be used as an economical and feasible solution for addressing antibiotic pollution in aquatic environments.

Environmental fate and ecotoxicological effects of antiretrovirals: A current global status and future perspectives

The therapeutic efficacy of antiretroviral drugs as well as challenges and side effects against the human immunodeficiency virus is well documented and reviewed. Evidence is available in literature indication that antiretrovirals are only partially transformed and become completely excreted from the human body in their original form and/or as metabolites in urine and feces. The possibility of massive release of antiretrovirals through human excreta that enters surface water through surface runoff and wastewater treatment plant effluents is now of environmental concern because the public might be experiencing chronic exposure to antiretrovirals. The primary concern of this review is limited data concerning environmental fate and ecotoxicity of antiretrovirals and their metabolites. The review aims to provide a comprehensive insight into the evaluation of antiretrovirals in environmental samples. The objective is therefore to assess the extent of analysis of antiretrovirals in environmental samples and also look at strategies including instrumentation and predictive models that have been reported in literature on the fate and ecotoxicological effects due to presence of antiretrovirals in different environmental compartments. The review also looks at current challenges and offers possible areas of exploration that could help minimize the presence of antiretrovirals in the environment.