Pharmaceutical waste from hospitals and homes: Need for better strategies

Shraddha M Pore 
 Department of Pharmacology, Government Medical College, Miraj, Maharashtra, India

Correspondence Address:
Shraddha M Pore
Department of Pharmacology, Government Medical College, Miraj, Maharashtra
India

Full Text

Sir,

It has become clear now that the ever-increasing use of pharmaceuticals in clinical and veterinary practice can have adverse influence on the environment, which is probably best exemplified by the association between the use of diclofenac for treatment in livestock and decline in number of vultures in the Indian subcontinent. [1] Consequently, the concept of ecopharmacovigilance (defined as science and activities concerning detection, assessment, understanding, and prevention of adverse effects or other problems related to the presence of pharmaceuticals in the environment, which affect human and other animal species) is gaining momentum. [2] Leftover, unwanted medication from hospitals and homes are one of the major source of pharmaceutical waste, and its safe disposal has become more important than ever.

Pharmaceutical waste in hospital wards could be generated through partially used or unused dosage forms, patient's personal medications, outdated drugs, etc. Besides, expired drugs may accumulate, though albeit slowly, in dispensaries and drug stores of hospitals due to inappropriate donations or inadequacies in stock management and distribution. In healthcare facilities purchasing drugs through rate contract system, it is not uncommon to come across substandard or misbranded drugs. All these factors contribute to increase in pharmaceutical waste in hospitals. Substantial waste, similarly, can be generated from leftover medicines from households and other places in society ranging from workplaces to zoos and cruise ships. Because these products are frequently purchased in excess or are not fully consumed as directed (due to patient non-compliance, physician-altered treatment, intolerable effects, etc.), widespread accumulation of unwanted leftover drugs can occur eventually leading to need for disposal. [3]

The question is how is this pharmaceutical waste disposed? A study assessing pharmaceutical waste management at selected hospitals and homes in Ghana showed that four out of five hospitals do not have any separate collection and disposal program for pharmaceutical waste. Half of the population surveyed confirmed having unused, leftover, or expired medicines at home, and over 75% population disposed them through the normal waste bins, which end up in the landfills or dump sites. [4] A questionnaire survey in dental students from North India showed that 70% of students possessed up to five expired medications at home, and the predominant method adopted for disposal was via household trash. [5]

In India, rules and regulations regarding handling and management of various types of wastes are applicable to six main categories of waste: Municipal solid waste, hazardous waste, bio-medical waste (BMW), plastic waste, e-waste, and batteries. [6] All healthcare establishments, irrespective of the quantum of waste generated, come under BMW rules. [7] These rules classify discarded, contaminated, or outdated medicines and cytotoxic drugs into category five and recommend their disposal by incineration. Deep burial can be an option only in rural areas with no access to centralized treatment facility, with prior approval from prescribed authority. However, hardly anything is known about actual practices followed by healthcare facilities. The authorities concerned with disposal of these pharmaceuticals also need to be extra cautious to ensure security from scavenging and pilferage. Anti-neoplastics or cytotoxic drugs must be handled with extreme care as they have the ability to kill or stop growth of living cells and can have extremely serious effects, such as interfering with reproductive processes in various life forms. [8]

It is noteworthy that the current BMW guidelines are not applicable to radioactive waste or hazardous chemicals. Some of the pharmaceutical waste (e.g. unused discarded nicotine patches [9] ) meets the definition of hazardous waste by the Resource Conservation and Recovery Act (RCRA), U.S. Proper management of hazardous waste is highly complex and needs methods different from those used for disposal of biomedical waste. Presently, those who handle drugs (pharmacists and nurses) in hospitals do not receive appropriate training in hazardous waste management during their academic studies, and those who do receive such training (environment personnel) may not be familiar with active ingredients in various pharmaceutical formulations. All this confusion stresses the need to formulate specific guidelines that would include all aspects of pharmaceutical waste management for hospitals and homes and to implement appropriate programs for collection and disposal of unwanted medications from these sources. As pharmaceutical waste not only poses threat to the environment but also indicates wastage of valuable resources, measures to minimize pharmaceutical waste generation are equally important.

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