Safe disposal of unused medicines
We are all aware that different Medicines are required for the treatment of different diseases in human beings and animals and at times many of them are life-saving for them. They are consumed in different forms viz. Tablets, capsules, Injections, Dry Syrups, Powders, Lotions etc and are usually a combination of various Chemicals are known as Pharmaceuticals. In special cases Radio-Pharmaceuticals are also required to treat and mitigate disease conditions. All these Medicines contain biologically active substances and have the potential of affecting other species also.
Almost every Pharmacy- whether retail or wholesale, Doctor’s Clinic, Dispensary, Hospital, Drug Manufacturing unit, Drug Testing Laboratory, Clinical Research Organisations and even households are faced with the problem of disposal of unused or at times expired medicines. Different types of unused medicines, whether before their Expiry Date or after their Expiry Date, they all need to be disposed of in a safe manner since their indiscriminate disposal may lead to a different types of environmental pollution resulting in contamination of drinking water, vegetables, fruits, aquatic living beings which form part of human and animal food chain.
This environmental pollution has already started contributing to the ever increasing pollution of the air, water bodies, rivers, sea and soil due to many other factors and is telling on the health of humans, animals, plants and perhaps every species on this planet. If this is not well understood and controlled by all of us, it is likely to have disastrous results for our mother earth. Even Ayurvedic, Siddha, Unani or Homeopathic. Medicines, many of which are plant based and considered comparatively safe, also have similar effects on our ecological system, if not disposed of properly.
Sources of Unused medicines:
In a Pharmacy, Doctor’s Clinic, Dispensary, Hospital, Drug Manufacturing unit, Drug Testing Laboratory, Clinical Research Organisation Unused Medicines could be there because of different reasons which may include excess inventory, over production or expiry of the Medicines.
In a household setting, Unused Medicines could be there due to any or all of the below mentioned reasons:
- Discontinuation of treatment due to adverse/allergic reactions to the Patient
- Change of treatment by the Physician
- Change of Physician by the Patient
- Self-discontinuation by the Patient with the first signs of recovery
- Expiry of Drug(s)
- Death of the Patient
There are different well established and result oriented methods for the disposal of unused medicines. They are:
- Take Back
- Down the drain, and
Another method for disposal of medicines is Chemical Inactivation but is seldom used because of cost factor and other collateral disadvantages.
Take back option of Medicines is preferred way to safely dispose of most types of unneeded and unused medicines. It is also considered to be more effective in the case of the Retail Pharmacy, Wholesalers, Doctor’s Clinic, Dispensary and Hospitals. All discarded medicines should preferably be sent up the distribution chain back to manufacturer for appropriate disposal at its level.
There are generally two kinds of take-back options:
- Periodic events viz door to door collection on particular day of a month or week by authorized persons/NGO’s.
- Permanent collection sites viz. placing collection boxes in religious places, community places or Hospitals etc.
Down the drain method of disposal of medicines has a very limited applicability. When the quantity of the Unused Medicine is very small say 20-30 tablets or 1-2 Ampoules of particular Injection or 20 to 30 ml of a liquid oral then the said quantity is crushed and mixed with any inert substance like used tea leaves or animal litter, kept a disposable but bio-degradable bag and disposed of in usual garbage bin. Else, the said small quantity of Unused Medicine is diluted in a bucket of water and drained through the common sink. Before such disposal, all the primary, secondary and tertiary packing of the Unused/Expired Medicines must be removed and disposed of separately.
Incineration of unused medicines is done at a larger facility where the material is exposed to a temperature as high as 900 to 1200⁰C. Medicines to be disposed of by this method are also first segregated and all tertiary, secondary and primary coverings and labels removed which need to be destroyed separately. Disposal by way of incineration is preferred over chemical inactivation for different types of unused medicines. This method is also preferred where the quantity to be disposed of is sufficiently large and where other methods become uneconomical.
The Medicines disposed of by this method are converted to about Ninety percent of ash and about five percent of flue gases which are passed through special precipitators so as to reduce air-pollution and then released.
Disposal of all unused medicines must meet with the requirements laid down under Bio-Medical Waste Management Rules, 2016. Only Yellow coloured, non-chlorinated plastic bags or containers must be used for collection of unused or expired cytotoxic medicines.
Cost of Disposal of Unused Medicines:
As per the data available in reliable literature, approximate cost of disposal of Unused Medicines is Rs.15 to 25 per Kilogram. In other terms, it requires about 5% of the fuel feed to that of the total quantity required to be disposed of.
Every effort has a cost:
Manufacturing, Testing, Sales, Distribution or Research of Medicines involves lot of expenditure. And if the Medicines are not consumed, they need to be disposed of in an appropriate manner, which again is cost intensive. In view of the same, mass awareness is required among all stake holders to minimize overstocking, excess purchase and ultimately reducing the level of destroying the otherwise useful medicines. This in all probability will reduce the ultimate cost to the consumer.
Disposal of Unused Medicines by Trained Personnel:
Proper records need to be prepared and maintained for all the Unused Medicines and disposal must be carried out under proper supervision of Trained Pharmacist(s) or other para-medical staff.
(Views expressed by the author are based on his personal experience as a Pharmacist and authentic published literature)