Environmental Sustainability Impacts of Improper Disposal of Domestic Pharmaceutical Waste in the Global South

Siti Hajar Mahamad Dom, Hisyam Abdul Hamid, Janattul Ain Jamal, Ahmad Fauzi Dali, Kamaliah Md Saman, Norkasihan Ibrahim

Abstract


Improper pharmaceutical waste disposal is a rising environmental pollutant around the world. Pharmaceutical waste disposal legislation and regulations are available to some extent but limited to industrial premises and health-care institutions. Information on the disposal of pharmaceutical waste in public hands, known as domestic pharmaceutical waste (DPW), is limited. This scoping review aims to comprehend the global practice of DPW disposal by following the PRISMA Extension for Scoping Reviews guideline. Three online databases were searched for eligible articles: peer-reviewed in English language, describing the methods that the public disposed of unwanted or expired pharmaceuticals at home (DPW Disposal) and the public’s participation in their local DPW programs (DPW Program). Search terms were derived from Medical Subject Headings (MeSH) and free text when applicable. One expert report and thirty research publications were analysed. The articles originated from Asia (n=13), the Middle East (n=6), Africa (n=4), Europe (n=3), the United States (n=3) and Australia (n=1). Most pharmaceuticals are disposed of as household garbage (58.8%), returned to health facilities (17.9%) and flushed down the toilet drain (8.1%). There is a large range of diversity in public awareness (range: 14% - 82%) and participation in DPW Programs (range: 8.3% to 64%) with higher percentages reported from European countries. Existing regulations and policies have modest to moderate impact on proper DPW disposal. Our findings provide new information that may be utilised by policymakers in the process of laying the groundwork for a national plan outlining the most effective methods for disposing of DPW.

Keywords: Household pharmaceutical; domestic pharmaceutical; unused medicines; waste, disposal; sustainable cities; expired medicines

References

Akici, A., Aydin, V., & Kiroglu, A. (2018). Assessment of the association between drug disposal practices and drug use and storage behaviors. Saudi Pharmaceutical Journal, 26(1), 7–13. https://doi.org/10.1016/j.jsps.2017.11.006

Alfian, S. D., Insani, W. N., Halimah, E., Qonita, N. A., Jannah, S. S., Nuraliyah, N. M., Supadmi, W., Gatera, V. A., & Abdulah, R. (2021). Lack of awareness of the impact of improperly disposed of medications and associated factors: A cross-sectional survey in Indonesian households. Frontiers in Pharmacology, 12. https://doi.org/10.3389/fphar.2021.630434

Alhomoud, F. (2019). Sharing may not be caring – Prescription medication sharing among adults in Saudi Arabia. International Journal of Pharmacy Practice, 28(3), 255–256. https://doi.org/10.1111/ijpp.12592

Ali, M. D., Ahmad, A., Kannan, L. S., Lewis, S., Al Suliaman, Z. S., Almanasif, F. D., & Alnabi, Z. A. A. (2021). Assessment of knowledge, attitude and practice towards disposal of in-home medication among community in Eastern Province, Saudi Arabia. Journal of Pharmaceutical Research International, 33(46B), 325–334. https://doi.org/10.9734/JPRI/2021/v33i46B32946

Al-Odaini, N. A., Zakaria, M. P., Yaziz, M. I., Surif, S., & Abdulghani, M. (2013). The occurrence of human pharmaceuticals in wastewater effluents and surface water of Langat River and its tributaries, Malaysia. International Journal of Environmental Analytical Chemistry, 93(3), 245–264. https://doi.org/10.1080/03067319.2011.592949

Al-Qaim, F. F., Abdullah, M. P., Othman, M. R., Mussa, Z. H., Zakaria, Z., Latip, J., & Afiq, W. M. (2015). Investigation of the environmental transport of human pharmaceuticals to surface water: A case study of persistence of pharmaceuticals in effluent of sewage treatment plants and hospitals in Malaysia. Journal of the Brazilian Chemical Society, 26(6), 1124–1135. https://doi.org/10.5935/0103-5053.20150075

Alqurshi, A. (2020). Household disposal and recycling of medication in Saudi Arabia : A call for introducing Drug Take-Back Programs. Pharmacology & Pharmacy, 316–329. https://doi.org/10.4236/pp.2020.1111026

Al-Shareef, F., Abu El-Asrar, S., Al-Bakr, L., Al-Amro, M., Alqahtani, F., Aleanizy, F., & Al-Rashood, S. (2016). Investigating the disposal of expired and unused medication in Riyadh, Saudi Arabia: a cross-sectional study. International Journal of Clinical Pharmacy, 38(4), 822–828. https://doi.org/10.1007/s11096-016-0287-4

Althagafi, A., Alshibani, M., Alshehri, S., Noor, A., Baglagel, A., & Almeleebia, T. (2022). Assessment of knowledge and awareness of safe disposal of unused or expired medication in Saudi Arabia: A cross-sectional study. Saudi Pharmaceutical Journal, 30(11), 1672–1678. https://doi.org/10.1016/j.jsps.2022.09.012

Amaral, M. J., & Fop, L. Healthcare without harm (2013). Unused Pharmaceuticals Where Do They End Up? A Snapshot of European Collection Schemes. https://noharm-europe.org/sites/default/files/documents-files/4646/2013-12 Unused pharmaceuticals.pdf

Ariffin, M., & Zakili, T. S. T. (2019). Household pharmaceutical waste disposal in Selangor, Malaysia—policy, public perception, and current practices. Environmental Management, 64(4), 509-519. https://doi.org/10.1007/s00267-019-01199-y

Arkaravichien, W., Ruchipiyarak, T., Benjawilaikul, S., & Thawinwan, W. (2014). A threat to the environment from practice of drug disposal in Thailand. Environment Asia. 7(1), 13-18.

Ayele, Y., & Mamu, M. (2018). Assessment of knowledge, attitude and practice towards disposal of unused and expired pharmaceuticals among community in Harar city, Eastern Ethiopia. Journal of Pharmaceutical Policy and Practice, 11(1). https://doi.org/10.1186/s40545-018-0155-9

Barnett-Itzhaki, Z., Berman, T., Grotto, I., & Schwartzberg, E. (2016). Household medical waste disposal policy in Israel. Israel Journal of Health Policy Research, 5. https://doi.org/10.1186/s13584-016-0108-1

Bashaar, M., Thawani, V., Hassali, M. A., & Saleem, F. (2017). Disposal practices of unused and expired pharmaceuticals among general public in Kabul. BMC Public Health, 17. https://doi.org/10.1186/s12889-016-3975-z

Begum, M. M., Rivu, S. F., Al Hasan, M. M., Nova, T. T., Rahman, M. M., Alim, M. A., Uddin, M. S., Islam, A., Nurnahar, Tabassum, N., Moni, M. M. R., Roselin, R., Das, M., Begum, R., & Rahman, M. S. (2021). Disposal practices of unused and leftover medicines in the households of Dhaka Metropolis. Pharmacy, 9(2). https://doi.org/10.3390/pharmacy9020103

Bettington, E., Spinks, J., Kelly, F., Gallardo-Godoy, A., Nghiem, S., & Wheeler, A. J. (2018). When is a medicine unwanted, how is it disposed, and how might safe disposal be promoted? Insights from the Australian population. Australian Health Review, 42(6), 709–717. https://doi.org/10.1071/AH16296

Beyene, K. A., Sheridan, J., & Aspden, T. (2014). Prescription medication sharing: A systematic review of the literature. J Public Health, 104, 15–26. https://doi.org/10.2105/AJPH

Beyene, K., Aspden, T., & Sheridan, J. (2016). Prescription medicine sharing: exploring patients ’ beliefs and experiences. Journal of Pharmaceutical Policy and Practice, 1–13. https://doi.org/10.1186/s40545-016-0075-5

Boxall, A. B. A. (2004). The environmental side effects of medication. EMBO Reports, 5(12), 1110–1116. https://doi.org/10.1038/sj.embor.7400307

Chong, K. M., Rajiah, K., Chong, D., & Maharajan, M. K. (2022). Management of medicines wastage returned medicines and safe disposal in Malaysian community pharmacies: A qualitative study. Frontiers in Medicine, 9. https://doi.org/10.3389/fmed.2022.884482

Ehrhart, A. L., Granek, E. F., Nielsen-Pincus, M., & Horn, D. A. (2020). Leftover drug disposal: Customer behavior, pharmacist recommendations, and obstacles to drug take-back box implementation. Waste Management, 118, 416–425. https://doi.org/10.1016/j.wasman.2020.08.038

Environmental Quality (Scheduled Wastes) Regulations 2005. https://ewaste.doe.gov.my/wp-content/uploads/2020/12/Environmental_Quality_Scheduled_Wastes_Regulations_2005_-_P.U.A_294-2005.pdf

Esseku, Y. Y., Mante, P. K., Dodoo, A. N. O., & Woode, E. (2022). Drug disposal and ecopharmacovigilance practices in the Krowor Municipality, Ghana. Journal of Toxicology, Article 7674701. https://doi.org/10.1155/2022/7674701

European Union. (2001). Directive 2001/83/EC of the European parliament and of the council. Official Journal of the European Communities. https://eur-lex.europa.eu/LexUriServ/LexUriServ.do?uri=OJ:L:2001:311:0067:0128:en:PDF

Ghemrawi, R., Kharaba, Z., Aldulaymi, R., AlBataineh, N., Alghaly, F., Qasem, N., & Khair, M. (2022). Expired medications and disposal practices in Arab households. International Journal of Pharmacy Practice, 30(6), 534–540. https://doi.org/10.1093/ijpp/riac066

Hajj, A., Domiati, S., Haddad, C., Sacre, H., Akl, M., Akel, M., Tawil, S., Abramian, S., Zeenny, R. M., Hodeib, F., & Salameh, P. (2022). Assessment of knowledge, attitude, and practice regarding the disposal of expired and unused medications among the Lebanese population. Journal of Pharmaceutical Policy and Practice, 15(1). https://doi.org/10.1186/s40545-022-00506-z

Hassali, M. A., & Shakeel, S. (2020). Unused and Expired Medications Disposal Practices among the General Public in Selangor, Malaysia. Pharmacy, 8(4). https://doi.org/10.3390/pharmacy8040196
Insani, W. N., Qonita, N. A., Jannah, S. S., Nuraliyah, N. M., Supadmi, W., Gatera, V. A., Alfian, S. D., & Abdulah, R. (2020). Improper disposal practice of unused and expired pharmaceutical products in Indonesian households. HELIYON, 6(7). https://doi.org/10.1016/j.heliyon.2020.e04551

Kahsay, H., Ahmedin, M., Kebede, B., Gebrezihar, K., Araya, H., & Tesfay, D. (2020). Assessment of knowledge, attitude, and disposal practice of unused and expired pharmaceuticals in community of Adigrat City, Northern Ethiopia. Journal of Environmental and Public Health, 2020. https://doi.org/10.1155/2020/6725423

Kristina, S. A., Wiedyaningsih, C., Cahyadi, A., & Ridwan, B. A. (2018). A survey on medicine disposal practice among households in Yogyakarta. Asian Journal of Pharmaceutics, 12(3), S955-S958

Kumar, S. L., Logeshwaran, Rani, N. V, Thennarasu, P., Keerthana, M., & Lavanya, M. (2019). Assessment of knowledge and awareness on the disposal of expired and unused medicines among medication consumers. Journal of Young Pharmacists, 11(4), 410–416. https://doi.org/10.5530/jyp.2019.11.84

Kusturica, M. P., Jevtic, M., & Ristovski, J. T. (2022). Minimizing the environmental impact of unused pharmaceuticals: Review focused on prevention. Frontiers in Environmental Science, 10. https://doi.org/10.3389/fenvs.2022.1077974

Lim, M. T. (2016). Disposal practices of unused and unwanted medications among patients in a tertiary hospital. Education in Medicine Journal, 8(3). https://doi.org/10.5959/eimj.v8i3.453

Luo, Y. M., Reimers, K., Yang, L., & Lin, J. P. (2021). Household drug management practices of residents in a second-tier city in China: Opportunities for reducing drug waste and environmental pollution. International Journal of Environmental Research and Public Health, 18(16). https://doi.org/10.3390/ijerph18168544

Magagula, B. K., Rampedi, I. T., & Yessoufou, K. (2022). Household pharmaceutical waste management practices in the Johannesburg area, South Africa. International Journal of Environmental Research and Public Health, 19(12). https://doi.org/10.3390/ijerph19127484

Mitkidis, P., Chrysochou, P., Obolevich, V., & Mitkidis, K. (2022). Effectiveness of environmental health and loss framing on household pharmaceutical take-back schemes. Waste Management, 143, 61–68. https://doi.org/10.1016/j.wasman.2022.02.017

Mobrad, A. M., Ahmad, F., Al Saleh, S., Al Rammah, A. A. A., Syed, W., & Samreen, S. (2020). Unused and expired medicines: Investigating the knowledge and practice of general community. Latin American Journal of Pharmacy, 39(3), 526–531.

National Environment Agency Singapore. (2023, July). Toxic Waste Control. https://www.nea.gov.sg/our-services/pollution-control/hazardous-waste/toxic-waste-control

OECD. Organisation for Economic Co-operation and Development (2022). Limiting Environmental Impacts of Unused or Expired Medicine Management of Pharmaceutical Household Waste. https://www.oecd-ilibrary.org/sites/3854026c-en/index.html?itemId=/content/publication/3854026c-en

Ong, S. C., Ooi, G. S., Shafie, A. A., & Hassali, M. A. (2020). Knowledge, attitude and disposing practice of unused and expired medicines among the general public in Malaysia. Journal of Pharmaceutical Health Services Research, 11(2), 141–148. https://doi.org/10.1111/jphs.12333

Ortúzar, M., Esterhuizen, M., & Olicón-hernández, D. R. (2022). Pharmaceutical pollution in aquatic environments: A concise review of environmental impacts and bioremediation systems. Frontiers in Microbiology 13(April), 1–25. https://doi.org/10.3389/fmicb.2022.869332

Pramestutie, H. R., Hariadini, A. L., Ebtavanny, T. G., & Illahi, R. K. (2021). Managing unused, damaged, and expired medications: Knowledge and attitudes among people of Malang, Indonesia. Journal of Applied Pharmaceutical Science, 11(09), 102–109. https://doi.org/10.7324/JAPS.2021.110912

Praveena, S. M., Shaifuddin, S. N. M., Sukiman, S., Nasir, F. A. M., Hanafi, Z., Kamarudin, N., Ismail, T. H. T., & Aris, A. Z. (2018). Pharmaceuticals residues in selected tropical surface water bodies from Selangor (Malaysia): Occurrence and potential risk assessments. Science of the Total Environment, 642, 230–240. https://doi.org/10.1016/j.scitotenv.2018.06.058

Renny, M. H., Thaker, R. H., & Dayan, P. S. (2019). Frequency of and factors associated with prescription medication sharing within families. Pediatric Emergency Care. 37(12), 599–605. https://doi.org/10.1097/PEC.0000000000001804

Rogowska, J., & Zimmermann, A. (2022). Household pharmaceutical waste disposal as a global problem-a review. International Journal of Environmental Research and Public Health, 19(23). https://doi.org/10.3390/ijerph192315798

Rogowska, J., Zimmermann, A., Muszynska, A., Ratajczyk, W., & Wolska, L. (2019). Pharmaceutical household waste practices: preliminary findings from a case study in Poland. Environmental Management, 64(1), 97–106. https://doi.org/10.1007/s00267-019-01174-7

Song, S., Kim, S., Shin, S., Lee, Y., & Lee, E. (2022). Evaluation of prescription medication sharing among adults in South Korea: a cross-sectional survey. 13(February), 1–9. Frontiers in Pharmacology. 13(2022). https://doi.org/10.3389/fphar.2022.773454

Stoddard, K. I., Hodge, V., Maxey, G., Tiwari, C., Cready, C., & Huggett, D. B. (2017). Investigating research gaps of pharmaceutical take back events: An analysis of Take Back Program participants’ socioeconomic, demographic, and geographic characteristics and the public health benefits of Take Back Programs. Environmental Management, 59(6), 871–884. https://doi.org/10.1007/s00267-017-0834-3

UNESCO. (2017). Transforming our world: the 2030 Agenda for Sustainable Development. https://sdgs.un.org/2030agenda

United Nations. (2015). Transforming our world: The 2030 Agenda for Sustainable Development, 1630(October). https://sustainabledevelopment.un.org/post2015/transformingourworld/ publication

United Nations. (2023). Progress towards the Sustainable Development Goals: Towards a Rescue Plan for People and Planet. https://sdgs.un.org/sites/default/files/2023-04/SDG_Progress_Report_Special_Edition_2023_ADVANCE_UNEDITED_VERSION.pdf

Vatovec, C., Kolodinsky, J., Callas, P., Hart, C., & Gallagher, K. (2021). Pharmaceutical pollution sources and solutions: survey of human and veterinary medication purchasing, use, and disposal. Journal of Environmental Management, 285. https://doi.org/10.1016/j.jenvman.2021.112106

Vellinga, A., Cormican, S., Driscoll, J., Furey, M., O’Sullivan, M., & Cormican, M. (2014). Public practice regarding disposal of unused medicines in Ireland. Science of the Total Environment, 478, 98–102. https://doi.org/10.1016/j.scitotenv.2014.01.085

Vieno, N., Hallgren, P., & Wallberg, P. (2017). Pharmaceuticals in the aquatic environment of the Baltic Sea region – A status report. UNESCO Emerging Pollutants in Water Series – No. 1. https://helcom.fi/wp-content/uploads/2019/08/BSEP149.pdf

Wang, L. S., Aziz, Z., & Chik, Z. (2021). Disposal practice and factors associated with unused medicines in Malaysia: a cross-sectional study. BMC Public Health, 21(1). https://doi.org/10.1186/s12889-021 11676-x

Watkins, S., Barnett, J., Standage, M., Kasprzyk-Hordern, B., & Barden, R. (2022). Household disposal of pharmaceuticals: attitudes and risk perception in a UK sample. Journal Of Material Cycles and Waste Management, 24(6), 2455–2469. https://doi.org/10.1007/s10163-022-01494-7

Yang, S. L., Tan, S. L., Goh, Q. L., & Liau, S. Y. (2018). Utilization of Ministry of Health medication return programme, knowledge and disposal practice of unused medication in Malaysia. Journal Of Pharmacy Practice and Community Medicine, 4(1), 07–11. https://doi.org/10.5530/jppcm.2018.1.3

Zorpas, A. A., Dimitriou, M., & Voukkali, I. (2018). Disposal of household pharmaceuticals in insular communities: social attitude, behaviour evaluation and prevention activities. Environmental science and pollution research, 25(27), 26725–26735. https://doi.org/10.1007/s11356-017-9551-y


Full Text:

PDF


DOI: http://dx.doi.org/10.17576/ebangi.2023.2004.37

Refbacks

  • There are currently no refbacks.


-


 

_________________________________________________

eISSN 1823-884x

Faculty of Social Sciences & Humanities
Universiti Kebangsaan Malaysia
43600 UKM Bangi, Selangor Darul Ehsan
MALAYSIA

© Copyright UKM Press, Universiti Kebangsaan Malaysia