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

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 medicinesReferencesAkici, 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.2017.11.006Alfian, 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.2021.630434Alhomoud, 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.12592Ali, 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/v33i46B32946Al-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/10.1080/03067319.2011.592949Al-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/10.5935/0103-5053.20150075Alqurshi, 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.2020.1111026Al-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/s11096-016-0287-4Althagafi, 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.2022.09.012Amaral, 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.pdfAriffin, 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-yArkaravichien, 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/s40545-018-0155-9Barnett-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/s13584-016-0108-1Bashaar, 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-zBegum, 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/pharmacy9020103Bettington, 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/AH16296Beyene, 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/AJPHBeyene, 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/s40545-016-0075-5Boxall, A. B. A. (2004). The environmental side effects of medication. EMBO Reports, 5(12), 1110–1116. https://doi.org/10.1038/sj.embor.7400307Chong, 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.2022.884482Ehrhart, 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.2020.08.038Environmental 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.pdfEsseku, 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/10.1155/2022/7674701European 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:PDFGhemrawi, 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/riac066Hajj, 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-zHassali, 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.e04551Kahsay, 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/10.1155/2020/6725423Kristina, 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-S958Kumar, 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.2019.11.84Kusturica, 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.2022.1077974Lim, 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.v8i3.453Luo, 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/ijerph18168544Magagula, 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/ijerph19127484Mitkidis, 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.2022.02.017Mobrad, 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-controlOECD. 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-enOng, 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.12333Ortúzar, 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.2022.869332Pramestutie, 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.2021.110912Praveena, 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.2018.06.058Renny, 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.0000000000001804Rogowska, 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/ijerph192315798Rogowska, 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/s00267-019-01174-7Song, 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.2022.773454Stoddard, 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/s00267-017-0834-3UNESCO. (2017). Transforming our world: the 2030 Agenda for Sustainable Development. https://sdgs.un.org/2030agendaUnited Nations. (2015). Transforming our world: The 2030 Agenda for Sustainable Development, 1630(October). https://sustainabledevelopment.un.org/post2015/transformingourworld/ publicationUnited 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.pdfVatovec, 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.2021.112106Vellinga, 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.2014.01.085Vieno, 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.pdfWang, 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-xWatkins, 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/s10163-022-01494-7Yang, 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.2018.1.3Zorpas, 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