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It is the usual tendency to throw the unused and expired medicines in the household trash, which is then collected by the waste collector or thrown into vacant plots in the neighborhood or on the streets. But this is approach to drug disposal is hazardous to the environment and thence to life.
Through the waste (in the open or landfills), these medicines may pollute water sources and also enter the soil. There are chances of accidental exposure to these medicines for waste pickers or children. Then, there is the hypothetical risk of these drugs being recycled back into the market.
Unused and expired medicines are considered as “domestic hazardous waste” in India as per the Solid Waste Management Rules 2016. These new rules mandate segregation of waste at source into biodegradable, non-biodegradable (recyclable and combustible), sanitary waste and domestic hazardous wastes.
“direct waste generators not to litter i.e throw or dispose of any waste such as paper, water bottles, liquor bottles, soft drink cans, tetra packs, fruit peel, wrappers, etc., or burn or burry waste on streets, open public spaces, drains, waste bodies and to segregate the waste at source as prescribed under these rules and hand over the segregated waste to authorised the waste pickers or waste collectors authorised by the local body”
The rules also require the local authorities to ensure door to door collection of segregated solid waste from all households and transport it in covered vehicles to the processing or disposal facilities.
Biomedical Waste Management Rules, 2016 categorize Discarded or Expired Medicine Pharmaceutical waste like antibiotics, cytotoxic drugs including all items contaminated with cytotoxic drugs along with glass or plastic ampoules, vials etc. in the yellow category, which are to be discarded in the yellow coloured non-chlorinated Plastic Bags
The US FDA has listed three disposal methods for unused or expired medicines:
- Medicine take-back options
- Disposal in the household trash and
- Flushing certain potentially dangerous medicines in the toilet
Medicine take-back option is the preferred option to safely dispose of most types of unneeded medicines. This can be done via temporary collection sites or authorized permanent collection sites, which may be available in may be in retail pharmacies, hospital or clinic pharmacies, and law enforcement facilities.
The FDA has laid down simple steps when considering disposal in the household trash
- Mix medicines (do not crush tablets or capsules) with an unpalatable substance such as dirt, cat litter, or used coffee grounds;
- Place the mixture in a container such as a sealed plastic bag;
- Throw the container in your household trash; and
- Delete all personal information on the prescription label of empty pill bottles or medicine packaging, then dispose of the container.
Some medicines such as fentanyl patches, diazepam have specific instructions to immediately flush down the toilet when no longer needed and a take-back option is not readily available. The FDA has created a list of medicines recommended for disposal by flushing that are no longer needed and when take-back options are not readily available.
In an article published in 2017 in the journal Science of the Total Environment, the FDA examined the risks associated with the environmental release of 15 active pharmaceutical ingredients (APIs) currently on its "flush list”. The FDA concluded that most of these APIs present a negligible eco-toxicological risk, although some additional data would be helpful for confirming this finding for some of these medicines. And, all 15 APIs present negligible risk through ingestion of water and fish (Sci Total Environ. 2017 Dec 31;609:1023-1040).
It is important to be aware of the drug disposal methods to avoid potential harm to the community. Patients should be counselled about safe drug disposal.
India has the rules and regulations in place for safe drug disposal, but they need to be implemented strictly.
Dr KK Aggarwal
Padma Shri Awardee
President Elect Confederation of Medical Associations in Asia and Oceania (CMAAO)
Group Editor-in-Chief IJCP Publications
President Heart Care Foundation of India
Past National President IMA