Pharmaceutical Household Waste Practices: Preliminary Findings from a Case Study in Poland

Advanced oxidation and biological integrated processes for pharmaceutical wastewater treatment: A review

The stress of pharmaceutical and personal care products (PPCPs) discharging to water bodies and the environment due to increased industrialization has reduced the availability of clean water. This poses a potential health hazard to animals and human life because water contamination is a great issue to the climate, plants, humans, and aquatic habitats. Pharmaceutical compounds are quantified in concentrations ranging from ng/Lto μg/L in aquatic environments worldwide. According to (Alsubih et al., 2022), the concentrations of carbamazepine, sulfamethoxazole, Lutvastatin, ciprofloxacin, and lorazepam were 616-906 ng/L, 16,532-21635 ng/L, 694-2068 ng/L, 734-1178 ng/L, and 2742-3775 ng/L respectively. Protecting and preserving our environment must be well-driven by all sectors to sustain development. Various methods have been utilized to eliminate the emerging pollutants, such as adsorption and biological and advanced oxidation processes. These methods have their benefits and drawbacks in the removal of pharmaceuticals. Successful wastewater treatment can save the water bodies; integrating green initiatives into the main purposes of actor firms, combined with continually periodic awareness of the current and potential implications of environmental/water pollution, will play a major role in water conservation. This article reviews key publications on the adsorption, biological, and advanced oxidation processes used to remove pharmaceutical products from the aquatic environment. It also sheds light on the pharmaceutical adsorption capability of adsorption, biological and advanced oxidation methods, and their efficacy in pharmaceutical concentration removal. A research gap has been identified for researchers to explore in order to eliminate the problem associated with pharmaceutical wastes. Therefore, future study should focus on combining advanced oxidation and adsorption processes for an excellent way to eliminate pharmaceutical products, even at low concentrations. Biological processes should focus on ideal circumstances and microbial processes that enable the simultaneous removal of pharmaceutical compounds and the effects of diverse environments on removal efficiency.

Environmental pitfalls and associated human health risks and ecological impacts from landfill leachate contaminants: Current evidence, recommended interventions and future directions

The improper management of solid waste, particularly the dumping of untreated municipal solid waste, poses a growing global challenge in both developed and developing nations. The generation of leachate is one of the significant issues that arise from this practice, and it can have harmful impacts on both the environment and public health. This paper presents an overview of the primary waste types that generate landfill leachate and their characteristics. This includes examining the distribution of waste types in landfills globally and how they have changed over time, which can provide valuable insights into potential pollutants in a given area and their trends. With a lack of specific regulations and growing concerns regarding environmental and health impacts, the paper also focuses on emerging contaminants. Furthermore, the environmental and ecological impacts of leachate, along with associated health risks, are analyzed. The potential applications of landfill leachate, suggested interventions and future directions are also discussed in the manuscript. Finally, this work addresses future research directions in landfill leachate studies, with attention, for the first time to the potentialities that artificial intelligence can offer for landfill leachate management, studies, and applications.

Event-related potentials for investigating the willingness to recycle household medical waste

Household medical waste (HMW) recycling in the reverse supply chain has become a primary channel for infectious, toxic, or radioactive substances for environmental protection and a circular economy. Recycling managers need to understand the recycling decision-making mechanisms of households to improve the intention-behavior gap and recycling participation rate, especially in cognitive neuroscience. This study designed an event-related potential (ERPs) experiment to explore the differences in ERPs components between the willingness and unwillingness to make recycling decisions. Our findings confirmed that willingness and unwillingness to recycle can lead to a significant difference in the P300 and N400 scores. A larger P300 was evoked by willingness rather than unwillingness in the prefrontal, frontal, and frontal-temporal regions. This indicates that willingness to recycle results from a rational choice in the decision-making process. However, a larger N400 was evoked by unwillingness rather than willingness in the parietal, parietal-occipital, and occipital regions. A negative wave was evoked in households unwilling to recycle because they thought it was dangerous and unsanitary, causing a higher conflict with intrinsic cognition. The combination of HMW recycling decisions and neurology may accurately measure pro-environmental decision-making processes through brain science. Advancing the knowledge of psychological and brain mechanism activities for understanding pro-environmental choices. In turn, this can help recycling managers to accurately understand household demands for increasing the recycling intention and designing effective HMW take-back systems to solve the intention-behavior gap related to the global recycling dilemma.

Modeling Predictors of Medication Waste Reduction Intention in Algeria: Extending the Theory of Planned Behavior

COVID-19 caused an increase in the demand for medications, which led to an increase in pharmaceutical waste and there is no doubt that this contributes to environmental pollution. Hence, it became necessary to search for how to protect and improve the environment by encouraging the behavior of medication waste reduction. Accordingly, this study aims to investigate the factors affecting intentions to reduce medication waste. Considering this, we develop an extended theory of planned behavior (TPB) framework by incorporating the constructs of moral obligation, environmental awareness, and medication waste risk perception. Using the convenience sampling method and based on a self-administered questionnaire, a total of 225 usable responses were collected in five Algerian cities. The results showed that positive attitudes (β = 0.316, p < 0.001), moral obligation (β = 0.291, p < 0.001), environmental awareness (β = 0.227, p < 0.001), perceived behavior control (PBC) (β = 0.151, p = 0.001), greater perceived risks (β = 0.127, p < 0.001), and subjective norm (β = 0.096, p < 0.05) significantly and positively influence the medication waste minimization intention. Furthermore, our analyses revealed that the extended TPB model explained 73.40% of the intention variance. In conclusion, we have explored the intentions, and there may be a gap between intent and actual behavior. Therefore, we recommend future studies to examine the factors affecting the actual behavior of medication waste reduction and to investigate environmental ethics and religious commitment as predictors of waste reduction intentions.

Pharmaceutical waste management system - Are the current techniques sustainable, eco-friendly and circular? A review

Most households and healthcare facilities usually dispose of contaminated, unused, or expired (CUE) medicines with municipal wastes, the disposal of which usually amounts to $790/ton in the USA and £450/ton in the UK. Solid (e.g., tablets, capsules, powders) and semi-solid (e.g., ointment, creams) pharmaceuticals are managed with incineration/pyrolysis, encapsulation, and engineered landfills, whereas wastewater treatment plants (WWTPs) are recommended for liquid pharmaceutical wastes (PWs). However, to date, the sustainability and eco-friendliness profile of these techniques are only subjectively ensured, leading to controversial viewpoints in many guidelines. Each technique has relative strengths and weaknesses, and their comparative weighting to maximize these profiles is sought after. The present comprehensive review aims to fulfil knowledge gaps in this regard. Four electronic databases (e.g., PubMed/MEDLINE, Scopus, and ScienceDirect) were searched for PW management (PWM)-related qualitative and quantitative articles published till December 31, 2022. Articles without details of waste disposal techniques and their health and environmental impacts were excluded. Based on the literature review, we determine that incineration can be considered a sustainable option for solid and semi-solid PWs, and WWTPs can be eco-friendly for liquid PWs, whereas encapsulation and landfilling are less sustainable. It is high time that objectively proven sustainable and eco-friendly techniques be implemented for PWM based on their dosage forms or nature of hazards. Medicine take-back, eco-pharmacovigilance, extended producer responsibility, co-payment, and life cycle analysis of pharmaceuticals focusing on reduction, reuse/re-dispensing can be integrated to make existing models sustainable, circular, and eco-friendly.

Occurrence, bioconcentration, and human health risks of pharmaceuticals in biota in the Sea of Marmara, Türkiye

The presence, bioconcentration, and health risk via seafood consumption of 11 pharmaceutical compounds belonging to different therapeutic groups (anti-inflammatory, antiepileptic, lipid regulators, and hormones) were investigated in the muscle tissues of fish and the meat of shrimp in the Sea of Marmara. Six biota species (Merlangius merlangus, Trachurus meditterraneus, Serranus hepatus, Pomatomus saltatrix, Parapenaeus longirostris, Spratus sprattus) were collected from the five stations in October and April 2019. Ultrasonic extraction method followed by solid phase extraction was used for extraction of pharmaceutical compounds from biota samples and then analyzed using high-performance liquid chromatography. Of the 11 compounds, 10 were detected in biota species. Ibuprofen was the most frequently detected pharmaceutical in the biota tissues at high concentrations (<3.0-1225 ng/g, dw). The other widely detected compounds were fenoprofen (<3.6-323 ng/g, dw), gemfibrozil (<3.2-480 ng/g, dw), 17α-ethynylestradiol (<2.0-462 ng/g, dw), and carbamazepine (<7.6-222 ng/g, dw). The bioconcentration factors of the selected pharmaceuticals calculated in various aquatic organisms ranged from 9 to 2324 L/kg. The estimated daily intakes of anti-inflammatories, antiepileptics, lipid regulators, and hormones via seafood consumption were 0.37-568, 1.1-324, 8.5-197, 3-340 ng/kg bw. Day, respectively. Based on hazard quotients, estrone, 17β-estradiol, and 17α-ethynylestradiol may pose a health risk to humans through the consumption of this seafood.

National Wastewater Reconnaissance of Analgesic Consumption in Australia

A wastewater-based epidemiology (WBE) method is presented to estimate analgesic consumption and assess the burden of treated pain in Australian communities. Wastewater influent samples from 60 communities, representing ∼52% of Australia's population, were analyzed to quantify the concentration of analgesics used to treat pain and converted to estimates of the amount of drug consumed per day per 1000 inhabitants using pharmacokinetics and WBE data. Consumption was standardized to the defined daily dose per day per 1000 people. The population burden of pain treatment was classified as mild to moderate pain (for non-opioid analgesics) and strong to severe pain (for opioid analgesics). The mean per capita weighted total DDD of non-opioid analgesics was 0.029 DDD/day/person, and that of opioid-based analgesics was 0.037 DDD/day/person across Australia. A greater burden of pain (mild to moderate or strong to severe pain index) was observed at regional and remote sites. The correlation analysis of pain indices with different socioeconomic descriptors revealed that pain affects populations from high to low socioeconomic groups. Australians spent an estimated US $3.5 (AU $5) per day on analgesics. Our findings suggest that WBE could be an effective surveillance tool for estimating the consumption of analgesics at a population scale and assessing the total treated pain burden in communities.

End-of-life management strategies of pharmaceuticals in Portuguese households

The end of life of pharmaceutical products through environmentally unsafe routes is a growing concern in our society. However, the studies reported so far, apart from being limited in number, do not reflect the current management practices for the end-of-life management of pharmaceuticals. Published work lacks an in-depth analysis in focusing on the pharmaceutical waste in households. The present work focused on (1) performing a state-of-the art overview to compare worldwide studies and the results and (2) implementing a comprehensive survey in Portugal (n = 454 respondents). The results showed that the delivery to pharmacies was used by the majority of the respondents (72%), indicating a good awareness of pharmaceutical waste management issues, when compared to the reviewed studies. Statistically significant variables for the destination of end-of-use pharmaceuticals include gender, age and distance from the residence to the pharmacy (p < 0.05). Most participants believe that educating the population on existing structures of medication and packaging management is of the utmost importance to improve the national managing system. This is the first study conducted in Portugal; it includes statistical analysis of the data and reflects on the practices that should be adopted to reduce incorrect pharmaceutical waste disposal. These findings call upon the strategies to strengthen the pharmaceutical waste management programme.

Assessment of knowledge, attitude, and practice regarding the disposal of expired and unused medications among the Lebanese population

BACKGROUND

Medication waste is a public health problem affecting developed and developing countries. In Lebanon, a developing country in the Middle East, efforts are being deployed in hospitals but not in the community.

OBJECTIVE

This study aimed to validate a questionnaire to explore the knowledge, attitude, and practice (KAP) towards the disposal of unused and expired medicines among the Lebanese population and then identify the factors associated with these variables comparatively between the general population and healthcare professionals.

METHODS

A cross-sectional study was conducted among the general Lebanese population in May-June 2022 using a standardized questionnaire. The validity and reliability of the KAP scales were assessed, then a thorough statistical analysis was done to explore the factors associated with these scales.

RESULTS

The KAP scales generated by this study were valid and reliable. Using these scales, 24.5%, 22.6%, and 21% of participants demonstrated proper knowledge, attitude, and practice, respectively. Higher knowledge scores were significantly associated with female gender (Beta = 0.97), a high monthly income (Beta = 1.68), a secondary (Beta = 6.11) or university (Beta = 6.80) education level, and postgraduate education (Beta = 7.13). However, older age (Beta = - 0.06) and a low monthly income (Beta = - 3.06) were significantly associated with lower knowledge scores. A higher knowledge score (Beta = 0.06) was significantly associated with a more positive attitude regarding unused or expired medication disposal. Being a healthcare professional (Beta = 0.72) was significantly associated with a higher practice score, while being a female (Beta = - 0.32) and living in a rural area (Beta = - 0.37) were significantly associated with lower practice scores.

CONCLUSION

This study validated KAP scales regarding medication waste in Lebanon and showed low KAP scores in the majority of respondents. Factors associated with higher KAP scores in various aspects of medication disposal, including gender, age, education level, and profession (healthcare professionals), suggest the need to consider those when implementing targeted corrective measures. Although further studies are required to confirm our findings, this study could be the ground for a medication waste management national strategy in Lebanon.

Household Pharmaceutical Waste Disposal as a Global Problem-A Review

The negative effect of the pharmaceuticals presence (persistence?) in various components of the environment is a global problem today. These compounds are released into the environment as a result of, inter alia, their use and improper disposal. Therefore, it is important to reduce excessive drug consumption and to develop a system for the collection of unused/expired pharmaceuticals. The effectiveness of actions in this area is inextricably linked with the need to educate society on how to deal properly with unwanted medications. The aim of the study was to show that the inappropriate handling of unused/expired drugs by society is an important problem in waste management systems, and it impacts the state of the environment. Forty-eight scientific articles published between 2012 and 2021 were taken into account that discussed the systems in various countries for the collection of unused/expired pharmaceuticals. This literature review shows that the main method of disposing of unused/expired medications, according to respondents from different countries, is either by disposing of them in household waste or flushing them into the sewage system. This is also the case in countries with systems or programs for the return of redundant drugs, which indicates that these systems are not sufficiently effective. This may be influenced by many factors, including the lack or ineffective education of the society.

Photocatalytic Activity of Sulfanyl Porphyrazine/Titanium Dioxide Nanocomposites in Degradation of Organic Pollutants

Magnesium(II) sulfanyl porphyrazine with peripheral morpholinethoxy substituents was embedded on the surface of titanium(IV) dioxide nanoparticles. The obtained nanocomposites were characterized with the use of particle size and distribution (NTA analysis), electron microscopy (SEM), thermal analysis (TGA), FTIR-ATR spectroscopy, and X-ray powder diffraction (XRD). The measured particle size of the obtained material was 327.4 ± 15.5 nm. Analysis with XRD showed no visible changes in the crystallinity of the material after deposition of porphyrazine on the TiO₂ surface. However, SEM images revealed noticeable changes in the morphology of the obtained hybrid material: higher aggregation and less ordered structure of the aggregates. The TGA analysis revealed the lost 3.6% (0.4 mg) of the mass of obtained material in the range 250-550 °C. In the FTIR-ATR analysis, C-H stretching vibratins in the range of 3000-2800 cm^-1, originating from porphyrazine moieties, were detected. The photocatalytic applicability of the nanomaterial was assessed in photodegradation studies of methylene blue and bisphenol A as reference environmental pollutants. In addition, the photocatalytic degradation of carbamazepine with porphyrazine/TiO₂ hybrids as photocatalysts was studied, accompanied by an HPLC chromatography assessment of photodegradation. In total, 43% of the initial concentration was achieved in the case of bisphenol A, after 4 h of irradiation, whereas 57% was achieved in the case of carbamazepine. In each photodegradation reaction, the activity of the obtained photocatalytic nanomaterial was proved with almost linear degradation. The photodegradation reaction rate constants were calculated, and revealed 5.75 × 10^-5 s^-1 for bisphenol A and 5.66 × 10^-5 s^-1 for carbamazepine.

From the pills to environment - Prediction and tracking of non-steroidal anti-inflammatory drug concentrations in wastewater

The extend of environment pollution by pharmaceuticals is in a stage that required more automatic and integrated solutions. The non-steroidal anti-inflammatory drugs (NSAIDs) are one of the most popular pharmaceutical in the world and emerging pollutants of natural waters. The aim of the paper was to check the correlation of the sales data of selected NSAIDs (ibuprofen, naproxen, diclofenac) and their concentration in the WWTP in order to enable predicting their loads, having only the sales data. For calculations, we apply three discharge scenarios (the fates between purchased to the presence in influents), having in mind that some part of sold mass can be improperly dispose to sewage system. To support predictions, chemical analysis was conducted in two conventional wastewater treatment plants (WWTPs) located in Poland during 2018 and 2020, thereby before and during pandemic situation. The NSAIDs concentration in the influent was higher than that which would be obtained if all of the administrated mass of the pharmaceutical went through the metabolic pathway of transformation. This means that substantial mass of sold NSAIDs in improperly dispose to sewage system, and this factor need to be taken into account in future predictions. Furthermore, results indicate that the variance of naproxen and diclofenac concentrations in the influent has no correlation with relatively stable sales throughout whole year. The pandemic situation had yet no direct effect to diclofenac concentrations in influents, despite observed increasing of sales. It was calculated that more than 60 kg of diclofenac was discharged into the Baltic Sea in 2018, and 20 kg in the first half of 2021 from two tested WWTPs. The presence of 4OH-diclofenac in effluents often in higher concentration compared to diclofenac mean that this still biologically active compound need to be taken into account in future risk assessment.

Management of pharmaceutical micropollutants discharged in urban waters: 30 years of systematic review looking at opportunities for developing countries

Pharmaceutical micropollutants' contamination of urban waters has been studied globally for decades, but the concentration of innovations in management initiatives is still in developed economies. The gap between the locus of innovations in pharmaceuticals and the relative stagnation in less developed economies to manage waste originating in this activity seems fruitful for investigations on innovation in integrated micropollutant management strategies. These tensions allow for advances in current knowledge for environmental management and, particularly, finding solutions for the contamination by pharmaceutical micropollutants of urban water bodies in developing countries. We aim to list the main strategies for managing pharmaceutical micropollutants discussed to point out opportunities for developing countries to advance in this direction. Methodologically, we conducted a systematic literature review from 1990 to 2020, covering 3027 documents on "pharmaceutical micropollutants management." The framework formed by the macro-approach to integrated management operationalized by the dimensional micro-approaches: technical, organizational, community, and governmental allowed us to understand that (1) the management of pharmaceutical micropollutants tends to occur through a technical approach centered on the removal of aquatic matrices, green chemistry, and urine diversion; (2) management with an organizational approach has enabled removing drugs from water bodies by drug take-back program, collaborative projects, drug use reduction, and better organizational practices; (3) the community approach have helped minimize this type of pollution by reducing the consumption of medicines and the proper destination for medicines that are no longer in use. Finally, the government management approach emerges as a source of legal, economic, and informational instruments to reduce pollution by pharmaceutical micropollutants. Furthermore, these management approaches allowed us to identify 15 opportunities for possible adjustments for developing societies. These opportunities can be promising for practices and research and, in the medium term, contribute to minimizing pollution by pharmaceutical micropollutants in urban waters.

Aquatic concentration and risk assessment of pharmaceutically active compounds in the environment

Pharmaceutically active compounds are increasingly detected in raw and treated wastewater, surface water, and drinking water worldwide. These compounds can cause adverse effects to the ecosystem even at low concentrations and, to assess these impacts, toxicity tests are essential. However, the toxicity data are scarce for many PhACs, and when available, they are dispersed in the literature. The values of pharmaceuticals concentration in the environment and toxicity data are essential for measuring their environmental and human health risks. Thus this review verified the concentrations of pharmaceuticals in the aquatic environment and the toxicity related to them. The risk assessment was also carried out. Diclofenac, naproxen, erythromycin, roxithromycin, and 17β-estradiol presented a high environment risk and 17α-ethinylestradiol presented a high human health risk. This shows the potential of these pharmaceuticals to cause adverse effects to the ecosystem and humans and establishes the necessity of their removal through advanced technologies.

Promotion of Household Waste Utilization in China: Lessons Learnt from Three Case Studies

Household waste utilization has been regarded as an important pathway to promote the circular economy paradigm and sustainable development for a long time. However, relevant enterprises are facing dilemmas in terms of the backward disposal methods for food waste, inadequate recycling of low-value recyclable waste and the lack of leading enterprises, resulting in unsustainable expansion of the industry. To address these problems, we investigated governmental departments and 20 household waste utilization enterprises in China. From the investigation, three typical enterprises, representing the advanced technology for food waste, the recycling mode of recyclable waste and the cultivation mode of leading enterprises, were selected for case studies. The results indicate that applying the technology of bioconversion by maggots could improve the utilization of food waste and adopting the “online and offline” dual-channel mode could benefit the recycling of low-value recyclable waste. Additionally, leading enterprises can be cultivated by franchise mode, which can drive the utilization of household waste in China effectively. The findings enrich the theory of household waste utilization in terms of disposal methods, recycling modes and enterprise operation. Practically, this research should enlighten decision-makers to improve household waste utilization. Furthermore, the research results could be generalized in other countries, thereby advancing the household waste management worldwide.

Effective treatment of hospital wastewater with high-concentration diclofenac and ibuprofen using a promising technology based on degradation reaction catalyzed by Fe0 under microwave irradiation

Real hospital wastewater was effectively treated by a promising technology based on degradation reaction catalyzed by Fe⁰ under microwave irradiation in this work. Fe⁰ powders were synthesized and characterized by different techniques, resulting in a single-phase sample with spherical particles. Optimum experimental conditions were determined by a central composite rotatable design combined with a response surface methodology, resulting in 96.8% of chemical oxygen demand reduction and 100% organic carbon removal, after applying MW power of 780 W and Fe⁰ dosage of 0.36 g L^-1 for 60 min. Amongst the several organic compounds identified in the wastewater sample, diclofenac and ibuprofen were present in higher concentrations; therefore, they were set as target pollutants. Both compounds were completely degraded in 35 min of reaction time. Their plausible degradation pathways were investigated and proposed. Overall, the method developed in this work effectively removed high concentrations of pharmaceuticals in hospital wastewater.

Disposal Practices of Unused and Leftover Medicines in the Households of Dhaka Metropolis

Background: This fact-finding study aimed to attain an overall idea and knowledge about medicine disposal practices in Dhaka Metropolitan households. Methods: This mixed study (both quantitative and qualitative) was orchestrated to inspect the household leftover medicine disposal pattern's governing status. A cross-sectional survey was conducted following a structured questionnaire and key informant interview with a household person and in-depth interviews with the top pharmaceutical and government officials. Results: Findings disclose that, for most of the key informants, the terms "drug disposal" and "drug pollution" were unknown; more precisely, 67% and 74% of key informants even did not hear these two terms. Almost all (87%) households faced undesired incidents due to the insecure storage of medicines. People disposed of excess and expired medication in regular dustbins (47%), threw out of the window (19%), flushed within commode (4%), burnt in fire (2%), and reused (4%). A good percentage of people (21%) returned unexpired drugs to the pharmacy and bought other medicines on a need basis. A total of 72% wanted a medicine take-back program, and 100% agreed on mass education on this issue. Officials of pharmaceuticals conferred mixed opinion: top-ranked pharmaceuticals will adopt leftover medicine disposal practices; middle and low-ranked pharmaceutical companies are reluctant, merely denied mentioning the less important issue. Conclusions: The absence of mass awareness and standard laws and policies may explain these existing aberrant practices.

Antibiotic resistance in the environment: a critical insight on its occurrence, fate, and eco-toxicity

The overuse, misuse, and underuse of antibiotics tend to increase the antibiotic burden in the environment resulting into the evolution in microbial community to possess resistance that renders antibiotics ineffective against them. The current review recapitulates the present state of knowledge about the occurrence and fate of antibiotics in various environmental matrices. Also, the prevalence of antibiotic-resistant bacteria/antibiotic-resistant genes (ARB/ARGs) in various biological and non-biological systems, eco-toxicity of antibiotics on non-target organisms, and remediation methods for antibiotics and ARB/ARGs removal were critically reviewed. Furthermore, a comparison of various technologies for their efficiency to eliminate antibiotic residues and ARB/ARGs is made. The study identified gaps in the investigation of toxic effects of low concentration of antibiotics and the mixture of multiple antibiotics on non-target organisms. The study of antibiotics' phytotoxicity and toxicity towards sediment and soil-dwelling organisms are also recognized as a knowledge gap. The review also details policies implemented across the globe to fight against antibiotic resistance, and the scarcity of data on lab to land transferred remediation technology was identified. The present study entails a critical review of literature providing guidelines for the articulation of policies for prudent use of antibiotics, limits on the amount of antibiotics in pharmaceutical formulations, and regular surveillance in the Indian context.

Pharmaceutical pollution sources and solutions: Survey of human and veterinary medication purchasing, use, and disposal

Human and veterinary pharmaceuticals offer many benefits, but they also pose risks to both the environment and public health. Life-cycle stewardship of medications offers multiple strategies for minimizing the risks posed by pharmaceuticals, and further insight is required for developing best practices for pharmaceutical management. The goal of this study was to clarify points of intervention for minimizing environmental and public health risks associated with pharmaceuticals. Specifically, our objectives were to provide insight on purchasing, use, and disposal behaviors associated with human and veterinary medications. This study used a state-wide representative sample of Vermont adults (n = 421) to survey both human and veterinary pharmaceuticals as potential sources of the unintended consequences of prescribed and over-the-counter (OTC) medications. The majority (93%) of respondents had purchased some form of medication within the past twelve months, including OTC (85%), prescription (74%), and veterinary (41%) drugs. Leftover drugs of any kind were reported by 59% of respondents. While 56% of people were aware of drug take-back programs, the majority reported never being told what to do with leftover medications by their physician (78%), pharmacist (76%), or veterinarian (53%). Among all respondents, take-back programs were the most common disposal method (22%), followed by trash (19%), and flushing (9%), while 26% of respondents reported keeping unused drugs. Awareness of pharmaceutical pollution in the environment and having received information about proper disposal were both significantly associated with participation in take-back programs. These findings indicate that a large volume of drugs are going unused annually, and that only a portion of leftover medications are returned to take-back programs where they can be appropriately disposed. Our results warrant further investigation of clinical interventions that support lower dose prescribing and dispensing practices in order to reduce the unintended environmental and public health consequences of pharmaceuticals within the consumer sphere. In addition, our findings suggest that directed efforts to raise awareness of proper disposal may be more effective than broad awareness campaigns, and we recommend research on the efficacy of providing disposal instructions on drug packaging.

Nanostructures derived from expired drugs and their applications toward sensing, security ink, and bactericidal material

In this research, a facile and economical route is introduced for the transformation of pharmaceutical waste (i.e., expired medicines) into value-added fluorescent carbon quantum dots (pharmaceutically derived CQDs abbreviated as 'P-CQDs'). The synthesized P-CQDs were identified to have surface functionalities of -OH, C=O, and C=C with an average size of ~2-3 nm and a high quantum yield of 35.3%. The photoluminescence of P-CQDs recorded a maximum optical emission intensity at 2.8 eV (425 nm). The binding of Cu (II) ions by -COOH functionalities on the surface of P-CQDs led to its fluorescence quenching (turn-off) over a wide Cu (II) concentration range of 0.25-50 ppm. The P-CQDs exhibited the detection limit of 0.66 ppm (well below the WHO permissible limit of 2 ppm). The fluorescence intensity of the P-CQDs-Cu (II) complex was recovered from NaHCO_3.Hence, their "off-on" behavior was also explored for security ink applications for information encryption and decryption. Moreover, the rich oxygenated groups on the surface of the P-CQDs were utilized for green synthesis of plasmonic Ag@P-CQDs nanostructures, which were also demonstrated to have enhanced potential as bactericidal materials (e.g., against both E. coli and S. aureus). The overall results of this study are demonstrated to help create new and diverse routes for converting expired drugs into value-added nanostructures.

Medications disposal and medications storage in Jordan: A cross-sectional study

AIMS

Many concerns arise from the improper disposal of medications, which is associated with a negative impact on health and wildlife. The majority of the consumers of pharmaceutical products remain unaware of the procedures of disposal of unused or expired medicines. This study aimed to explore the practices of Jordanian individuals regarding the disposal and storage of unused or expired medications.

METHODS

A cross-sectional study was conducted in Jordan for the period between July and November 2019 of patients who reported having unused, leftover or expired medications in their homes. The questionnaire tool was constructed based on a number of studies concerning medication recycling and international guidelines about correct and safe disposal of expired, unwanted or unused medication.

RESULTS

A total of 1092 participants were included in the study. Their mean age was 32.4 (SD = 13.6) years and 56.8% (n = 620) were males. More than half of the participants (58.1%, n = 634) reported that they had unused, leftover or expired medications in their homes. The bedroom, kitchen and store room were the three most commonly reported places for the storage of unused, leftover or expired medications. The pharmacist was the main source for information regarding the storage of medications. The three most common reasons reported by the participants regarding having unused/leftover medications at home were change or discontinuation by the doctor (29.4%), self-discontinuation as the illness symptoms improved or resolved (28.2%) and forgetfulness (25.1%).

CONCLUSION

A high percentage of the Jordanian population improperly handles their unused, leftover or expired medications. More restrictions are needed on the prescribing and dispensing of medications by the authorities concerned and there is a need to establish public guidelines regarding the use and correct disposal of pharmaceuticals.

Can We Create a Circular Pharmaceutical Supply Chain (CPSC) to Reduce Medicines Waste?

BACKGROUND

The increase in pharmaceutical waste medicines is a global phenomenon and financial burden. The Circular Economy, as a philosophy within the pharmaceutical supply chain, aims to promote waste reduction, maximise medicines value, and enable sustainability within this supply chain (increasing circularity). Circularity strategies for pharmaceuticals are not currently implemented in many countries, due to quality and safety barriers. The aim of this study was to determine whether the application of circular economy principles can minimise pharmaceutical waste and support sustainability in the pharmaceutical supply chain; Methods: a detailed narrative literature review was conducted in order to examine pharmaceutical waste creation, management, disposal, and the application of circular economy principles; Results: the literature scrutinised revealed that pharmaceutical waste is created by multiple routes, each of which need to be addressed by pharmacists and healthcare bodies through the Circular Economy 9R principles. These principles act as a binding mechanism for disparate waste management initiatives. Medicines, or elements of a pharmaceutical product, can be better managed to reduce waste, cost, and reduce negative environmental impacts through unsafe disposal.

CONCLUSIONS

the study findings outline a Circular Pharmaceutical Supply Chain and suggests that it should be considered and tested as a sustainable supply chain proposition.

Green Microalgae Scenedesmus Obliquus Utilization for the Adsorptive Removal of Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) from Water Samples

In view of the valorisation of the green microalga Scenedesmus obliquus biomass, it was used for the biosorption of two nonsteroidal anti-inflammatory drugs, namely salicylic acid and ibuprofen, from water. Microalgae biomass was characterized, namely by the determination of the point of zero charge (pH_PZC), by Fourier transform infrared (FT-IR) analysis, simultaneous thermal analysis (STA) and scanning electron microscopy with energy dispersive spectroscopy (SEM/EDS). Kinetic and equilibrium batch experiments were carried out and results were found to fit the pseudo-second order equation and the Langmuir isotherm model, respectively. The Langmuir maximum capacity determined for salicylic acid (63 mg g⁻¹) was larger than for ibuprofen (12 mg g⁻¹), which was also verified for a commercial activated carbon used as reference (with capacities of 250 and 147 mg g⁻¹, respectively). For both pharmaceuticals, the determination of thermodynamic parameters allowed us to infer that adsorption onto microalgae biomass was spontaneous, favourable and exothermic. Furthermore, based on the biomass characterization after adsorption and energy associated with the process, it was deduced that the removal of salicylic acid and ibuprofen by Scenedesmus obliquus biomass occurred by physical interaction.

Consumer willingness to pay for a pharmaceutical disposal program in Serbia: A double hurdle modeling approach

Proper collection and disposal of pharmaceutical waste from households can reduce the negative influence of medicines on the environment. The aim of this paper is to examine the current methods of disposal of unused medicines from households, as well as the willingness of Serbian residents to participate and bear the costs of an organized collection program. Moreover, this research aims to define factors contributing to an individual's willingness to participate and pay for a medicine collection program. The survey included randomly selected patients older than 18 years visiting private pharmacies in the four largest Serbian cities. The questionnaire included information regarding the presence of unwanted medicines within the household, general medicine disposal practices, the likelihood to participate in a medicine take-back program, willingness to pay for a medicine disposal program (per prescription and per visit), importance to the environment, and demographic variables from participants. Approximately 80% of surveyed respondents are very or somewhat likely to participate, however less than half of the respondents are willing to pay for the collection of their unused medicines. The factors that influenced willingness to participate are environmental awareness and income, while the factors affecting willingness to pay, are previously received advice about proper disposal, education level, number of unwanted medicines in the household and gender. The majority of Serbian people dispose unused medicines improperly, mostly into household garbage. Well-organized and easily accessible collection programs are essential in order to enable the general public to return unused medicines for proper disposal.

Expired Medication: Societal, Regulatory and Ethical Aspects of a Wasted Opportunity

A massive volume of expired medications amasses annually around the world because of pharmaceutical overprescription, combined with overproduction. The accumulation of pharmaceutical waste imposes ecological, economic and social/ethical burdens. Managing this presumed “waste” has developed into a global challenge due to the absence of specific regulations, unreasonable behavior of the patients, and an improper understanding of the concept of “expired medications” in general. This paper summaries, first, the recent literature reporting practices related to the disposal of unused medications. In this context, 48 papers from 34 countries with a total of 33,832 participants point towards a significant lack of public awareness regarding the appropriate disposal of such biologically potent chemicals. These findings are corroborated by a local survey on the disposal practices of unused medicines among pharmacy students at Saarland University. The regulatory aspects surrounding this topic, often based on the official guidelines for the disposal of expired medications and local waste management strategies, are then discussed in light of these findings. Finally, a closer inspection of the epistemic values of expired medications and different strategies for managing expired medications have been reviewed.

Household Pharmaceutical Waste Disposal in Selangor, Malaysia-Policy, Public Perception, and Current Practices

Although pharmaceuticals treat illnesses and prevent diseases in humans and animals, ironically, they are now among the emerging pollutants in the environment. As individuals continue to consume medicines, households can become a primary source of pharmaceutical pollutants. This paper explains relevant Malaysian law and policy on the issue. Using a questionnaire survey, it also assesses public perception concerning the environmental impact of pharmaceutical waste and the current methods of disposal that are practiced in Selangor. The survey used a convenience sampling and the data collected were analysed using statistical descriptive analysis. Most of the participants were aware that pharmaceutical waste can have an adverse impact on the environment and public health. Half of the participants disposed of their pharmaceutical waste in trash bins. About 2.9% of the respondents poured their household pharmaceutical waste (HPW) directly down the drain, while 8.8% poured them down the sink in the kitchen or toilet. The study also discovered that while 73.8% of the respondents felt that HPW should be separated from other household solid waste, only 25.2% returned their medicinal waste through the medicine return-back programme. The majority of the respondents (82.5%) agreed that information concerning the proper disposal of HPW is insufficient. The study concludes that while the respondents were aware of the adverse impact of HPW, their practices to ensure proper disposal is discouraging. There is a need for effective unwanted medicines return-back programme as a more prudent disposal method of HPW to avoid any risk to the environment or human health.