Disposal practices for unused medications around the world

Pharmaceuticals have been detected throughout the environment where at least in some cases, they have been shown to have a detrimental effect. Many result from improper patient disposal of unused pharmaceuticals via environmentally-unfriendly routes, such as the sink, toilet or rubbish bin. This review surveys the current peer-reviewed literature on attitudes and practices to medicine disposal methods as reported by patients and the various medication disposal and destruction systems around the world. A literature search was carried out using the keywords 'medicines disposal', 'unused medicines', 'medicines wastage', and 'medication disposal' in the PubMed TM, ISI Web of Knowledge TM, Google Scholar TM, Medline TM, Scopus TM and International Pharmaceuticals Abstracts TM up to the end of May 2010. Twelve peer-reviewed articles with specified sample sizes were selected. The most popular methods for medication disposal were in the garbage, toilet or sink. Liquid medications were more likely to be rinsed down the sink, as opposed to solid tablets and capsules which were more likely deposited in the rubbish bin. Much confusion exists about the 'proper' way of medication disposal as many countries do not have standard medication disposal protocols. Furthermore, some pharmacies around the world refused to accept unused medications or discouraged the practice. Patients with knowledge about the impact of pharmaceuticals in the environment were more likely to return medications for proper disposal and destruction. It is concluded that it is of paramount importance that a formalized protocol for patient disposal and destruction of pharmaceuticals be implemented around the world.     

Disposal practices for unused medications in New Zealand

BackgroundThere is an enhanced international awareness that the improper disposal of unwanted and unused medications may have a detrimental effect on the environment.ObjectivesThe aim of this study was to determine the proportion of unused medications in New Zealand that are not returned to a pharmacy for disposal and are instead disposed of via land fill or water systems. In addition, this study intended to identify why these medications were unused or unwanted.DesignAn online survey was placed on the New Zealand National Poisons Centre website for a period of three months during 2008. This consisted of a series of questions with predefined answer sets and asked about collection of medications, why there may be unused medications, storage of medications and disposal of medications.ResultsThis survey was completed by 452 individuals. 62% of respondents currently had unwanted medications in their house. The most common reason for people to have leftover medication was ‘medical condition improved or resolved’ (n = 307). Depending on formulation type, between 13–24% of unused medications were returned to pharmacies with tablets and capsules being most likely to be returned and liquids most likely to be added to water systems.ConclusionsA significant percentage of unwanted medications are disposed of via routes that have the potential to adversely affect the environment. Reducing excess medications and wastage as well as education of appropriate disposal techniques may minimize their potential impact on the environment.     

Beyond the medicine cabinet: an analysis of where and why medications accumulate

Active pharmaceutical ingredients (APIs) from medications can enter the environment as trace contaminants, at individual concentrations generally below a part per billion (microg/L). APIs enter the environment primarily via the discharge of raw and treated sewage. Residues of unmetabolized APIs from parenteral and enteral drugs are excreted in feces and urine, and topically applied medications are washed from skin during bathing. These trace residues may pose risks for aquatic life and cause concern with regard to subsequent human exposure. APIs also enter the environment from the disposal of unwanted medications directly to sewers and trash. The relative significance of this route compared with excretion and bathing is poorly understood and has been subject to much speculation. Two major aspects of uncertainty exist: the percentage of any particular API in the environment originating from disposal is unknown, and disposal undoubtedly occurs from a variety of dispersed sources. Sources of disposal, along with the types and quantities of APIs resulting from each source, are important to understand so that effective pollution prevention approaches can be designed and implemented. Accumulation of leftover, unwanted drugs poses three major concerns: (i) APIs disposed to sewage or trash compose a diverse source of potential chemical stressors in the environment. (ii) Accumulated drugs represent increased potential for drug diversion, with its attendant risks of unintentional poisonings and abuse. (iii) Leftover drugs represent wasted healthcare resources and lost opportunities for medical treatment. This paper has four major purposes: (1) Define the processes, actions, and behaviors that control and drive the consumption, accumulation, and need for disposal of pharmaceuticals. (2) Provide an overview of the diverse locations where drugs are used and accumulate. (3) Present a summary of the first cataloging of APIs disposed by a defined subpopulation. (4) Identify opportunities for pollution prevention and source reduction.     

垃圾块体填埋法及其应用前景

分析了垃圾排弃的现状、危害、潜在价值及现有的垃圾处理方法,提出创新垃圾处理方法势在必行。与已有的垃圾处理方法比较,垃圾块体填埋法有自己的特点,以社区为单元的垃圾源头分类投放、收集和预处理,能使垃圾实现分类化处理;通过垃圾中可回收废物的回收利用,能使垃圾最大限度资源化;通过垃圾分类粉碎、脱水、压缩成块体,使垃圾有效地减量化;经过消毒、分类堆砌有助于垃圾填埋场地的分类管理和安全监控,使垃圾处理基本无害化;回收、堆肥、焚烧、填埋,使垃圾处理综合化;填埋场的复垦与开发利用,使垃圾处理环保化。该方法的推广应用,可使垃圾处理无害化、减量化、资源化和市场化目标得以实现。     

Issues in reverse supply chains,part I: end‐of‐life product recovery and inventory management – an overview

Recovery of used products has become a field of rapidly growing importance in reverse supply chain management. Product recovery includes collection, inspection/separation, disassembly, reconditioning/reuse, remanufacturing, and recycling. In real time situations, the collection of end‐of‐life (EoL) products from the customer and their return to the manufacturer is tedious and time consuming. Reduced product life cycles have increased the rate of product returns and disposals. Owing to shortened product economic life cycles, the recovery of value from EoL products is becoming a necessity. Companies have realised the value that they could recover by remanufacturing or recycling EoL products. Researchers have developed various models for product recovery network design, optimal inventory, production planning and control, remanufacturing, recycling, disposal, etc. The main purpose of this paper is to review the literature on EoL product recovery and inventory management issues in reverse supply chains and to outline some future directions for research on these issues.     

Identifying municipal solid waste management opportunities in Al-Bayda City,Libya

In Libya, municipal solid waste management is one of the services provided by the authorities to keep the county clean. This study was conducted in the City of Al-Bayda, located in the eastern part of Libya, as there have been several major problems facing the city in dealing with solid waste management. One of these problems is the generation, collection, handling, transportation, recycling, and disposal of municipal solid waste (MSW). This study has identified that the ongoing disposal of MSW to poorly engineered “dump sites” on the outskirts of the city is unsustainable and will not meet the demands of the growing population and increasing urbanization currently experienced within Al-Bayda. Factors impacting the decision-making and operational processes of MSW include lack of resources and services that significantly affect the disposal of waste, an inadequate number of waste collection containers making the distance to these containers for many households excessive, and thus leading to an increasing likelihood of dumping solid waste in open areas and roadsides. The study recommends that the city government of Al-Bayda should identify synergies and increase partnership-working arrangements with the private sector to ensure efficient management of MSW within the city area.     

Consumption-based approach for assessing the contribution of hospitals towards the load of pharmaceutical residues in municipal wastewater

Hospitals are considered as major sources of pharmaceutical residues discharged to municipal wastewater, but recent experimental studies showed that the contribution of hospitals to the loads of selected, quantifiable pharmaceuticals in sewage treatment plant (STP) influents was limited. However such conclusions are made based on the experimental analysis of pharmaceuticals in hospital wastewater which is hindered by a number of factors such as access to suitable sampling sites, difficulties in obtaining representative samples and availability of analytical methods. Therefore, this study explores a refined and extended consumption-based approach to predict the contribution of six selected Australian hospitals to the loads of 589 pharmaceuticals in municipal wastewater. In addition, the possibility that hospital-specific substances are present at levels that may pose a risk for human health was evaluated. For 63 to 84% of the pharmaceuticals investigated, the selected hospitals are not a major point source with individual contributions likely to be less than 15% which is in line with previous experimental studies. In contrast, between 10 and 20% of the pharmaceuticals consumed in the selected hospitals are exclusively used in these hospitals. For these hospital-specific substances, 57 distinct pharmaceuticals may cause concerns for human health as concentrations predicted in hospital effluents are less than 100-fold lower than effect thresholds. However, when concentrations were predicted in the influent of the corresponding STP, only 12 compounds (including the antineoplastic vincristine, the antibiotics tazobactam and piperacillin) remain in concentration close to effect thresholds, but further decrease is expected after removal in STP, dilution in the receiving stream and drinking water treatment. The results of this study suggest that risks of human exposure to the pharmaceuticals exclusively administered in the investigated hospitals are limited and decentralised wastewater treatment at these sites would not have a substantial impact on pharmaceutical loads entering STPs, and finally the environment. Overall, our approach demonstrates a unique opportunity to screen for pharmaceuticals used in hospitals and identifying priority pollutants in hospital wastewater explicitly accounting for site-specific conditions. Being based on consumption and loads discharged by hospitals into municipal wastewater, it is not limited by 1) the big effort to obtain representative samples from sewers, 2) the availability of sensitive chemical analysis or 3) a pre-selection of consumption data (e.g. consumption volume).     

公共产品供给民营化背景下的政府规制研究

20世纪90年代开始,我国启动了公用事业市场化改革,民营资本特别是外资流向自来水供给、污水处理、城市生活垃圾收集与处理、燃气供应等行业。私人部门的介入激活了公共产品供给市场,有利于社会福利的增进,但也招致了诸多问题。公共产品供给民营化,并不意味着政府的完全退出,政府始终负有向社会公众提供公共产品或服务的原始责任,民营化只是在提供的形式上完成了向私人部门的转移,政府应完成从公共产品直接提供者向规制者的角色转换。本文以城市生活垃圾产业为例,进行了系统的分析。认为有效的规制应建立在真实的规制环境上,在城市生活垃圾产业民营化的规制中,面临着现有规制者与合约方一体、规制机构与企业信息不对称、政府部门承诺有限等规制约束。基于目前的规制环境,我国城市生活垃圾产业在推进民营化的同时,应建立起独立的规制机构,加强监管,逐步纵向一体民营化以降低交易成本,在合约中采用指数化价格分享企业租金。     

Hazardous waste, impact on health and environment for development of better waste management strategies in future in India

Industry has become an essential part of modern society, and waste production is an inevitable outcome of the developmental activities. A material becomes waste when it is discarded without expecting to be compensated for its inherent value. These wastes may pose a potential hazard to the human health or the environment (soil, air, water) when improperly treated, stored, transported or disposed off or managed. Currently in India even though hazardous wastes, emanations and effluents are regulated, solid wastes often are disposed off indiscriminately posing health and environmental risk. In view of this, management of hazardous wastes including their disposal in environment friendly and economically viable way is very important and therefore suggestions are made for developing better strategies. Out of the various categories of the wastes, solid waste contributes a major share towards environmental degradation. The present paper outlines the nature of the wastes, waste generating industries, waste characterization, health and environmental implications of wastes management practices, steps towards planning, design and development of models for effective hazardous waste management, treatment, approaches and regulations for disposal of hazardous waste. Appraisal of the whole situation with reference to Indian scenario is attempted so that a better cost-effective strategies for waste management be evolved in future.     

Estrogenic activity of pharmaceuticals in the aquatic environment

In the last years pharmaceuticals have aroused great interest as environmental pollutants for their toxic effects towards non target organisms. This study wants to draw attention to a further adverse effect of drugs, the endocrine interference. The most representative drugs of the widespread classes in environment were investigated. The YES-test and the E-screen assay were performed to detect the capability of these substances to bind the human estrogenic receptor α (hERα) in comparison with 17β-estradiol. Out of 14 tested pharmaceuticals, 9 were positive to YES-assay and 11 were positive to E-screen assay; in particular, Furosemide and the fibrates (Bezafibrate, Fenofibrate and Gemfibrozil) gave the maximal estrogenic response. Tamoxifen showed its dual activity as agonist and antagonist of hERα.     

完善我国医疗废物集中处置收费政策的思考和建议

医疗废物处置收费政策是医疗废物处置产业化发展的重要前提和保障。当前,医疗废物处置收费政策执行难,欠费、漏费等问题非常突出,医疗废物集中收集十分困难。在对我国医疗废物处置收费政策进行全面分析和评估的基础上,对当前收费政策存在的主要问题和产生的原因进行了分析。以加快完善医疗废物处置收费政策为目标,从完善政策体系、加强监管执法、提高标准合理性、综合确定费用承担方、制定鼓励性的经济政策、提高宣传和缴费意识等方面,提出医疗废物处置收费政策改革完善的若干建议。     

Effect of precipitation,sorption and stable of isotope on maximum release rates of radionuclides from engineered barrier system (EBS) in deep repository

The basic function of the engineered barrier system (EBS) in geological disposal is to prevent or limit the release of radionuclides into the underground environment. For this purpose, the vitrified waste is contained in an overpack to isolate it from contact with groundwater for a certain initial period of time. However, it is impossible to ensure complete containment for all time. Therefore, the eventual release of nuclides must be minimized after the overpack fails (AEC, 1984. Radioactive waste processing and disposal measures; JNC, 2000a. Project to establish the scientific and technical basis for HLW disposal in Japan – first progress report-H3. Geological Environment in Japan, JNC TN1410 2000-002; JNC, 2000b. H12: project to establish the scientific and technical basis for HLW disposal in Japan – repository design and engineering technology, JNC TN1410 2000-003.).     

北京市城市生活垃圾收运系统研究

对北京市城市生活垃圾收运系统现状进行了全面的分析,对北京城八区生活垃圾收集、分类收集、转运、生活垃圾处理设施和垃圾物流现状进行了分析,同时对北京市城市生活垃圾收运系统进行了分析,指出了北京市城市生活垃圾收运系统存在的主要问题和今后改进的建议及处理处置设施的规划,为北京城市生活垃圾收运系统的建设和完善起到了积极地推动作用。     

Sediment problems and lake restoration in Wisconsin

Twelve dredging projects are underway or will soon begin in Wisconsin. These include both natural and man-made lakes, with lake size and sediment removal up to 205 ha and 1,720,250 m³, respectively. Solids content of the sediments ranges from 70%–80% to 1%–5%. The projects were designed using a mixture of on-site data collection, predictive models, and professional judgement. Sediment disposal has limited project implementation, with arsenic being a special problem. Theoretically, sediment concentrations below 4 μg/g could still produce unacceptable contamination of groundwater at the disposal site. One project is being held up, pending completion of laboratory testing. Organic sediments from Lilly Lake were deposited in an active gravel pit and within diked areas on agricultural land. Passage through a spray irrigation system proved impractical. Rapid infiltration of water into the bottom and sides of the settling basins was short-lived due to the self-sealing characteristics of these sediments. Studies are now underway to determine the effect of lake sediment application to upland soils on corn production.     

Radiological risk assessment and biosphere modelling for radioactive waste disposal in Switzerland

Long-term safety assessments for geological disposal of radioactive waste in Switzerland involve the demonstration that the annual radiation dose to humans due to the potential release of radionuclides from the waste repository into the biosphere will not exceed the regulatory limit of 0.1 mSv. Here, we describe the simple but robust approach used by Nagra (Swiss National Cooperative for the Disposal of Radioactive Waste) to quantify the dose to humans as a result to time-dependent release of radionuclides from the geosphere into the biosphere. The model calculates the concentrations of radionuclides in different terrestrial and aquatic compartments of the surface environment. The fluxes of water and solids within the environment are the drivers for the exchange of radionuclides between these compartments. The calculated radionuclide concentrations in the biosphere are then used to estimate the radiation doses to humans due to various exposure paths (e.g. ingestion of radionuclides via drinking water and food, inhalation of radionuclides, external irradiation from radionuclides in soils). In this paper we also discuss recent new achievements and planned future work.     

Containment area sizing for disposal of dredged material

Procedures are given for containment area sizing for retention of suspended solids based on the settling characteristics of the dredged material. Separate sizing procedures for freshwater and saltwater sediments provide for determination of the respective surface area or detention time required to accomodate continuous dredged material disposal. Procedures are given for the laboratory testing required to obtain data for sediment characterization, containment area sizing, and estimates of storage capacity required. These procedures can also be used for designing containment areas for other slurries having high suspended solids concentrations. Settling tests performed in a 20-cm-diam column were found to be satisfactory for defining dredged material settling behavior. Settling behavior in the freshwater environment was best described by a flocculent settling test, while behavior in a saltwater environment was best described by a zone settling test. The same settling columns were used for both tests withonly minor procedural changes. Procedures are presented for designing new containment areas for suspended solids retention and for evaluating the suspended solids retention potential of existing containment areas during planned disposal activities.     

Removal of residual pharmaceuticals from aqueous systems by advanced oxidation processes

Over the past few years, pharmaceuticals are considered as an emerging environmental problem due to their continuous input and persistence to the aquatic ecosystem even at low concentrations. Advanced oxidation processes (AOPs) are technologies based on the intermediacy of hydroxyl and other radicals to oxidize recalcitrant, toxic and non-biodegradable compounds to various by-products and eventually to inert end-products. The environmental applications of AOPs are numerous, including water and wastewater treatment (i.e. removal of organic and inorganic pollutants and pathogens), air pollution abatement and soil remediation. AOPs are applied for the abatement of pollution caused by the presence of residual pharmaceuticals in waters for the last decade. In this light, this paper reviews and assesses the effectiveness of various AOPs for pharmaceutical removal from aqueous systems.     

Industrial pollution discharges from the West African region

Information on the type and quantity of industrial pollutants from major land-based sources entering the marine environment through direct coastal discharges or indirectly through rivers, as well as on the present status of industrial waste management (treatment and disposal) practices, are provided for the West African region. Most of the data utilized in this analysis were collected by six UNIDO experts who visited the eighteen countries of the West African region during the period of January through August 1980. Industrial operations were visited and information was collected from the various ministries involved with industrial development and environmental protection. Estimates of the mass of pollutants discharged to the ocean were based upon production rates used in conjunction with actual measurements made by the industries located in the countries visited; studies reported in the literature; and an extrapolation of the U.S. Environmental Protection Agency Effluent Standards for various industrial sectors. The West African region was divided into five zones closely approximating the major currents of the Atlantic Ocean. The estimated pollution discharged by the industrial sector was calculated for each of the zones by adding the contribution from each country assigned to a zone.