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Abstract

Introduction

Irrational use and improper disposal of medicines lead to environmental pollution. There is compelling evidence of the negative impact of medications on biological systems. In Russia, there is no legislation regarding the disposal of expired medications at home. Expired medications generated at home are considered household waste.

Objective

To study the effectiveness of separate collection of medicines and analyze unused medicines discarded by patients.

Methods

We organized separate collection of expired and unused medicines in two polyclinics in Kazan. An ATC/DDD (Anatomical Therapeutic Chemical/Defined Daily Dose) analysis was conducted to estimate how many drugs are not consumed by people and are thrown away in the general waste.

Results

From November 2022 to April 2024, a total of 4737 trade names of medicines or 707 INNs (International Nonproprietary Names) and 195 dietary supplements were collected, totaling 243 kg of medicines and supplements that were subsequently sent for proper disposal. The ATC/DDD analysis showed that the largest number of DDDs collected were medicines for treating cardiovascular system disorders, digestive system and metabolism disorders, and blood and hematopoietic system disorders.

Conclusions

To assess the rationality of medicine use, it is important to conduct qualitative and quantitative evaluation of disposed medicines. Such analysis can be part of actual consumption analysis, as not all medicines dispensed to patients in pharmacies are actually consumed by them.

Keywords

rational pharmacotherapy expired and unused medicines proper disposal of medicines ATC/DDD analysis

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References

McRae

Gould

Price-Davies

, et al. Public attitudes towards medicinal waste and medicines reuse in a ‘free prescription’ healthcare system. Pharmacy 2021; 9(2): 77.

Thomas

World Health Organization Regional Office for Europe . Pharmaceutical waste in the environment: a cultural perspective. Public Health Panorama 2017; 3(1): 127–132.

Rogowska

Zimmermann

. Household pharmaceutical waste disposal as a global problem—a review. Int J Environ Res Publ Health 2022; 19(23): 15798.

Schlüter

Szczepanowski

Pühler

, et al. Genomics of IncP-1 antibiotic resistance plasmids isolated from wastewater treatment plants provides evidence for a widely accessible drug resistance gene pool. FEMS Microbiol Rev 2007; 31(4): 449–477.

Dzieweczynski

Hebert

. The effects of short-term exposure to an endocrine disrupter on behavioral consistency in male juvenile and adult Siamese fighting fish. Arch Environ Contam Toxicol 2013; 64(2): 316–326.

Hallgren

Sorita

Berglund

, et al. Effects of 17α-ethinylestradiol on individual life-history parameters and estimated population growth rates of the freshwater gastropods Radix balthica and Bithynia tentaculata. Ecotoxicology 2012; 21: 803–810.

Barnett-Itzhaki

Berman

Grotto

, et al. Household medical waste disposal policy in Israel. Isr J Health Pol Res 2016; 5: 48.

Lester

Avisar

Mamane

, et al. Removal of pharmaceuticals using combination of UV/H₂O₂/O₃ advanced oxidation process. Water Sci Technol 2011; 64(11): 2230–2238.

Smith

Skibinski

Livingston

. Response: update on pharmaceutical waste disposal regulations-strategies for success. Am J Health Syst Pharm 2020; 77(3): 1720–1721.

10.

Wilkinson

Boxall

Kolpin

, et al. Pharmaceutical pollution of the world’s rivers. Proc Natl Acad Sci USA 2022; 119(8): e2113947119.

11.

Kleywegt

Pileggi

Yang

, et al. Pharmaceuticals, hormones and bisphenol A in untreated source and finished drinking water in Ontario, Canada – occurrence and treatment efficiency. Sci Total Environ 2011; 409(8): 1481–1488.

12.

Sui

Cao

, et al. Occurrence, sources and fate of pharmaceuticals and personal care products in the groundwater: a review. Emerging Contam 2015; 1(1): 14–24.

13.

Makhmudova

Khaziakhmetova

. The pharmaceutical environmental pollution problem: a literature review. Remedium 2023; 1: 76–80.

14.

Medsdisposal [Internet]. Available from: https://medsdisposal.eu/about-us/

15.

Safe, convenient medicine disposal [Internet]. Return Unwanted Medicine (the RUM project). Available from. https://www.returnmed.com.au/ (2024).

16.

Brooks

Chambliss

Stanley

, et al. Determination of select antidepressants in fish from an effluent-dominated stream. Environ Toxicol Chem 2005; 24(2): 464–469.

17.

WHO Collaborating Centre for Drug Statistics Methodology . The ATC/DDD system [Internet]. Available from. https://atcddd.fhi.no/atc_ddd_alterations__cumulative/ddd_alterations/

18.

Defined Daily Dose (DDD) [Internet]. World Health Organization; 2023. Available from. https://www.who.int/tools/atc-ddd-toolkit/about-ddd