Drug Disposal Research Articles

Drug disposing behavior and awareness of the concept of ecopharmacovigilance among the medical faculty

Background: The ever-increasing impact of drugs on the environment has added an altogether new dimension of monitoring, assessing and documenting the known and unknown drug effects on our fragile environment in the form of ecopharmacovigilance. This study was carried out to document the drug disposing behavior and awareness of the concept of ecopharmacovigilance among the medical faculty of a tertiary care Medical Hospital.Methods: A detailed, structured, anonymous questionnaire consisting of both open and close ended essential queries on drug disposal practices was prepared and response obtained from the participants which included an agglomeration of teaching faculty and the clinicians of various disciplines of the Institute.Results: 97.87% of the participants obtained drugs in excess which included a majority of solid (68.12%) and liquid (31.88%) dosage forms. The maximum medicines obtained in excess included analgesics and antipyretics (89.36%), anti-asthmatics (15.22%), and anti-emetics (13.48%). 82.8% of the respondents were unaware of the proper drug disposal technique and 94.7 % of the respondents practiced open disposal of the drugs.Conclusions: An abysmally low level of awareness about ecopharmacovigilance and unhealthy, irrational method of drug disposal was documented in our study. Appropriate training of those who handle drugs in hospitals and healthcare establishments is the need of the hour.

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.

Research continues to show that pharmaceutical environmental contamination causes adverse effects to aquatic life. There are also public health risks associated with pharmaceuticals because in-home reserves of medications provide opportunities for accidental poisoning and intentional medication abuse. Pharmaceutical take back programs have been seen as a potential remedy for these issues; however, a thorough review of past programs indicates limited research has been conducted on take back programs. Furthermore, there are significant gaps in take back program research. To address these gaps and ultimately determine if take back programs could improve public health, research was conducted in conjunction with the take back program Denton drug disposal days held in Denton, Texas. Socioeconomic, demographic, and geographic characteristics of Denton drug disposal days participants were investigated using surveys and Geographic Information Systems. Potential impacts of the Denton drug disposal days program on public health were determined by comparing data from Denton drug disposal days events with data supplied by the North Texas Poison Center. Results suggest that Denton drug disposal days events may have prevented accidental poisonings or intentional abuse, however only qualitative comparisons support this statement and there was insufficient empirical evidence to support the conclusion that Denton drug disposal days events were exclusively responsible for public health improvements. An interesting finding was that there was a definitive travel threshold that influenced participation in Denton drug disposal days events. Overall, this study fills some geographic, socioeconomic, and demographic data gaps of take back programs and proposes methods to analyze and improve participation in future take back programs. These methods could also be applied to improve participation in other local environmentally-focused programs such as household hazardous collection events.

Knowledge and awareness of disposal of unused and expired medications among medical undergraduates of A Tertiary Care Teaching Hospital at B G Nagar: A cross-sectional observational study

Background: Majority of the consumers remain unaware about the disposal of unused or expired medicines. The misuse and improper disposal of medications are a major safety and environmental concern, and therefore the proper disposal of these medications is critically important. Aims and Objectives: The aim of this study was to know the behavior of individual’s disposal practices of unused and expired medicines among the medical undergraduate in B G Nagar. Materials and Methods: This was a descriptive, cross-sectional questionnaire based study done on 2nd year medical students of Adichunchanagiri Institute of Medical Sciences, B G Nagar. Returned questionnaires were double-checked for accuracy. Statistical Package for Social Science (SPSS) and Microsoft excel was used for statistical analysis. Results: Total of 128 valid questionnaires were returned with 38.28% male and 61.72% female student participation. About half of the respondents (50%) stored more than 5 medicines followed by 46.88% stored 1-5 medications at home. Majority of them disposed unused/expired drugs in municipality garbage. Majority of respondents held government responsible for creation of awareness for proper medicine disposal. 71.43% felt that drug leftover at home was in tablet form. 74.22% of them were aware of the environmental damage due to unscientific way of drug disposal methods. Conclusion: The present study demonstrated that the awareness of proper and safe drug disposal among the medical students is quite fair. To make it more effective, the concerned authorities need to implement educational programs regularly.

Protecting California’s Marine Environment from Flushed Pollutants

I. INTRODUCTION II. THE WASTEWATER LIFE CYCLE--A PATHWAY TO THE OCEAN A. Flushed Pollutants B. The Effects of Flushed Pollutants on Marine Organisms 1. Pharmaceuticals 2. Illicit Drugs 3. Caffeine III. EXISTING LEGAL AND REGULATORY LANDSCAPE A. The Clean Water Act and Porter-Cologne Water Quality Control Act B. The Controlled Substances Act and California Uniform Controlled Substances Act C. The Resource Conservation and Recovery Act and California Medical Waste Management Act D. Endangered Species Act and California Endangered Species Act IV. TOOLS FOR PROTECTING THE MARINE ENVIRONMENT A. Policy Reform and Legislative Amendments 1. The Management Standards for Hazardous Waste Pharmaceuticals Rule and the Safe Drug Disposal Act of 2009 2. Amending the CWA/Porter-Cologne Act 3. Amending the CSA/Uniform Controlled Substances Act 4. Adoption of a Universal No-Pharmaceutical Flushing Policy B. Public Education and Continued Research V. CONCLUSION I. INTRODUCTION Big cities produce a lot of sewage, which often contains pharmaceuticals, illicit drugs, and caffeine. These flushed pollutants can remain in wastewater even after processing by a wastewater treatment plant, and may have negative effects on marine organisms and ecosystems if introduced into the marine environment. California is home to Los Angeles, San Diego, and San Jose--three of the ten most populous cities in the United States. (1) All three are located in coastal counties (2) and utilize wastewater treatment plants (publicly owned treatment works or POTWs) (3) that discharge treated wastewater effluent directly into the Pacific Ocean. (4) As our cities grow, municipal wastewater is expected to contain increasing concentrations of flushed pollutants, posing a heightened threat to the health of our coasts and the marine environment more broadly. However, monitoring and regulation of flushed pollutants is currently insufficient, allowing them to be introduced into the marine environment undetected. This raises serious concern that flushed pollutants may devastate the marine environment beyond repair. The precautionary principle, a central tenet of environmental law and policy, asserts that regulators and decision makers should act in anticipation of environmental harm, without regard to the certainty of the scientific information pertaining to the risk of harm. (5) In the face of great uncertainty as to the amounts of flushed pollutants being introduced into the marine environment and the effects they will have on marine organisms and ecosystems, a precautionary approach is necessary to ensure adequate protection. This Article advocates for policy reform to increase monitoring and regulation of pharmaceuticals, illicit drugs, and caffeine in wastewater, and to ultimately minimize the amounts of these flushed pollutants that are discharged into California's coastal waters. Part I provides an overview of the wastewater life cycle as a pathway for flushed pollutants to enter the marine environment. This is followed by a discussion of the effects that pharmaceuticals, illicit drugs, and caffeine may have on marine organisms. Part II discusses the current legal and regulatory landscape for managing pollutants in municipal wastewater and its inadequacies in preventing flushed pollutants from harming marine organisms and ecosystems. Part III proposes various legislative tools that can be used to address this issue and suggests topics for future research. II. THE WASTEWATER LIFE CYCLE--A PATHWAY TO THE OCEAN In addition to their contributions to tourism and the economy, coastal ecosystems offer unique recreational and educational opportunities, hold important cultural value, and provide a variety of ecosystem services. …

Sustainable Pharmacy: Piloting a Session on Pharmaceuticals, Climate Change, and Sustainability within a U.S. Pharmacy Curriculum.

Objective:To design and assess an innovative session for pharmacy students that addresses the role of pharmaceuticals with climate change and sustainability.Innovation:One hundred and sixteen third-year students at the University of California, San Francisco School of Pharmacy participated during their required Health Policy course. This 3-hour session included guided pre-course activities, an interactive lecture, a panel of healthcare professionals discussing complex decision-making and small group case-based learning. Curricular assessment was conducted through pre-/post-test measures of knowledge acquisition, student evaluations, and course projects.Critical Analysis:One hundred and two students (response rate 88%) completed the pre-test and 115 students (response rate 99%) completed the post-test assessment. We identified a significant increase in the proportion of correct answers on post-test questions addressing drug disposal legislation (75% pre-test vs 91% post-test, p=0.002) and the predicted effects of climate change on health (55% pre-test vs 90% post-test, p < 0.001). The session was also well received; average student evaluation scores were above 4 in all areas of course evaluation (where 5=ideal). In addition, 17% of student groups (relative to 0% in 2015) proposed a sustainability-related policy as their final coursework project.Next Steps:The development and implementation of this brief session resulted in knowledge gain and favorable student response. This project is feasible for other Schools of Pharmacy to adapt and implement.

A Multiyear Assessment of Public Response to a Statewide Drug Take-Back and Disposal Campaign, 2010 to 2012.

This study is the first to analyze public response to a drug take-back program, the American Medicine Chest Challenge, in a single state over a period of 3 years (2010-2012). The study utilized a three-wave repeated cross-sectional design and an annual phone survey conducted with a representative sample of adults ( N = 906 in 2010, N = 907 in 2011, and N = 906 in 2012), which assessed exposure to the campaign, drug disposal behaviors, possible mediators of campaign effects (risk appraisal, personal agency, normative influence, and interpersonal talk), and potential confounders. Logistic regression and causal mediation analysis were employed to estimate confounder-adjusted direct and mediated effects of the campaign. Results showed that the campaign reached a sizable portion (50% to 60%) of state adults and that campaign exposure was associated with increased likelihood of having conversations with others about this topic. About 55% of all adults in the state reported taking at least one of the actions recommended by the campaign, and campaign exposure was associated with increased likelihood of disposing of prescription drugs at a drug collection day event (adjusted odds ratio = 4) and of talking to a child about the risks associated with prescription drug abuse (adjusted odds ratio = 2). The causal mediation analysis demonstrated that the campaign influenced audiences by reinforcing their efficacy to safely dispose of prescription drugs, but also potentially by stimulating conversations among community members about this topic. Drug take-back campaigns can be an effective mechanism to decrease the availability of prescription drugs in communities.

Adsorption of pharmaceuticals in water through lignocellulosic fibers synergism

The contamination of water from disposal of drugs is an emerging problem due to their consequences on trophic webs. This study evaluated the ability of sugarcane and coconut fiber to reduce water toxicity contaminated by pharmaceuticals. The toxicity of solutions containing pharmaceuticals was studied by bioassay using Allium cepa, before and after filtration of contaminated water. The coconut and sugarcane fiber have not been satisfactory in reducing toxicity when tested separately. Despite no induction of chromosomal aberrations, our study found a reduction of the mitotic index. The mixture of fibers showed better results providing total reduction of toxicity, in addition to maintenance in the mitotic index and induction of chromosome aberrations. The interaction between fibers and drugs was confirmed by Thermogravimetry and Differential Thermal Analyses (TG/DTA) which presented differences in profile between the fibers before and after adsorption. The mixture of coconut and sugarcane proved viable for reduction of toxicity in contaminated water by a mixture of pharmaceuticals.

Variable Effects of Non-steroidal Anti-inflammatory Drugs (NSAIDs) on Selected Biochemical Processes Mediated by Soil Microorganisms.

Non-steroidal anti-inflammatory drugs (NSAIDs) are the most frequently used group of pharmaceuticals. The high consumption and the uncontrolled disposal of unused drugs into municipal waste or their deposit in landfills can result in an increased concentration of these compounds in soils. Moreover, these drugs can affect the microbial activity. However, there is a lack of knowledge about these effects or it is very limited. Therefore, the objective of this study was to compare the impact of selected commercially available NSAIDs, i.e., diclofenac (DCF), naproxen (NPX), ibuprofen (IBF) and ketoprofen (KTP), applied at concentrations of 1 and 10 mg/kg soil, on the activity of soil microorganisms during the 90-day experiment. To ascertain this impact, substrate-induced respiration (SIR), soil enzyme activities, i.e., dehydrogenase (DHA), acid and alkaline phosphatases (PHOS-H and PHOS-OH) and urease (URE) as well as changes in the rates of nitrification and ammonification processes were determined. In addition, the number of culturable bacteria and fungi were enumerated. In general, the obtained data showed a significant stimulatory effect of NSAIDs on the microbial activity. Higher concentrations of NSAIDs caused a greater effect, which was observed for SIR, PHOS-H, PHOS-OH, URE, N-NO3- and N-NH4+, even during the whole incubation period. Moreover, the number of heterotrophic bacteria and fungi increased significantly during the experiment, which was probably a consequence of the evolution of specific microorganisms that were capable of degrading NSAIDs and used them as an additional source of carbon and energy. However, an inhibitory effect of NPX, IBF or KTP for SIR, DHA, on both phosphatases and culturable bacteria and fungi was observed at the beginning of the experiment. At lower concentrations of NSAIDs, in turn, the effects were negligible or transient. In conclusion, the application of NSAIDs altered the biochemical and microbial activity of soil what may cause the disturbance in soil functioning. It is reasonable to assume that some components of the NSAID formulations could stimulate soil microorganisms, thus resulting in an increase in biochemical activities of the soil.

From dispensed to disposed: evaluating the effectiveness of disposal programs through a comparison with prescription drug monitoring program data

ABSTRACTBackground: Organized disposal of controlled medications, such as take-back events and permanent drug donation boxes, is a prevention strategy that has been widely used to reduce the availability of controlled medications for diversion or abuse. However, little is known as to whether this strategy actually reduces the overall availability of these medications for the purposes of diversion or abuse. Objectives: The objective of this study was to compare the number and types of controlled medications that were disposed through organized efforts to the number dispensed in local communities. Methods: The quantity and type of controlled medication collected from three take-back events and permanent drug donation boxes over 4-week-long periods in five counties in south-central Kentucky was measured and compared to the number of controlled medications dispensed, as reported by Kentucky All Schedule Prescription Electronic Reporting system. Results: In 2013, 21,121,658 controlled medications units were dispensed in the participating counties. Of those, 46.9% were opioid analgesics, 13.1% tranquilizers, and 37.3% “other.” During the assessment periods, a total of 21,503 controlled medication units were collected. Of those, 39.9% were opioid analgesics, 2.7% tranquilizers, and 57.4% “other.” Annually, controlled medications disposed were estimated to account for 0.3% of those dispensed. Conclusion: Controlled medications collected by take-back events and permanent drug donation boxes constituted a miniscule proportion of the numbers dispensed. Our findings suggest that organized drug disposal efforts may have a minimal impact on reducing the availability of unused controlled medications at a community level.

Unused opioid analgesics and drug disposal following outpatient dental surgery: A randomized controlled trial

BackgroundIndividuals who abuse prescription opioids often use leftover pills that were prescribed for friends or family members. Dental surgery has been identified as a common source of opioid prescriptions. We measured rates of used and unused opioids after dental surgery for a pilot program to promote safe drug disposal. Methods: We conducted a randomized controlled trial of opioid use patterns among patients undergoing surgical tooth extraction at a university-affiliated oral surgery practice. The primary objective was to describe opioid prescribing and consumption patterns, with the number of unused opioid pills remaining on postoperative day 21 serving as the primary outcome. The secondary aim was to measure the effect of a behavioral intervention (informing patients of a pharmacy-based opioid disposal program) on the proportion of patients who disposed or reported intent to dispose of unused opioids. (NCT02814305) Results: We enrolled 79 patients, of whom 72 filled opioid prescriptions. On average, patients received 28 opioid pills and had 15 pills (54%) left over, for a total of 1010 unused pills among the cohort. The behavioral intervention was associated with a 22% absolute increase in the proportion of patients who disposed or reported intent to dispose of unused opioids (Fisher’s exact p=0.11). Conclusion: Fifty-four percent of opioids prescribed in this pilot study were not used. The pharmacy-based drug disposal intervention showed a robust effect size but did not achieve statistical significance. Dentists and oral surgeons could potentially reduce opioid diversion by moderately reducing the quantity of opioid analgesics prescribed after surgery.

Investigating dynamic sources of pharmaceuticals: Demographic and seasonal use are more important than down-the-drain disposal in wastewater effluent in a University City setting

Pharmaceutical pollution in surface waters poses risks to human and ecosystem health. Wastewater treatment facilities are primary sources of pharmaceutical pollutants, but little is known about the factors that affect drugs entering the wastewater stream. This paper investigates the effects of student pharmaceutical use and disposal behaviors and an annual demographic shift on pharmaceutical pollution in a university town. We sampled wastewater effluent during a ten-day annual spring student move-out period at the University of Vermont. We then interpreted these data in light of survey results that investigated pharmaceutical purchasing, use, and disposal practices among the university student population. Surveys indicated that the majority of student respondents purchased pharmaceuticals in the previous year. Many students reported having leftover drugs, though only a small portion disposed of them, mainly in the trash.We detected 51 pharmaceuticals in 80% or more of the wastewater effluent samples collected over the ten-day sampling period. Several increased in concentration after students left the area. Concentrations of caffeine and nicotine decreased weakly. Drug disposal among this university student population does not appear to be a major source of pharmaceuticals in wastewater. Increases in pharmaceutical concentration after the students left campus can be tied to an increase in the seasonal use of allergy medications directly related to pollen, as well as a demographic shift to a year-round older population, which supports national data that older people use larger volumes and different types of pharmaceuticals than the younger student population.

Opioid control law in Vermont addresses provider status for pharmacists

Vermont Governor Peter Shumlin on June 8 signed legislation that both tackles the state’s opioid abuse problem and indirectly confers healthcare provider status on pharmacists in the state. Opioid-related provisions in the law, formerly known as Vermont Senate Bill 243 (S.243), include mandated use of the Vermont Prescription Monitoring System (VPMS) by prescribers; the creation, by January 1, 2017, of a statewide program for the disposal of unused prescription drugs; and an informed consent process for patients treated with an opioid. The law also directs the state health department to consult with the Vermont Board of Pharmacy to examine and report to the legislature about the role of pharmacies in preventing opioid misuse, abuse, and diversion. “There’s a lot going on in the state in this area,” said Wesley McMillian, pharmacy clinical manager for the University of Vermont Medical Center (UVMC) in Burlington and immediate past president of the Vermont Society of Health-System Pharmacists (VtSHP).

The American Medicine Chest Challenge: Evaluation of a Drug Take-Back and Disposal Campaign.

Prescription drug take-back programs provide a safe and convenient way to dispose of expired, unwanted, or unused medications that people store in homes, thus limiting the potential misuse of prescription drugs. This study evaluated public response to a social marketing campaign promoting a community-based drug take-back program, the American Medicine Chest Challenge. A telephone survey was conducted with a representative sample of adults in New Jersey (N = 906) 2 weeks following the conclusion of the statewide collection day event in November 2010. The survey assessed public exposure to the campaign and the extent to which it is associated with public perceptions and behaviors the campaign was designed to influence. The campaign, which relied heavily on community channels for the dissemination of messages, was able to reach directly more than 60% of its target audience. When potential confounders were controlled for, campaign exposure was a strong predictor of a respondent having one or more conversations with others about medicine disposal (odds ratio [OR] = 2.4, 95% CI [1.5, 3.6]); actually disposing of expired, unwanted, or unused medicine in a collection site (OR = 2.14, 95% CI [1.15, 3.9]); and talking to kids about the dangers of prescription drug abuse (OR = 1.65, 95% CI [1.1, 2.45])-all of which were exclusively promoted through the campaign. This case illustrates the potential efficacy of community-based prevention marketing efforts to stimulate community discourse regarding the dangers of prescription drug misuse and to decrease the availability of expired, unwanted, or unused medicine in the community.

Markers of anthropogenic contamination: A validated method for quantification of pharmaceuticals, illicit drug metabolites, perfluorinated compounds, and plasticisers in sewage treatment effluent and rain runoff

An effective, specific and accurate method is presented for the quantification of 13 markers of anthropogenic contaminants in water using solid phase extraction (SPE) followed by high performance liquid chromatography (HPLC) tandem mass spectrometry (MS/MS). Validation was conducted according to the International Conference on Harmonisation (ICH) guidelines. Method recoveries ranged from 77 to 114% and limits of quantification between 0.75 and 4.91 ng/L. A study was undertaken to quantify the concentrations and loadings of the selected contaminants in 6 sewage treatment works (STW) effluent discharges as well as concentrations in 5 rain-driven street runoffs and field drainages. Detection frequencies in STW effluent ranged from 25% (ethinylestradiol) to 100% (benzoylecgonine, bisphenol-A (BPA), bisphenol-S (BPS) and diclofenac). Average concentrations of detected compounds in STW effluents ranged from 3.62 ng/L (ethinylestradiol) to 210 ng/L (BPA). Levels of perfluorinated compounds (PFCs) perfluorooctanoic acid (PFOA) and perfluorononanoic acid (PFNA) as well as the plasticiser BPA were found in street runoff at maximum levels of 1160 ng/L, 647 ng/L and 2405 ng/L respectively (8.52, 3.09 and 2.7 times more concentrated than maximum levels in STW effluents respectively). Rain-driven street runoff may have an effect on levels of PFCs and plasticisers in receiving rivers and should be further investigated. Together, this method with the 13 selected contaminants enables the quantification of various markers of anthropogenic pollutants: inter alia pharmaceuticals, illicit drugs and their metabolites from humans and improper disposal of drugs, while the plasticisers and perfluorinated compounds may also indicate contamination from industrial and transport activity (street runoff).

Assessment of the storage and disposal of medicines in some homes in Jos north local government area of Plateau State, Nigeria

Purpose : The purpose of this study was to assess the way medicines are stored and disposed in some households in Jos North Local Government Area (LGA) of Plateau State, Nigeria. Methods : A cross-sectional survey of 130 households in Jos was carried out using a questionnaire to ascertain practices associated with medicine storage and their disposal. Results : The results showed that 105 (80.8%) households had 635 medicines in their homes, 65.8% of which were unused medicines (3.2 unused medicines per household). Some households stored their medicines in bags/containers (76.2%) while others kept them in cup-boards/cabinets (21.96%), refrigerators (10.5%) or other places (3.3%). Methods for disposal of unused drugs varied among households with some disposing them in trash cans (70.5%) while other disposed them in toilets (19.0%) or burnt them (10.5%). Only 10.5% (n=11) of respondents knew how medicines were properly disposed. Conclusion : While most households store their medicines appropriately, majority of them adopt poor disposal methods for medicines they no longer need in their homes. Public health education on problem disposal of medicines is of the essence. Keywords : Jos North Households, Medicines, Storage, Disposal.

Proper Disposal of Unused Household Medications: The Role of the Pharmacist.

As the number of unused household medications within the United States continues to rise, so does the need for proper education among patients and health care professionals on proper drug disposal. Consumers have been provided conflicting directions on how to properly dispose of medications; as a result, harmful and unsafe disposal practices have been used that increased the risk for diversion and environmental damage. Recently, several governmental agencies have published recommendations for household medication disposal, and the number of national and statewide drug take-back programs has increased. Although these programs now have taken hold, consumers are often unaware of their presence or benefit. Pharmacists have a unique opportunity to educate the public and themselves on the importance of proper medication disposal as well as the programs available for patients to access.

Validated multi-drug determination using liquid chromatography with tandem mass spectrometry for the evaluation of a commercial drug disposal product

Currently, there are limited effective means of drug disposal for consumers, and this creates a gateway to illicit use and environmental contamination. Here, we evaluated the efficacy of a new drug disposal product, composed from a slurry of activated carbon, which claims to sequester up to 100% of a drug's active ingredient when the loading capacity is not exceeded, making it safe to dispose in landfill. High-performance liquid chromatography with tandem mass spectrometry was applied to quantify as many as 24 drugs (opiates, barbiturates, statins, amphetamine, and benzodiazepine drugs) in the residual solvent solution from the product. Calibration curves were established in the concentration ranges of 0.25-7.0 μg/mL and showed good linearity. The limits of detection varied from 0.001 to 0.02 μg/mL, depending on the drug. Accuracy ranged from 80 to 111% for quality control samples, with a few minor exceptions. Precision overall varied between 0.2 to 12.7%. In sample bottles tested, where active ingredient of the loaded drug was below the maximum sorption capacity stated on the label, 98 to >99.9% of the active ingredient was sequestered. Percent active ingredient adsorbed was slightly lower in bottles loaded in excess of label specifications.

New Framework To Diagnose the Direct Disposal of Prescribed Drugs in Wastewater - A Case Study of the Antidepressant Fluoxetine.

Intentional or accidental release (direct disposal) of high loads of unused pharmaceuticals into wastewater can go unnoticed. Here, direct disposal of a pharmaceutical drug via the sewer network was identified for the first time using wastewater analysis. An irregularly high load of the antidepressant fluoxetine in raw wastewater (10.5 ± 2.4 g d(-1)) was up to 11 times greater than any other day. National prescription data revealed a predicted daily fluoxetine load for the studied treatment works to be 0.4-1.6 g d(-1). Enantio-selective analysis showed the high load of fluoxetine was present as a racemic mixture, which is typical for fluoxetine in dispensed formulations. As fluoxetine undergoes stereoselective metabolism within the body, a racemic mixture in wastewater suggests a nonconsumed drug was the major contributor of the high load. This was confirmed by its major metabolite norfluoxetine whose load did not increase on this day. Considering the most commonly prescribed formulation of fluoxetine, this increased load accounts for the disposal of ∼915 capsules. Furthermore, as fluoxetine is prescribed as one capsule per day, disposal is unlikely to be at the patient level. It is postulated that direct disposal was from a facility which handles larger quantities of the drug (e.g., a pharmacy).

Investigating the disposal of expired and unused medication in Riyadh, Saudi Arabia: a cross-sectional study.

Background Improper disposal of medication has several possible consequences such as childhood poisoning, environmental pollution, a negative impact on wildlife, and antibiotic resistance. The number of studies conducted to characterize pharmaceutical disposal practices is limited, particularly in the Middle East. Objective The aim of this cross-sectional study was to examine the behaviour of individuals with respect to the disposal of expired and unused medications. Furthermore, we aimed to identify the best methods of education regarding appropriate, safe disposal of medication. Setting The study was carried out in King Khalid University Hospital (KKUH), and King Saud University (KSU), during a 3-month period from February 2015 to April 2015. Method Twelve hundred patients were randomly selected from KKUH and KSU. Participants were invited to complete paper-based questionnaire with self enumeration. Pilot testing was conducted and involved 50 randomly selected participants. Main outcome measures The proportion of expired medications present in the home and their therapeutic groups, disposal methods of expired and unused medications, and preferred educational methods regarding safe and proper disposing of medications. Results A substantial proportion (79.15%) of respondents disposed of unwanted medication via household waste, while a small proportion (1.70%) returned unwanted medication to a pharmacy. Although currently practised disposal methods are undoubtedly unsuitable, 70.20% of respondents considered finding appropriate, safe methods via which to dispose of unwanted medication their responsibility, and 78.6% expressed an interest in receiving information concerning the correct disposal of unwanted medication. Conclusion We have demonstrated that a low percentage of respondents have ever received information regarding correct medication disposal. Moreover, the results have shown that over half of the respondents store antibiotics in their households. Additionally, respondents weren't aware of the consequences of keeping expired medication at home. It is quite clear that the awareness of proper and safe drug disposal among the Saudi population is quite low making it a priority of concerned authorities to implement educational programs.

In response: Government perspective.

In response: Government perspective.