DOI: http://dx.doi.org/10.18203/2319-2003.ijbcp20184863

A study of knowledge and practice for disposal of unused and expired pharmaceuticals among medical undergraduates at tertiary care teaching hospitals in Uttar Pradesh, India

Meenakshi Jindal, Raj Kumar Goel

Abstract


Background: Increasing disease incidence and prevalence necessitate healthcare practitioners to prescribe diverse medications. Families and patients are in possession of unused or expired medications and its risks have started gaining notice across the world. Majority of them including medical students are unaware about the disposal of unused or expired medicines. Misuse and improper disposal of unused/expired medications is a major safety and environmental concern, and thus proper disposal of those medications is highly important.

Methods: Questionnaire based study was conducted among medical undergraduates of third year MBBS in two tertiary care teaching hospitals of Uttar Pradesh after approval from Institutional Ethical Committees during July-August 2018.

Results: There were 65% of respondent had unused drugs in their home while 30% had the expired drugs. The most common reason for the unused and expiry drugs in the home was self-discontinuation. Analgesics were the main group of drugs possessed by participants. 67% in this study responded that drug disposal method was disposing the expired drugs to garbage. Only 26% know about the area in the city where unused/expired drugs are collected. 46% think that proper education of the community is required for appropriate disposal of unused drugs.

Conclusions: Intervention by education about prudent drug disposal techniques that are also environmentally safe and acceptable is the need of time to change their behavior. There is also needing to understand the practice and awareness of the public to make any such education by program a success.


Keywords


Analgesic, Drug disposal, Expired drugs, Unused drugs, Yellow bags

Full Text:

PDF

References


Seehusen DA, Edwards J. Patient practices and beliefs concerning disposal of medications. J Am Board Fam Med. 2006;19(6):542-7.

Ruhoy IS, Daughton CG. Beyond the medicine cabinet: an analysis of where and why medications accumulate. Environ Int. 2008;34(8):1157-69.

WHO. Challenges in expanding access to essential medicines; 2004. 2014. Available at: http://apps.who.int/medicinedocs/en/d/Js5571e/2.html. Accessed 30 June 2016.

WHO. The world medicines situation. 2004. Available at: http://apps.who.int/ medicinedocs/pdf/s6160e/s6160e.pdf Accessed 30 June 2016.

Ananth AP, Prashanthini V, Visvanathan C. Healthcare waste management in Asia. Waste Manag. 2010;30(1):154-61.

Wang J, Hu X. Ecopharmacovigilance: Current state, challenges, and opportunities in China. Indian J Pharmacol. 2014;46:13-7.

Srivastava B, Sinha AK, Gaur S, Gaur S, Palaria U. Ecopharmacovigilance: Its importance and challenges. J Biomed and Pharmaceutical Res. 2014;3:81-7.

Oaks JL, Gilbert M, Virani MZ, Watson RT, Meteyer CU, Rideout BA, et al. Diclofenac residues as the cause of vulture population decline in Pakistan. Nature. 2004;427:630-3.

Kvarnryda M, Grabicb R, Brandta I, Berg C. Early life progestin exposure causes arrested oocyte development, oviductal agenesis and sterility in adult Xenopus tropicalis frogs. Aquat Toxicol. 2011;103:18-24.

Comeau F, Surette C, Brun GL, Losier R. The occurrence of acidic drugs and caffeine in sewage effluents and receiving waters from three coastal watersheds in Atlantic Canada. Sci Total Environ. 2008;396:132‑46.

Zeilinger J, Steger‑Hartmann T, Maser E, Goller S, Vonk R, Länge R. Effects of synthetic gestagens on fish reproduction. Environ Toxicol Chem. 2009;28:2663‑70.

Ekedahl AB. Reasons why medicines are returned to Swedish pharmacies unused. Pharm World Sci. 2006;28:352‑8.

Lindberg MJ, Andersen SE, Christensen HR, Kampmann JP. Compliance to drug prescriptions. Ugeskr Laeger. 2008;170:1912‑6.

Medhi B and Sewal RK. Ecopharmacovigilance: An issue urgently to be addressed. Indian J Pharmacol. 2012; 44(5): 547–549.

BIO Intelligence Service. Study on the environmental risks of medicinal products, Final Report prepared for Executive Agency for Health and Consumers; 2013. Available at: ec.europa.eu/health/files/environment/study_environment.pdf, accessed on Oct 12, 2014.

Velo G, Moretti U. Ecopharmacovigilance for better health. Drug Saf. 2010;33:963- 8.

Frimpter GW, Timpanelli AE, Eisenmenger WJ, Stein HS, Ehrlich LI. Reversible Faconi syndrome caused by degraded tetracycline. JAMA. 1963;184:111‑3.

Oaks JL, Gilbert M, Virani MZ, Watson RT, Meteyer CU, Rideout BA, et al. Diclofenac residues as the cause of vulture population decline in Pakistan. Nature. 2004;427(6975):630-3.

Costanzo SD, Murby J, Bates J. Ecosystem response to antibiotics entering the aquatic environment. Mar Pollut Bull. 2005;51(1):218-23.

Wu M, Atchley D, Greer L, Janssen S, Rosenberg D, Sass J. Dosed without prescription: preventing pharmaceutical contamination of our nation’s drinking water. Natural Resources Defense Council White Pape;. 2009:1-60.

Holm G, Snape JR, Murray-Smith R, Talbot J, Taylor D, Sorme P. Implementing ecopharmacovigilance in practice: Challenges and potential opportunities. Drug Saf. 2013;36:533-46.

Bound JP, Voulvoulis N. Household disposal of pharmaceuticals as a pathway for aquatic contamination in the United Kingdom. Environ Health Perspect. 2005;113:1705‑11.

Aditya S. Safe medication disposal: Need to sensitize undergraduate students. Int J Pharm Life Sci. 2013;4:2475‑80.

Prüss A, Giroult E, Rushbrook P. Safe management of wastes from healthcare activities: World Health Organization; 1999.

Braund R, Peake BM, Shieffelbien L. Disposal practices for unused medications in New Zealand. Environ Int. 2009;35(6):952-5.

Gagnon E. Pharmaceutical disposal programs for the public: A Canadian perspective. Ottawa, Ontario: Health Canada, Environmental Impact Initiative; 2009.

Sirisha A, Janardhan M, Sree PK, Rao YV, Raikar SR, Patil S, et al. Knowledge, attitude and practice on safe disposal of medicines among medical and dental undergraduates. J Basic Clin Res. 2016;3(1):5-9.

Shivaraju PT, Gangadhar M. 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. Natl J Physiol Pharm Pharmacol. 2017;7(11):1268-73.

Maharana SP, Paul B, Dasgupta A, Garg S. Storage, reuse, and disposal of unused medications: A cross-sectional study among rural households of Singur, West Bengal. Int J Med Sci Public Health. 2017;6(7):1185-9.

Osei-Djarbeng SN, Larbi GO, Abdul-Rahman R, Osei-Asante S, Owusu-Antwi R. Household acquisition of medicines and disposal of expired and unused medicines at two suburbs (Bohyen and Kaase) in Kumasi-Ghana. Pharm Innov J. 2015;4(8):85-8.

Ahmed A, Mushtaq N, Tariq M, Durrani M, Akhtar S, Arif M, et al. Disposal practices of unused and expired pharmaceuticals in Karachi and their impact on health and environment. JUMDC. 2013;2007(4):2.

Swaroop HS, Chakraborty A, Virupakshaiah A. Knowledge, attitude and practice of medical professionals towards the safe disposal of unused medications in south India. World J Pharm Pharm Sci. 2015;4(5):1423-30.

Lagishetty R, Nagarajan P, Vijayanandhan SS. Practice towards disposal of medicines (left out/expired drugs) among the patients visiting tertiary care teaching hospital and primary health centre in south India. Asian J Biochem Pharm Res. 2013;1(4):175-82.

Expired Medications. Available at: http://www.emedexpert. com/tips/expired‑meds. html. [Last accessed 2015 Nov 25; Last updated on 2105 Dec 24].