Medication Waste Disposal

1. Introduction

2. Common Sources of Medication Waste

3. Official Recommendations

4. Programmes implemented in others countries

5. Suggestions

- Management

- Pharmacists' Role

Medication Waste Disposal

Outline

Group 8

Medication Waste Disposal

1. Introduction

2. Common Sources of Medication Waste

3. Official Recommendations

4. Programmes implemented in others countries

5. Suggestions

- Management

- Pharmacists' Role

Kwan Him Shek

Kwok Tsz Ying

Lee King Pan

Outline

Kong Kit Tung

Kwok Ching Yan

Lam Hin Tung Cheryl

Ng Yee Wa

Thank You

Suggestions

1. Introduction

2. Common Sources of Medication Waste

3. Official Recommendations

4. Programmes implemented in others countries

5. Suggestions

- Management

- Pharmacists' Role

(I) Management

Official

Recommendations

Outline

References

Recycling Medication Programme

1. Introduction

2. Common Sources of Medication Waste

3. Official Recommendations

4. Programmes implemented in others countries

5. Suggestions

- Management

- Pharmacists' Role

Example: US - Iowa Prescription Drug Corporation

Introduction

Barriers for Patients

1. Raise Awareness

• Illiteracy

• Safe management of waste from health care activities: http://apps.who.int/iris/bitstream/10665/85349/1/9789241548564_eng.pdf
• Leung, H. W. (2012). Occurrence, fate and risk assessment of human and veterinary pharmaceuticals in Hong Kong sewage treatment plants, surface water and fish and in Chinese tap water.
• Hospital Authority Head Office: Guidelines on the reuse of returned drugs (HAHO-COC-GL-PHA-001-v02) (CPO Ref: CPO-007), Guidelines on management of pharmaceutical chemical wastes (HAHO-COC-GL-PHA-009-v02) (CPO Ref: CPO-010)
• Code of Practice For Clinics Registered Under The Medical Clinics Ordinance (Cap. 343)
• Hospital Authority Head Office: Guidelines on maintenance of dangerous drugs register and handling and disposal of unserviceable dangerous drugs (HAHO-COC-GL-PHA-007-v03) (CPO Ref: CPO-002)
• Deadiversion.usdoj.gov, (2014). Drug Disposal Information - National Take-Back Initiative. [online] Derived from http://www.deadiversion.usdoj.gov/drug_disposal/takeback/
• Awarerx.org, (2014). Option 2: DEA Nationwide Drug Take-Back Sites - Find Disposal Information - Get Informed - AWARxE. [online] Derived from: http://www.awarerx.org/get-informed/find-disposal-information/option-2-dea-nationwide-drug-take-back-sites
• Fda.gov, (2014). How to Dispose of Unused Medicines. [online] Derived from http://www.fda.gov/forconsumers/consumerupdates/ucm101653.htm#guidelines
• Info.gov.hk, (2014). LCQ8: Clinical waste. [online] Derived from http://www.info.gov.hk/gia/general/201306/19/P201306190393.htm

• Recycle drugs
• Unit-dosed medications sealed in original package
• Drugs samples
• Under continuous control of medical profession
• Examined by a pharmacist before giving out to patients who are uninsured/ underinsured/ in poverty

• In differential disposal methods of medication
• In the importance of the proper disposal methods

Official Recommendations-

Hong Kong

• Respective in-patient and general public education
• Provide guidance on proper disposal of medications
• Potential environmental impacts
• Example: The Minnesota SMARxT DISPOSAL campaign
• Giving presentations and

having booth in different

programmes to empower

the public

• Lack of means

Handling medication waste in hospitals

• Related programmes/ education

Definition

• Inconvenience

Recycle Medication Wastes if...

What is "medication waste"?

Dispose if otherwise...

• Not encourage or even reject the return of out-patient drugs

• Complete blisters with satisfactory packaging and contents

• Kept under proper storage

• Not expired

• Call Chemical Waste Collector (private institutes) to collect the wastes

• Heavier workload
• Higher cost for disposal

• For Ward Return in less

busy hospitals

• Pharmaceutical Waste
• Expired, unused, split, and contaminated pharmaceutical products (drugs, vaccines, and sera, etc.) that are no longer required and need to be disposed of appropriately
• Discarded items used in the handling of pharmaceuticals (bottles/ boxes with residues, gloves, masks, connecting tubing, drug vials, etc.)

2. List Special Disposal

Requirements on

Online Databases

Hospital Authority Head Office:

Guidelines on the reuse of returned drugs (HAHO-COC-GL-PHA-001-v02) (CPO Ref: CPO-007)

Guidelines on management of pharmaceutical chemical wastes (HAHO-COC-GL-PHA-009-v02) (CPO Ref: CPO-010)

Reduction of Waste

• Sorted with registration numbers/ product/ generic names
• Similar online database: DailyMed

Disadvantage: High cost

1. Stock Management

Safe management of waste from health care activities: http://apps.who.int/iris/bitstream/10665/85349/1/9789241548564_eng.pdf

single-dose vials

Unserviceable / Expired Medicines

• Use the oldest batch first
• Use multi-dose vials
• Prevent over-stocking
• Order drugs dynamically according to turnover rates
• Frequent order relative small quantities (esp. for unstable products)
• Share stock with other hospitals

4. Medication Review

Consequences

2. Out-patient

• Ensure proper choice of drugs
• Increase monitoring of patient adherence and outcomes esp. antibiotics
• Encourage them to bring back their drugs and talk to their physician when they have follow-up consultation
• Increase vigilance for polypharmacy

B. Part II Non-

Poisons

A. Part I Poisons

& Antibiotics

Dangerous Drugs

Apply to EPD for disposal

(Form EPD-132)

2. In-patient

3. Dispensing

What are the influences of inappropriate disposal

of medication waste?

• Shorter refill period
• Patient’s own drugs policy
• Manage ward stock wisely

Pharmacy level

Contact Department of Health

• Trial scripts
• First prescription for a shorter duration of treatment esp. for medications with high rates of discontinuation (e.g. high incidence of side effects)

Make a list of all would–be-disposed medicines with classifications

( Part A or Part B, solid or liquid* or aerosol preparations)

EPD issues direction

for disposal

(Form EPD-131)

• Over-stocking

3. Include Simple Disposal

Instructions on the Labels

Environment

Take-Back Programme

Human

Disadvantage: Messy label

Patient level

Contact authorized chemical waste collector and obtain container(s) from it

4. Adopt “Reverse Distribution”

(accidental ingestion)

• Poisoning of humans

and pet

• Drug diversion
• Waste of resources

• Return drugs to collection sites
• Safe, convenient, responsible means of drugs disposal
• Identify medication problems (e.g drug non-compliance)
• Educate the general public

• Environmental pollution

(Land/ Water

contamination)

• Development of resistance to antibacterial

Contact the engaged collector for collection**

• Overlapping medications upon discharge
• PRN
• Change in therapy as prescribed by physicians
• Patient non-adherence
• Polypharmacy

• Return unused but potentially usable pharmaceuticals to manufacturer

Disadvantage: Potentially increases cost of manufacturer, lack of initiatives

Similar Programme: Mail-back Programme

* Liquid preparations less than 50 mL are treated as solid waste

**Except Fridays, collection would normally be arranged within 72 hours

Obtain “trip ticket” from the collector and retain it for future reference

Management of Waste Disposal

Example 2: Taiwan

1. Public Education

Example 1:

The National Prescription Drug Take-Back Day (US)

Current Situation

Disposal of dangerous drug

Safety manual for disposing cytotoxic drug

• Thousands of DEA (Drug Enforcement Administration)-coordinated collection sites will be available

• Equip patients with the proper disposal methods
• Encourage participation in take-back programmes in community pharmacies
• Encourage patients to take back their drugs on hand when they have the follow-up consultation

• Collection sites set by the government (e.g. different community pharmacies)
• Locations pinned on google map

*Citizens can know the nearest sites easier

How many medication wastes are produced in Hong Kong?

5. Take-back Programme

• Pharmaceutical Division of the Department of Health
• The supplying pharmaceutical company
• The Environmental Protection Department licensed chemical wastes collectors

Keeping record of the documents of disposal!(Form 278, record every single tablet)

Quantity of medication waste disposed of by

Hong Kong medical and healthcare institutions (tonnes)

• Specialised training, wearing protective clothing
• Do not dispose in drains or toilets
• Leak-proof, puncture-proof 'Sharps' box
• Thick polyethylene sealable bag
• Distinctive warning label
• Incineration

2. Categorization

2011

2008

2010

2012

2009

Disposal Facility

• Correctly categorize and dispose of out-patient returned medication wastes

• Hong Kong Academy of Pharmacy
• One-month take- back programme
• Community pharmacies and voluntary pharmacists were invited
• Hotlines set up for enquiry

Code of Practice For Clinics Registered Under The Medical Clinics Ordinance (Cap. 343)

Hospital Authority Head Office:

Guidelines on maintenance of dangerous drugs register and handling and disposal of unserviceable dangerous drugs (HAHO-COC-GL-PHA-007-v03) (CPO Ref: CPO-002)

73.0

59.2

37.6

73.0

40.5

Chemical Waste Treatment Centre

HKEC OSH Manual

Problems:

1.0

3.0

1.9

3.5

3.3

Landfill

• Lack of advertisement
• Lack of government support and promotion
• Extra space needed for storage of recycled drugs
• Pharmacists’ workload increased

> Motivation to participate decreased

> Ineffective

Hospital Setting

Government Participation >> Very important!

Data from the Department of Environment Protection

1. In-patient

What are the pollutions done by medication waste in Hong Kong?

Hong Kong

surface water

Hong Kong Sewage Treatment Plants(STP)

Suggestions

• 31 pharmaceuticals were detected
• Some drugs residues

>1.2 folds than global data

Instructions to Patients to Dispose of Medication

• Predominating wastes :
• Caffeine, salicylic acid, beta-blocker and antibiotics
• ~80% of residues cannot be attenuated effectively
• ~191kg pharmaceuticals loading into Victoria Harbour every day

Official Recommendations- Overseas

• Over-stocking
• Over-prescribing
• Disposal from ward-return
• Change in therapy as prescribed by physicians
• Death
• Late notification of home leave periods to pharmacy department
• Dispensing errors

(II) Pharmacists'

Role

Federal guidelines, US

Programmes Implemented in Other Countries

Leung, H. W. (2012). Occurrence, fate and risk assessment of human and veterinary pharmaceuticals in Hong Kong sewage treatment plants, surface water and fish and in Chinese tap water.

Step 1

• Follow any specific disposal instructions on the prescription drug labeling or patient information
• Do not flush medicines down the sink or toilet
• Take advantage of community drug take-back programmes
• National Prescription Drug Take-Back Days

Step 2

Public Awareness of Proper Disposal of Medication Waste in Hong Kong

Scratch out all information on the prescription label

Mix medicines with an

unpalatable substance

(e.g.kitty litter/ used coffee grounds)

Weak!

**Do NOT crush

tablets/ capsules

Common way of disposal: Garbage

Outline

Step 3

Place the mixture

in a container

(e.g. sealed plastic bag)

Step 4

Throw the container in household trash

1. Introduction

2. Common Sources of Medication Waste

3. Official Recommendations

4. Programmes implemented in others countries

5. Suggestions

- Management

- Pharmacists' Role

Common Sources

of Medication Waste

Outline