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Drug Disposal Awareness Program (DDAP) Under Foundation for Health and Environment Research

 

Clinical courses

The medicines used for common ailments are stored by many household for medical emergency use. Many times these medicines expire despite being stored under prescribed conditions. It is important to dispose these medicines that are date expired and unused in an appropriate manner. The guidelines for disposal for medicines are prescribed by World Health Organization (WHO) and United States Food and Drugs Administration (USFDA). Some of the methods suggested to dispose date expired and unused medicines include returning to manufacturer, landfill, and waste immobilization: encapsulation/ inertization, flushing it down the Sewer and incineration.

Despite precautions associated with these methods, these methods are not effective. FHER DDAP surveys have shown that  these methods sometime pose s a risk not only to human beings by increasing  chances of taking wrong medications, accidental poisoning, adverse drug  reactions, drug-drug interactions that increases health burden but also to  the environment.

In India, the knowledge regarding disposal of date expired and unused medicines is lacking among common people in society. A conceptual framework to dispose date expired and unused medicine is devised.

Irrespective of whether expired medicines have desired potency or not, they are toxic or not, it is legally and ethically not favorable to use them in clinical practice. But very often reports are on the contrary. The expired medicines get recycled with a new label showing fresh manufacturing and expiry date. The non-faithful mastermind of business of supply of expired medicines with a fresh label in India. While the expired medicines may not cause a serious health hazard to the public or to the environment, their improper disposal could be serious. Pilfering from a stockpile of waste drugs may result in expired drugs being diverted to the market for resale and misuse as incident described above. Expired medicines may come into the hands of scavengers and children if a landfill is insecure.


DDAP explroes Some of the issues relating to the inappropriate disposal of expired medicines are:
Possibility of contaminating drinking water source or supply from the disposal place the leachate may get access to the water supply system.
• Disposal of non-biodegradable antibiotics, anti-neoplastics and disinfectants into the sewage system may kill bacteria necessary for treatment of sewage. Flushing of anti-neoplastics into water resource may damage aquatic life or contaminate drinking water.
• Discharge of large amount of undiluted disinfectants into the sewage system or water resources may too cause similar situation.
• Burning of the expired medicines at low temperature or in open containers results in release of toxic pollutants to the air. Ideally this should be avoided.
• Inefficient and insecure disposal may lead to recycling of the expired medicines.

This is true especially when they are disposed in original containers. Before disposal, the expired medicines are required to be sorted out to different categories that require different disposal method or based on dosage forms. Based on dosage forms they may be classified into three basic categories: Solids, semi solids and powders; liquids and aerosols canisters. However, the special care is required for disposal of the controlled substances like narcotics and psychotropic substances; anti-infective drugs; anti-neoplastics; antiseptics and disinfectants etc.


Note: The procedure must be in place for safe disposal of expired medicines. In retail practice, when it is not feasible to return the expired medicines to the supplier, they should be separately stored in cupboard or shelf or any other designated area with adequate marking “expired good – not for sale”.  Most expired medicines become less efficacious and few may be toxic, but the defective disposal of them poses serious threat to the public health. Standard operating procedures for good disposal practice of expired medicines may be developed and made available to the all concerned starting from retailers to manufacturers, and the regulating authorities.

DDAP CONCLUSION
Pharmacies interested in program would be identified wherein patients visiting these pharmacies would be asked to register with pharmacy and return the unused/date expired medicines to participating pharmacies. The unused and date expired medicines collected in pharmacies shall be segregated into various types by participating volunteers. The segregation would include various dosage forms and packing material. The recovered contents will be sent to a specialist company that uses specific procedures in order to recycle the collect reusable components and safely dispose of chemical components based on prescribed procedures. The reusable components shall be collected and property treated for reuse. This concept would not only sensitize people but also community pharmacists and would be advantageous to protection of environment.

DDAP REQUEST & NEED:
FHER Drug Disposal Awareness Program (DDAP) bring to your kind notice that the improper disposal of drugs creates a vicious chain of events. The sequence of events that it follows is very scary and needs immediate attention. An unused, lethal drug which is improperly disposed reaches either to soil or contaminates the water; from there it enters the food chain via agricultural products or drinking water; finally leading to bio-magnification in not only aquatic animals and wildlife but in humans too; thereby leading to serious health problems. No one can deny the fact that most of the pathogenic bacteria have become resistant to the market available antibiotics and the situation will only grow more worrisome in future.
With this aim Our Mentor Mr. Sacheen Gandhi Ji & Dr. Sidharth Mehan actively involved in this drug disposal awareness program (DDAP) from last five years for the better health and environment services in our Indian society and suggests:
1. To provide proper law and system for the systematically disposal of expiry medicines
2. To provide sealed boxes as well as community centre or chemist shops for effectively collection of expired medicines weekly or monthly for further disposal processing
3. To conduct regular awareness camps in societies regarding danger of expiry medicines on our health and environment.

Initiated by
Mr. Sacheen Gandhi, Co-Founder-FHER, Chief Patron-DDAP, India.
Dr. Sidharth Mehan, Founder President-FHER, Professor, ISFCP, Moga, Punjab, India

Special Thanks To
Dr. (Mrs.) Vimal Rarh, Coordinator, National Resource Centre of Chemistry, MHRD, India
Dr. Harlokesh Narayan Yadav, Dept. of Pharmacology, AIIMS, Delhi, India
Dr. P.L.Sahu, Scientific Director, National Dope Test Laboratory, Govt. of India
Mr. Atul Nasa, Head of Office, Drug Controlling & Licensing Authority, Govt. of NCT, Delhi