"Recycling" and Disposal of Dispensed Drugs

Introduction

Responsible environmental practices encompass the management of drugs as well as materials purchased, used and disposed such as plastics, paper and glass. The focus of this unit is on drug management, however pharmacists are encouraged to implement effective environmental policies and procedures for all aspects of purchasing and waste management.

Tools and resources available to assist pharmacists in practicing in an environmentally responsible manner are found in the literature, in resources available from a number of provincial and regional pharmacy associations and from the pharmaceutical industry. These sources stress the importance of optimal drug utilization and of educating patients about the use of their medications in order to decrease the risk of drug misadventure and ultimately to prevent waste.

Recycling of drugs is generally illegal. In some provinces, drugs in sealed, unopened containers may be recycled if they have been returned from a controlled environment such as a long-term care facility. The environmental opportunity relates to reduction, re-use or recycling of the packaging, and appropriate disposal of the unused drugs.

More important then reducing the waste, is identifying and addressing the underlying reason for it. Is the patient non-compliant and if so, why? Pharmacists are in an ideal position to assess and act on the individual patient's reasons for returning medication and to assist in the safe disposal of unwanted drugs. Waste should be prevented wherever possible, through trial prescription programs, dispensing of smaller quantities, and education of patients, prescribers, government and the pharmaceutical industry on the cost of waste.

Although there appears to be little financial incentive for patients to return unused medication and packaging, or for pharmacists to dispose of these materials appropriately, pharmacists who are known to practice in an environmentally responsible manner are seen as community-minded, and may benefit from enhanced consumer loyalty.

Standards of Practice

Practice Unit #10 supports in general Standard #5 of NAPRA's "Model Standards of Practice for Canadian Pharmacists".

Specifically, this unit supports Operational Sub-Component #5.2.2 and Operational Component #5.5 of the Standards.

Reviewers noted that there is significant benefit to patients in appropriate recycling and disposal programs. In general, benefits include:

• Decreased medication is available for abuse and accidents
• Reduced potential for environmental damage
• Increased safety associated with improved syringe disposal
• Decreased costs to the system through decreased waste
• Prevention of inadvertent use of expired medication
• Prevention of adverse events which occur when patients take medications prescribed for someone else, or take medications that were discontinued previously
• Community appreciation for providing reliable, responsible disposal of medications in an organized and convenient way
• Self satisfaction for pharmacists.

Issues cited by graduating pharmacists and leading edge practitioners included:

• In some provinces, there is no consistent pick-up of items for disposal
• Physician sampling practices result in significant packaging waste
• Need for health care professionals and the pharmaceutical industry to work together to decrease this waste
• Pharmacists want pharmaceutical companies to accept returned packaging and share in the costs of disposal. (One idea for this is an allowance for disposal based on percent of purchases from the manufacturer)
• Need better public awareness. In spite of existing programs in some provinces, people still simply throw drugs in the garbage or flush them down the toilet
• Cost is another concern, many of the costs for these programs are borne by pharmacists.

The role for pharmacists in this area is significant. As one pharmacist stated, "if we sell it, we are responsible for collecting and disposing it as well". Elements of the role for pharmacists include:

• Establishing a disposal process, possibly in conjunction with associations, manufacturers and other community pharmacists
• Establishing a program for the return and disposal of unused drugs which includes:

• Encouraging patients to return their drugs to the pharmacy
• Collecting expired, discontinued and unused drugs from patients
• Tabulation and documentation of volume of waste and rationale/causes/sources for waste

• Using this information to support the need for waste reduction programs and attract or maintain sponsorship.

Successful drug disposal programs include the following elements:

• Convenience for customers
• Public awareness through advertising and promotion of the service
• Funding for waste disposal
• Organized collection centre
• Standard methods and facilities
• Individual initiative
• Continuing support from professional associations and their partners/sponsors.

Existing programs and resources include province-wide disposal services, provincial and regional "Medication Cabinet Cleanup" campaigns, patient education materials and medication review tools.

Alberta Pharmaceutical Association
The ENVIRx program encourages consumers to take unused medications back to Alberta pharmacies for environmentally safe disposal. Ultimately the unused drugs are transported to incinerators. The program provides posters, brochures, a pharmacist information guide and warning labels for waste containers. ENVIRx is aimed at managing post consumer waste, not returns. The program is run through APhA with funding from the Alberta Government and Pharmaceutical Industry.

Saskatchewan Pharmaceutical Association
SPhA works with Biomed Recovery and Disposal, a company that collects and disposes pharmaceutical waste directly from community pharmacies. The program includes posters reminding consumers to return all outdated, expired and unwanted drugs and sharps.

British Columbia Pharmacy Association
BCPhA also offers the ENVIRx program as a province-wide waste disposal program that encourages consumers to take unused medications back to pharmacies across the province for environmentally safe disposal. Ultimately the unused drugs are transported to incinerators. The program is sponsored through a partnership between BCPhA, the Pharmaceutical Manufacturers Association of Canada, the Canadian Drug Manufacturers Association and the Nonprescription Drug Manufacturers Association of Canada, and was launched in October 1996. As in Alberta, the ENVIRx program provides posters, brochures, a pharmacist information guide and warning labels for waste containers. ENVIRx is aimed at managing post consumer waste, not returns.

The College of Pharmacists of British Columbia
The College lists companies in BC that collect expired pharmaceuticals, chemicals, prescription drugs and household wastes.

Ontario, Manitoba and British Columbia
Browning Ferris Industries (BFI) offers a contract waste disposal system in Ontario, Manitoba and BC. The company takes returned medications and/or sterile preparation waste collected in pharmacies and incinerates them. The contact number is 1-905-791-4376.

Regional Medicine Cabinet Clean up Campaigns

Windsor and Essex County
This regions circulates a pamphlet for free safe disposal of used needles and medicine chest cleanup campaign.

Sudbury and District Pharmacists' Association
The region offers a cleanup campaign, and has published data collected as part of the campaign. Extrapolated, the total cost of waste across Canada is estimated to be as high as $113,381,687. The data collected supports the effectiveness of these campaigns.

Ottawa Carleton Pharmacists' Association
This region offers a Medicine Clean Up Campaign that includes letters to patients, data collection sheet for medicine cabinet cleanup month and commitment to participate form.

Other Resources and Programs

Apotex's "Time to talk"
This program includes a "brown bag medication review form" to assist in identifying medications for return and disposal.

Canadian Feed the Children and Canadian Medicine Aid Program
Unused drugs can be made available to third world countries through various programs including CANMAP. The World Health Organization has published guidelines for drug donations, which outline acceptable contributions in terms of shipping medications to third world countries. The guidelines are supported by four core principles:

1. A drug donation should benefit the recipient to the maximum extent possible
2. A donation should be given with full respect for the wishes and authority of the recipient, and be supportive of existing government policies and administrative arrangements
3. There should be no double standards in quality: if the quality of an item is unacceptable to the donor country, it is also unacceptable as a donation
4. There should be effective communication between the donor and the recipient; donations should be sent on expressed need and should not be sent unannounced.

The World Health Organization guidelines also state that only drugs that have not been previously dispensed and with at least a year remaining in their expiration date are considered acceptable.

More information on CANMAP is available through the Toronto Office at 416-778-7865.

"Your Medicine Cabinet" pamphlet from CPhA
This pamphlet educates patients about how to get the best from their medicine and includes storage and cleanup information. The contact number is 1-905-791-4376.

CSHP Guidelines for Responsible Environmental Practices
Although this guideline document speaks to responsibilities of hospital pharmacists, it has application in the community setting since it provides guidelines for reduction in waste for all dosage forms, for general reduction in waste of administrative materials/paper, drug information systems, computer supplies and purchasing policies. The contact number is 1-613-736-9733.

Other ideas

• Consider incorporating a question into your callback patient follow up to ask about unused or expired drugs and encourage patients to return these items to the pharmacy at their next visit.
• Consider including a "returned drugs bag" with new prescriptions.
• Purchase in bulk when possible
• Work with manufacturers on the return of packaging for recycling.
• In provinces where trial prescription programs have been introduced, significant decrease in waste (and associated cost) has been demonstrated.

1. Boivin, M. The Cost of Medication Waste. Can Pharm J 1997; May:32 - 39
2. Goddard H. It's not easy being green Can Pharm J 1991: May; 244
3. Poston J. The Facts of the Matter - Reduce Reuse Recycle Recover. Can Pharm J 1991. May; 245 - 246
4. Roschlaub J. The Green Dream. Can Pharm J 1991: May; 247.
5. Guidelines for Responsible Environmental Practices for Hospital Pharmacy, Canadian Society of Hospital Pharmacists 1994.