Deprescription: a global need to rationalize drug prescribing

Appropriate prescribing and deprescription of unwanted medicines are a global concern. Polypharmacy is common in old age due to multiple comorbidities. This poses many risks that can be prevented by deprescription as a measure of planned reduction in number of medicines no longer needed. For articles to be included in this narrative review, a non-systematic search of deprescription and related term was conducted at PubMed and Google Scholar database. Articles detailing deprescription in general were included whereas those about deprescription in a particular disease or of particular drug groups were excluded. The review discusses about related terms, process of deprescription, when it is to be planned, which patients need deprescription, tools available for appropriate prescription, importance of patient oriented deprescription, actual steps involved in deprescription, present scenario, future scope of trials and formulation of guidelines for deprescription, and finally current state of deprescription in India and actions needed.

A survey on the knowledge, perceptions and practices regarding unwanted medicine disposal among pharmacists in Sri Lanka

Background: Unwanted medicines are defined as expired, unused, damaged or contaminated pharmaceutical products. Improper disposal of unwanted medicines leads to many health and environmental hazards. The World Health Organisation recommends that unwanted medicines should always be disposed properly. The main objective of this study was to assess the knowledge, practices and perceptions on the disposal of unwanted medicines among pharmacists in Sri Lanka.Methods: A cross-sectional study was carried out among pharmacists in 40 private retail pharmacies in the Northern, Eastern and the Western provinces within a period of three months. The pharmacies were selected via stratified randomised sampling in each district. The most experienced pharmacist in each pharmacy was recruited for data collection. A pre-tested, self-administered questionnaire was used. The ethics approval was obtained (Ref: EC-12-190). The data was represented using simple descriptive statistics.Results: The data was collected from 40 pharmacies. Among the pharmacists, 65% were males. The majority answered that burning and landfill as the most appropriate methods of disposal for most of the types of medicinal waste. A significant number of pharmacists were not aware about the method of disposal for anti-infective agents and anti-neoplastic agents. The majority perceived the seriousness of environmental damage caused by disposal via trash or sink. A majority was not agreeing to have pharmacies as collecting centers for unwanted medicines. A discrepancy between the pharmacists’ perceptions and the practices was observed.Conclusions: The level of knowledge, practices and perceptions among pharmacists on unwanted medicines disposal was substandard and needs attention.

Enabling Medicine Reuse Using a Digital Time Temperature Humidity Sensor in an Internet of Pharmaceutical Things Concept

Medicinal waste due to improper handling of unwanted medicines creates health and environmental risks. However, the re-dispensing of unused prescribed medicines from patients seems to be accepted by stakeholders when quality and safety requirements are met. Reusing dispensed medicines may help reduce waste, but a comprehensive validation method is not generally available. The design of a novel digital time temperature and humidity indicator based on an Internet of Pharmaceutical Things concept is proposed to facilitate the validation, and a prototype is presented using smart sensors with cloud connectivity acting as the key technology for verifying and enabling the reuse of returned medicines. Deficiency of existing technologies is evaluated based on the results of this development, and recommendations for future research are suggested.

Attitudes and Practice Regarding Disposal for Unwanted Medications among Young Adults and Elderly People in China from an Ecopharmacovigilance Perspective

Due to the expensive cost and uncertain effectiveness of environmental management options in eliminating pharmaceutical residues, recently, decreasing the emission of pharmaceutical pollutants from a drug administration perspective has been considered a hot area of research. As a kind of drug administration for the environment, ecopharmacovigilance (EPV) emphasizes the source control of pharmaceutical pollutants. Disposal of unwanted medicines has been considered as the easiest target for source control of pharmaceutical contamination. Here, we focused on public attitudes and practice regarding disposal of unwanted medicines from the EPV perspective among 365 Chinese university young adults and 206 elderly retirement home residents. The results showed that the majority of respondents had positive attitudes, but exhibited inadequate awareness and poor practice. In addition, the young-adult respondents were found to pay more attention to the environmental problems posed by pharmaceutical residues, and be more supportive of the EPV intervention predominantly performed by pharmaceutical industries and pharmacists. Therefore, it is urgent to establish the standard medicine disposal protocols and educate the general public on the best way for medication disposal under the principle of EPV in China, and efforts on environmentally-preferred drug disposal under EPV should target for the specific demographics.

When is a medicine unwanted, how is it disposed, and how might safe disposal be promoted? Insights from the Australian population

Objective The aim of the present study was to explore disposal practices of unwanted medicines in a representative sample of Australian adults, compare this with previous household waste surveys and explore awareness of the National Return and Disposal of Unwanted Medicines (RUM) Project. Methods A 10-min online survey was developed, piloted and conducted with an existing research panel of adult individuals. Survey questions recorded demographics, the presence of unwanted medicines in the home, medicine disposal practices and concerns about unwanted medicines. Descriptive statistical analyses and rank-ordered logit regression were conducted. Results Sixty per cent of 4302 respondents reported having unwanted medicines in their household. Medicines were primarily kept just in case they were needed again and one-third of these medicines were expired. Two-thirds of respondents disposed of medicines with the household garbage and approximately one-quarter poured medicines down the drain. Only 17.6% of respondents had heard of the RUM Project, although, once informed, 91.7% stated that they would use it. Respondents ranked the risk of unintended ingestion as the most important public health message for future social marketing campaigns. Conclusions Respondents were largely unaware of the RUM Project, yet were willing to use it once informed. Limited awareness could lead to environmental or public health risks, and targeted information campaigns are needed. What is known about the topic? There is a growing international evidence base on how people dispose of unwanted medicines and the negative consequences, particularly the environmental effects of inappropriate disposal. Although insight into variation in disposal methods is increasing, knowledge of how people perceive risks and awareness of inappropriate disposal methods is more limited. What does this paper add? This study provides evidence of inappropriate medicines disposal and potential stockpiling of medicines in Australian households that could contribute to environmental and/or public health risks. It also reveals possible trends towards a higher frequency of inappropriate disposal practices in the Australian context. Insights into respondents’ perceptions of associated risks and awareness of a national scheme for appropriate disposal of medicines have not previously been reported. What are the implications for practitioners? The findings of the present study provide important insights for all health professionals as stakeholders in the quality use of medicines. It is important for those health professionals who assist consumers to manage their medicines to have strategies in place that routinely identify potential stockpiling and inform consumers about appropriate methods of medicines disposal. Although the findings of this study are specific to the Australian context, they may usefully inform policy, public health campaigns and the individual practices of health professionals and other stakeholders in promoting the quality use of medicines nationally and internationally.

MEDICATION DISPOSAL;

Introduction: Due to irresponsible and unsafe methods of drug disposal employedby consumers pharmaceutical waste enters the ecosystem, ultimately having a detrimentaleffect on both human health and environment. Objectives: The purpose of the study is tomeasure attitude and practice of local community in Karachi, Pakistan regarding safe disposalof unwanted medicines and assess willingness of participants to take part in a medicationtake-back program. Study Design: A two-phase observational study was conducted usingconvenience sampling. Period: January to February, 2016. Methodology: In Phase I (n = 200)students enrolled in various health sciences institutions in the study were asked to take part inthe survey. In Phase II(n = 300) household consumers were contacted by telephone and socialmedia. Results: Participants (response rate 84.4%) were given a questionnaire to explore theirattitudes towards medicine disposal. More than half of the consumers surveyed reported storingunused/expired medications in their homes, and majority threw away unwanted medicine in thegarbage. The most common reason was unawareness of expiry date (32.7%). Only 12.32%reported returning medication to a pharmacy for disposal. Majority of the consumers had neverreceived advice about medication disposal by a health care provider but were aware of thepossible negative consequences and were willing to participate in national pharmacy take-backprograms if implemented by the government. Conclusions: Our findings suggest that effectivecommunication and established protocols will promote appropriate disposal practices. Publicservices in Pakistan, and especially pharmacies, must play a more proactive role in this regard.