Drug recycling

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Drug recycling, also referred to as medication redispensing or medication re-use, is the idea that health care organizations or patients with unused drugs can transfer them in a safe and appropriate way to another patient in need. [1] The purpose of such a program is reducing medication waste, thereby saving healthcare costs, enlarging medications’ availability and alleviating the environmental burden of medication. [2]

Contents

The debate

Despite the need for waste-preventive measures, the debate of drug recycling programs is ongoing. It is traditional to expect that consumers get prescription drugs from a pharmacy and that the pharmacy got their drugs from a trusted source, such as manufacturer or wholesaler. [1] In a drug recycling program, consumers would access drugs through a less standardized supply chain. Consequently, concerns of the quality of the recycled drugs arise. [1]

However, in a regulated process, monitored by specialized pharmacies or medical organization, these uncertainties can be overcome. For example, monitoring the storage conditions, including temperature, light, humidity and agitation of medication, can contribute to regulation of the quality of recycled drugs. [3] For this purpose, pharmaceutical packaging could be upgraded with sensing technologies, that can also be designed to detect counterfeits. [4] Such packaging requires an initial investment, but this can be compensated with potential cost savings obtained by a drug recycling program. [5] Accordingly, drugs recycling seems economically viable for expensive drugs, such as HIV post-exposure prophylaxis medication. [6]

Donating practices

In some countries, drug recycling programs operate successfully by donating unused drugs to the less fortunate. In the United States drug recycling programs exist locally. [7] [8] As of 2010, Canada had fewer drug recycling programs than the United States. [9] These programs occur in specific pharmacies only, since these pharmacies are prepared to address the special requirements of participating in a recycling program. [10] Usually, drug returns happen without financial compensation. In Greece, the organization GIVMED operates in drug recycling, and saved over half a million euros by recycling almost 60k drug packages since 2016. [11]

However, in other countries, such as Canada, implementation of drug recycling programs is limited. [9] Other initiatives focus on donating drugs to third world countries. However, this is accompanied with ethical constraints due to uncertainties in quality, as well as practical constraints, due to making the drugs only temporarily available and not necessarily addressing local needs. The World Health Organization provided guidelines on appropriate drug donation, thereby discouraging donation practices that do not consider recipient's needs, government policies, effective coordination or quality standards. [12]

Towards redispensing as standard of care

Alternatively, drug recycling programs could be set as routine clinical practice with the aim of reducing the economic and environmental burden of medication waste. Still, for general implementation of drug recycling programs, clear professional guidelines are required. [2] Research could provide the rationale for these guidelines. For example, research showed that a majority of patients is willing to use recycled drugs if the quality is maintained, [13] and explored requirements for a drug recycling program perceived by stakeholders, including the general public, [14] pharmacists. [15] and policy-makers. [16]

One can assume that implementing drug recycling as routine clinical practice is only attractive from an economical perspective, if the savings exceed the operational pharmacy costs. For this purpose, research should assess the feasibility of drug recycling. In the Netherlands, redispensing of unused oral anticancer drugs is currently tested in routine clinical practice to determined cost-savings of a quality-controlled process. [17] This data could help policy-makers to prioritize drug recycling on their agenda, thereby facilitating guidelines for general implementation of drug recycling.

Related Research Articles

<span class="mw-page-title-main">Pharmacist</span> Healthcare professional

A pharmacist is a healthcare professional who specializes in the preparation, dispensing, and management of medications and who provides pharmaceutical advice and guidance. Pharmacists often serve as primary care providers in the community, and may offer other services such as health screenings and immunizations.

<span class="mw-page-title-main">Pharmacy</span> Clinical health science

Pharmacy is the science and practice of discovering, producing, preparing, dispensing, reviewing and monitoring medications, aiming to ensure the safe, effective, and affordable use of medicines. It is a miscellaneous science as it links health sciences with pharmaceutical sciences and natural sciences. The professional practice is becoming more clinically oriented as most of the drugs are now manufactured by pharmaceutical industries. Based on the setting, pharmacy practice is either classified as community or institutional pharmacy. Providing direct patient care in the community of institutional pharmacies is considered clinical pharmacy.

<span class="mw-page-title-main">Medical prescription</span> Health-care communication from a physician to a pharmacist

A prescription, often abbreviated ℞ or Rx, is a formal communication from a physician or other registered healthcare professional to a pharmacist, authorizing them to dispense a specific prescription drug for a specific patient. Historically, it was a physician's instruction to an apothecary listing the materials to be compounded into a treatment—the symbol ℞ comes from the first word of a medieval prescription, Latin recipere, that gave the list of the materials to be compounded.

<span class="mw-page-title-main">Prescription drug</span> Medication legally requiring a medical prescription before it can be dispensed

A prescription drug is a pharmaceutical drug that is permitted to be dispensed only to those with a medical prescription. In contrast, over-the-counter drugs can be obtained without a prescription. The reason for this difference in substance control is the potential scope of misuse, from drug abuse to practicing medicine without a license and without sufficient education. Different jurisdictions have different definitions of what constitutes a prescription drug.

<span class="mw-page-title-main">Pharmacogenomics</span> Study of the role of the genome in drug response

Pharmacogenomics is the study of the role of the genome in drug response. Its name reflects its combining of pharmacology and genomics. Pharmacogenomics analyzes how the genetic makeup of a patient affects their response to drugs. It deals with the influence of acquired and inherited genetic variation on drug response, by correlating DNA mutations with pharmacokinetic, pharmacodynamic, and/or immunogenic endpoints.

<span class="mw-page-title-main">Polypharmacy</span> Use of five or more medications daily

Polypharmacy (polypragmasia) is an umbrella term to describe the simultaneous use of multiple medicines by a patient for their conditions. The term polypharmacy is often defined as regularly taking five or more medicines but there is no standard definition and the term has also been used in the context of when a person is prescribed 2 or more medications at the same time. Polypharmacy may be the consequence of having multiple long-term conditions, also known as multimorbidity and is more common in people who are older. In some cases, an excessive number of medications at the same time is worrisome, especially for people who are older with many chronic health conditions, because this increases the risk of an adverse event in that population. In many cases, polypharmacy cannot be avoided, but 'appropriate polypharmacy' practices are encouraged to decrease the risk of adverse effects. Appropriate polypharmacy is defined as the practice of prescribing for a person who has multiple conditions or complex health needs by ensuring that medications prescribed are optimized and follow 'best evidence' practices.

Pharmacotherapy, also known as pharmacological therapy or drug therapy, is defined as medical treatment that utilizes one or more pharmaceutical drugs to improve on-going symptoms, treat the underlying condition, or act as a prevention for other diseases (prophylaxis).

Academic detailing is "university or non-commercial-based educational outreach." The process involves face-to-face education of prescribers by trained health care professionals, typically pharmacists, physicians, or nurses. The goal of academic detailing is to improve prescribing of targeted drugs to be consistent with medical evidence from randomized controlled trials, which ultimately improves patient care and can reduce health care costs. A key component of non-commercial or university-based academic detailing programs is that they do not have any financial links to the pharmaceutical industry.

An online pharmacy, internet pharmacy, or mail-order pharmacy is a pharmacy that operates over the Internet and sends orders to customers through mail, shipping companies, or online pharmacy web portal.

<span class="mw-page-title-main">Auxiliary label</span> Warning or information added to prescription package

An auxiliary label is a label added on to a dispensed medication package by a pharmacist in addition to the usual prescription label. These labels are intended to provide supplementary information regarding the safe administration, use, and storage of the medication. Auxiliary labels provide information which can augment but not replace verbal counselling from a pharmacist.

<span class="mw-page-title-main">Clinical pharmacy</span> Branch of pharmacy for direct provision

Clinical pharmacy is the branch of pharmacy in which clinical pharmacists provide direct patient care that optimizes the use of medication and promotes health, wellness, and disease prevention. Clinical pharmacists care for patients in all health care settings but the clinical pharmacy movement initially began inside hospitals and clinics. Clinical pharmacists often work in collaboration with physicians, physician assistants, nurse practitioners, and other healthcare professionals. Clinical pharmacists can enter into a formal collaborative practice agreement with another healthcare provider, generally one or more physicians, that allows pharmacists to prescribe medications and order laboratory tests.

Medication costs, also known as drug costs are a common health care cost for many people and health care systems. Prescription costs are the costs to the end consumer. Medication costs are influenced by multiple factors such as patents, stakeholder influence, and marketing expenses. A number of countries including Canada, parts of Europe, and Brazil use external reference pricing as a means to compare drug prices and to determine a base price for a particular medication. Other countries use pharmacoeconomics, which looks at the cost/benefit of a product in terms of quality of life, alternative treatments, and cost reduction or avoidance in other parts of the health care system. Structures like the UK's National Institute for Health and Clinical Excellence and to a lesser extent Canada's Common Drug Review evaluate products in this way.

Medication therapy management, generally called medicine use review in the United Kingdom, is a service provided typically by pharmacists, medical affairs, and RWE scientists that aims to improve outcomes by helping people to better understand their health conditions and the medications used to manage them. This includes providing education on the disease state and medications used to treat the disease state, ensuring that medicines are taken correctly, reducing waste due to unused medicines, looking for any side effects, and providing education on how to manage any side effects. The process that can be broken down into five steps: medication therapy review, personal medication record, medication-related action plan, intervention and or referral, and documentation and follow-up.

SIRUM (Supporting Initiatives to Redistribute Unused Medicine) is a non-profit social enterprise started by Stanford University students to decrease the amount of medicine going to waste in the U.S. by redistributing unused, unexpired drugs to safety-net clinics. Using an innovative technology platform, SIRUM saves lives, time, and money by allowing health facilities, manufacturers, wholesalers, and pharmacies to easily donate unused medicine rather than destroy it.

Automatic Generic Substitution is a proposal by the Department of Health (DH) whereby in January 2010 pharmacists could be obliged to substitute a generic version of a medication even if the prescriber had written the prescription for a specific brand, as part of a new deal on drug pricing.

<span class="mw-page-title-main">Deprescribing</span> Process to taper or stop medications

Deprescribing is a process to taper or stop medications with the intention to achieve improved health outcomes by reducing exposure to medications that are potentially either harmful or no longer required. Deprescribing is important to consider with changing health and care goals over time, as well as polypharmacy and adverse effects. Deprescribing can improve adherence, cost, and health outcomes but may have adverse drug withdrawal effects. More specifically, deprescribing is the planned and supervised process of intentionally stopping a medication or reducing its dose to improve the person's health or reduce the risk of adverse side effects. Deprescribing is usually done because the drug may be causing harm, may no longer be helping the patient, or may be inappropriate for the individual patient's current situation. Deprescribing can help correct polypharmacy and prescription cascade.

Separation of prescribing and dispensing, also called dispensing separation, is a practice in medicine and pharmacy in which the physician who provides a medical prescription is independent from the pharmacist who provides the prescription drug.

<span class="mw-page-title-main">Drug disposal</span> Safe disposal of unused drugs

Drug disposal is the discarding of drugs. Individuals commonly dispose of unused drugs that remain after the end of medical treatment. Health care organizations dispose of drugs on a larger scale for a range of reasons, including having leftover drugs after treating patients and discarding of expired drugs. Failure to properly dispose of drugs creates opportunities for others to take them inappropriately. Inappropriate disposal of drugs can also cause drug pollution.

An unused drug or leftover drug is the medicine which remains after the consumer has quit using it. Individual patients may have leftover medicines at the end of their treatment. Health care organizations may keep larger amounts of drugs as part of providing care to a community, and may have unused drugs for a range of reasons. The unused drugs should be destroyed utterly to eliminate the toxic effects of undisposed drugs on flora and fauna. The improper disposal of unused drugs could be the reason for the contamination of Surface, Ground and Drinking Water. Discharge of unused antibiotics and disinfectants in the sewage system may ruin the aquatic life or contamination of drinking water.

<span class="mw-page-title-main">Prescription drug addiction</span> Medical condition

Prescription drug addiction is the chronic, repeated use of a prescription drug in ways other than prescribed for, including using someone else’s prescription. A prescription drug is a pharmaceutical drug that may not be dispensed without a legal medical prescription. Drugs in this category are supervised due to their potential for misuse and substance use disorder. The classes of medications most commonly abused are opioids, central nervous system (CNS) depressants and central nervous stimulants. In particular, prescription opioid is most commonly abused in the form of prescription analgesics.

References

  1. 1 2 3 Pomerantz, JM (23 April 2004). "Recycling expensive medication: why not?". MedGenMed. 6 (2): 4. PMC   1395800 . PMID   15266231.
  2. 1 2 Connelly, D. (5 July 2018). "Should pharmacists be allowed to reuse medicines?". The Pharmaceutical Journal. 301 (7915): 20–23. doi:10.1211/PJ.2018.20205091.
  3. ↑ Hui, T.K.L. (27 March 2020). "Enhancing Pharmaceutical Packaging through a Technology Ecosystem to Facilitate the Reuse of Medicines and Reduce Medicinal Waste". Pharmacy. 8 (2). Bibcode:2020Senso..20.3080H. doi: 10.3390/s20113080 . PMC   7308820 . PMID   32485976.
  4. ↑ Hui, T.K.L. (29 May 2020). "Enabling Medicine Reuse Using a Digital Time Temperature Humidity Sensor in an Internet of Pharmaceutical Things Concept". Sensors. 20 (11): 3080. Bibcode:2020Senso..20.3080H. doi: 10.3390/s20113080 . PMC   7308820 . PMID   32485976.
  5. ↑ Bekker, C.L. (2019). "What does it cost to redispense unused medications in the pharmacy? A micro-costing study". BMC Health Services Research. 19 (1): 243. doi: 10.1186/s12913-019-4065-6 . PMC   6481041 . PMID   31014325.
  6. ↑ Bekker, C.L. (2019). "Redispensing of unused HIV Post-exposure prophylaxis therapy for medical exchange students". Travel Medicine and Infectious Disease. 29: 82–83. doi:10.1016/j.tmaid.2019.02.005. hdl: 1874/382242 . PMID   30818013. S2CID   73507190.
  7. ↑ Nelson, Gayle (26 May 2015). "The Next Recycling Frontier: Prescription Drugs". Nonprofit Quarterly. Retrieved May 4, 2017.
  8. ↑ Inskeep, Steve (22 May 2015). "Poor Residents Benefit From Oklahoma County's Medicine Recycling". Morning Edition . NPR.
  9. 1 2 Doyle, S. (8 February 2010). "Canada lags behind United States in drug return, reuse and recycling programs". Canadian Medical Association Journal. 182 (4): E197–E198. doi:10.1503/cmaj.109-3171. PMC   2831677 . PMID   20142378.
  10. ↑ Cauchi, Richard; Hanson, Karmen; Robinson, Savannah (31 March 2017). "State Prescription Drug Return, Reuse and Recycling Laws". www.ncsl.org. National Conference of State Legislatures. Retrieved May 9, 2017.
  11. ↑ "GIVMED webpage" . Retrieved June 11, 2020.
  12. ↑ World Health Organization. (October 2011). Guidelines for medicine donations, Revised 2010. Geneva. ISBN   978-92-4-150198-9.{{cite book}}: CS1 maint: location missing publisher (link)
  13. ↑ Bekker, C.L. (2019). "Willingness of patients to use unused medication returned to the pharmacy by another patient: a cross-sectional survey". BMJ Open. 9 (5): e024767. doi: 10.1136/bmjopen-2018-024767 . PMC   6530303 . PMID   31092644.
  14. ↑ Alhamad, H (2018). "How do people conceptualise the reuse of medicines? An interview study". International Journal of Pharmacy Practice. 26 (3): 232–241. doi: 10.1111/ijpp.12391 . PMC   5969265 . PMID   28795460.
  15. ↑ Mcrae, D (2016). "The redistribution of medicines: could it become a reality?". International Journal of Pharmacy Practice. 24 (6): 411–418. doi:10.1111/ijpp.12275. hdl: 10369/7993 . PMID   27238215. S2CID   45498652.
  16. ↑ Bekker, C.L. (2017). "Redispensing of medicines unused by patients: a qualitative study among stakeholders". International Journal of Clinical Pharmacy. 39 (1): 196–204. doi:10.1007/s11096-017-0424-8. hdl: 1874/348415 . PMID   28070689. S2CID   20006141.
  17. ↑ "The ROAD to sustainable medication use: redispensing unused oral anticancer drugs". Dutch trial register. Retrieved January 31, 2021.
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