DRUG DISPOSAL METHODS

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Drug Disposal Methods

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DRUG DISPOSAL:

Krishnaveni.K.A I.M.Pharm Periyar College of Pharmaceutical Sciences Trichy-21 DRUG DISPOSAL

Introduction:

Introduction Medicines play an important role in treating certain conditions and diseases, but they must be taken with care. Unused portions of these medicines must be disposed of properly to avoid harm. Many people toss expired or unused medications in the trash or flush them down the toilet. Some components of these drugs end up in our lakes, streams, and water supplies. The improper disposal of unused medications by flushing them or pouring them down the drain may be harmful to fish, wildlife and their habitats. Additionally, throwing medications away in the garbage may be dangerous since they can end up in the mouths of children or household pets .

Disposal methods:

Disposal methods Return to donor or manufacturer Landfill Waste immobilization: Encapsulation Waste immobilization: Inertization Sewer Burning in open containers Medium temperature incineration Novel high temperature incineration

Return to donor/ manufacturer :

Return to donor/ manufacturer Wherever practical the possibility of returning unusable drugs for safe disposal by the manufacturer should be explored; particularly drugs which present disposal problems, such as antineoplastics . For unwanted, unrequested donations, especially those that arrive pas t or unreasonably near their expiry date it may be possible to return them to the donor for disposal.

LANDFILL:

LANDFILL landfill means waste place - land disposal site without prior treatment or preparation. Landfill is the oldest and the most widely practiced method of disposing of solid waste Three types are recognized. Open uncontrolled non-engineered dump Engineered landfill Highly engineered sanitary landfill

Open uncontrolled non-engineered dump:

Open uncontrolled non-engineered dump A non-engineered dump is probably the most common land disposal method. Untreated waste discharged into an uncontrolled, non-engineered open dump does not protect the local environment and should not be used. Discarding of untreated waste pharmaceuticals into such a site is not recommended except as a last resort option. They should preferably be discharged after immobilization by encapsulation or inertization. As a last resort, where it is not possible to immobilize the waste pharmaceuticals, then the untreated wastes must be covered rapidly with large quantities of municipal waste to prevent scavenging. It should be noted that discarding in open, uncontrolled dumps with insufficient isolation from the aquifer or other watercourses can lead to pollution, with the risk of drinking water contamination in the worst cases.

Open uncontrolled non –engineered dump Landfill:

Open uncontrolled non –engineered dump Landfill

Modern Landfill:

Modern Landfill

Engineered landfill :

Engineered landfill Such a landfill has some features to protect from loss of chemicals into the aquifer. Direct deposit of pharmaceuticals is second best to discharging immobilized pharmaceutical waste into such a landfill.

Highly engineered sanitary landfill :

Highly engineered sanitary landfill Properly constructed and operated landfill sites offer a relatively safe disposal route for municipal solid wastes, including waste pharmaceuticals. The top priority is protection of the aquifer . An appropriate landfill consists of an evacuated pit isolated from watercourses and above the water table. Each day’s solid waste is compacted and covered with soil to maintain sanitary conditions. The term “ safe sanitary landfill ” refers to such a site that is adequately situated, constructed and managed. Upgrading an uncontrolled waste disposal site to a reasonable standard should be considered, and advice is available from WHO

Waste immobilization: Encapsulation:

Waste immobilization: Encapsulation Encapsulation involves immobilizing the pharmaceuticals in a solid block within a plastic or steel drum. Drums should be cleaned previously prior to use and should not have contained explosive or hazardous materials. They are filled to 75% capacity with solid and semi-solid pharmaceuticals, and the remaining space is filled by pouring in a medium such as cement or cement/lime mixture, plastic foam or bituminous sand. For ease and speed of filling, the drum lids should be cut open and bent back. Care should be taken to avoid cuts to hands when placing pharmaceuticals in the drums. Once the drums are filled to 75% capacity, the mixture of lime, cement and water in the proportions 15:15:5 (by weight) is added and the /drum filled to capacity.

…. Contin..:

…. Contin .. A larger quantity of water may be required sometimes to attain a satisfactory liquid consistency. Steel drum lids should then be bent back and sealed, ideally by seam or spot welding. The sealed drums should be placed at the base of a landfill and covered with fresh municipal solid waste. For ease of movement, the drums may be placed on pallets which can then be put on a pallet transporter.

Waste immobilization: inertization :

Waste immobilization: inertization Inertization is a variant of encapsulation and involves removing the packaging materials, paper, cardboard and plastic, from the pharmaceuticals. Pills need to be removed from their blister packs. The pharmaceuticals are then ground and a mix of water, cement and lime added to form a homogenous paste. Worker protection in the form of protective clothing and masks is required as there may be a dust hazard. The paste is then transported in the liquid state by concrete mixer truck to a landfill and decanted into the normal urban waste. The paste then sets as a solid mass dispersed within the municipal solid waste.

PowerPoint Presentation:

The process is relatively inexpensive and can be carried out with unsophisticated equipment. The main requirements are a grinder or road roller to crush the pharmaceuticals, a concrete mixer , and supplies of cement, lime and water. The approximate ratios by weight used are as follows: • pharmaceutical waste: 65% • lime: 15% • cement: 15% • water: 5% or more to form a proper liquid consistency.

Inertization :

Inertization

Sewer :

Sewer discharge lines (sewers) for the wastewater Some liquid pharmaceuticals , e.g. syrups and intravenous (IV) fluids, can be diluted with water and flushed into the sewers in small quantities over a period of time without serious public health or environmental affect. Fast flowing watercourses may likewise be used to flush small quantities of well-diluted liquid pharmaceuticals or antiseptics. The assistance of a hydrogeologist or sanitary engineer may be required in situations where sewers are in disrepair or have been war damaged.

SEWER:

SEWER

Burning in open containers :

Burning in open containers Pharmaceuticals should not be destroyed by burning at low temperature in open containers, as toxic pollutants may be released into the air. Paper and cardboard packaging, if they are not to be recycled, may be burnt. Polyvinyl chloride (PVC) plastic however must not be burnt. While burning pharmaceutical waste is not advocated as a method of disposal, it is recognized that it is not infrequently used. It is strongly recommended that only very small quantities of waste pharmaceuticals be disposed of in this way.

Burning in open containers:

Burning in open containers

Medium temperature incineration :

Medium temperature incineration Two-chamber incinerators designed with medium temperature furnaces and incinerators . In emergency situations the responsible authorities may consider it acceptable to treat expired solid form pharmaceuticals using a two-chamber incinerator that operates at the minimum temperature of 850°C, with a combustion retention time of at least two seconds in the second chamber.

Incineration:

Incineration

Novel high temperature incineration :

Novel high temperature incineration Industries which use high temperature technology, such as cement kilns, coal fired thermal power stations or foundries usually have furnaces that operate at temperatures well in excess of 850°C, have long combustion retention times and disperse exhaust gases via tall chimneys, often to high altitudes. Cement kilns are particularly suited for the disposal of expired pharmaceuticals, chemical waste, used oil, tyres , etc. Several features of cement kilns make them suitable for pharmaceutical disposal. During burning the cement raw materials reach temperatures of 1450°C while the combustion gases reach temperatures up to 2000°C. The gas residence time at these high temperatures is several seconds.

PowerPoint Presentation:

In these conditions all organic waste components are effectively disintegrated. Some potentially dangerous or toxic combustion products become adsorbed into the cement clinker product or are removed in the heat exchange equipment. Pharmaceuticals should be introduced into the furnace as a reasonably small proportion of the total fuel feed. It is suggested that as a sensible "rule of thumb" no more than 5% of the fuel fed into the furnace at any one time is pharmaceutical material. Cement kilns typically produce 1,500 to 8,000 metric tons of cement per day and therefore quite large quantities of pharmaceutical material can be disposed of in a short period. It may be necessary to remove packaging and/or to grind the pharmaceuticals to avoid clogging and blockage of the fuel feed mechanisms.

Incineration:

Incineration

Sorting categories:

Sorting categories The objective of sorting is to separate the pharmaceuticals into categories that require different disposal methods. The appropriate safe disposal method recommended will depend principally on the pharmaceutical dosage form of the drugs. Segregated temporary storage areas or receptacles must be provided for each sorted category.

PowerPoint Presentation:

Practical advice on sorting Sorting involves an initial overall evaluation of the stockpile and subsequent division of pharmaceuticals into those suitable for use and those to be discarded. For those to be discarded a decision is made on the best method of disposal. To be efficient items should only be handled once . Pharmaceuticals suitable for use should remain in their packaging. The pharmaceuticals to be discarded should, when necessary, be separated from their packaging as late in the process as possible.

Sorting Process:

Sorting Process The sorting process includes: identifying each item; making a decision on whether it is usable; if usable, leaving packaging intact; if not usable, making a judgement on the optimal method of disposal and sorting accordingly; leaving packages and boxes intact until reaching their location, prior to definitive disposal or transport to an institution for use.

Optimum conditions for sorting :

Optimum conditions for sorting Sorting should be done in the open or in a well ventilated and, if necessary, heated covered structure designated by the local authority. Sorting should be done as close as possible to the stockpile in an orderly way, with all sorted material clearly labelled and separated at all times. Staff supplied with protective equipment (gloves, boots, overalls, dust masks, etc.), should work under the direct supervision of a pharmacist, and should receive training on the sorting criteria, and health and safety risks associated with handling the materials. Once sorted, the pharmaceuticals should be carefully packed into steel drums or into containers such as sturdy cardboard boxes, with the contents clearly indicated on the outside of the containers. The materials should be kept in a dry secure and preferably separate room to avoid being confused with in-date pharmaceuticals, until disposal is carried out.

Sorting categories :

Sorting categories The top priority of the sorting process is to separate out the pharmaceuticals that are categorized as controlled substances (e.g. narcotics), antineoplastic ( cytotoxic -anti-cancer) drugs and any other hazardous non-pharmaceutical products that may have been mixed among the pharmaceuticals. These must all be stored in separate, secure designated areas prior to their separate, safe disposal. The remaining unwanted pharmaceuticals must be further sorted into different categories by dosage form, (capsules, powders, solutions, suppositories, syrups, tablets). The following sorting categories and subcategories are suggested.

Pharmaceuticals and other materials which can still be used :

Pharmaceuticals and other materials which can still be used A large proportion of the volume of a typical stockpile of waste drugs is not occupied by the pharmaceuticals themselves, but rather by other items, such as medical material and equipment, food, clothing, boxes, pallets, and general rubbish. The first step in dealing with these stockpiles is to remove and dispose of these non-drug, non-chemical items. All such items should be clearly separated from pharmaceuticals and chemicals. Non-pharmaceutical useful materials Medical equipment, beds, wheelchairs, dressings, clothing, laboratory glassware, etc. can either be utilized by the institution or by other facilities, recycled, cannibalized for spare parts or disposed to a landfill.

Useful pharmaceuticals :

Useful pharmaceuticals If feasible, pharmaceuticals within their expiry date and considered useful should be separated out and immediately used by the institution or reallocated according to the needs and instructions of the regional health authorities. A list can be prepared giving details of the items available, quantities and expiry dates and circulated to others who can use the materials. While this separation is logical and appealing, experience indicates that it may not always be an efficient use of time and resources . Chemicals Acids, alkalis, reagents, phenol-based chemicals used for cleaning floors, disinfectants, etc. can be put to good use. If large quantities of these items are found a list may be prepared and offered to other potential users, such as hospitals, universities, or school laboratories,etc .

PowerPoint Presentation:

Expired or unwanted pharmaceuticals Pharmaceuticals that should never be used and should always be considered as pharmaceutical waste are: • all expired pharmaceuticals; • all unsealed syrups or eye drops (expired or unexpired); • all cold chain damaged unexpired pharmaceuticals that should have been stored in a cold chain but were not (for example: insulin, polypeptide hormones, gamma globulins and vaccines); • all bulk or loose tablets and capsules. If unexpired these should only be used when the container is still sealed, properly labelled or still within the original unbroken blister packs; • all unsealed tubes of creams, ointments, etc. (expired or unexpired).

PowerPoint Presentation:

Sorted by active ingredient (special disposal needed): • controlled substances; e.g. narcotics, psychotropic substances; • anti-infective drugs; • antineoplastics ; • cytotoxic -anti-cancer drugs, toxic drugs; • antiseptics and disinfectants. The last three groups require special consideration.

PowerPoint Presentation:

Sorted by dosage form (all other pharmaceuticals): solids, semi-solids and powders tablets, capsules, granules, powders for injection, mixtures, creams, lotions, gels, suppositories, etc.; liquids • solutions, suspensions, syrups, etc.; • ampoules; aerosol canisters • including propellant-driven sprays and inhalers.

Hazardous or potentially hazardous non-pharmaceutical materials :

Hazardous or potentially hazardous non-pharmaceutical materials All non-pharmaceutical, potentially dangerous waste such as chemicals, cleaning solutions, batteries and waste oil must be dealt with on a case-by-case basis by the hazardous waste expert, and must not be handled by the pharmaceutical teams unless expressly directed to do so. This waste requires separate and careful labelling and storage until disposal.

Recyclable material :

Recyclable material Waste paper, packing materials, clothes, gauze and wooden items, such as pallets, can be recycled, burned or disposed of as normal waste to a landfill. Plastic, metal and glass items can be reused (glassware can be given to laboratories, mechanical items given to scrap dealers), recycled (if facilities are available) or disposed of in a landfill. Depending on the type of material and its proposed reuse, appropriate treatment, such as cleaning or disinfection, may be needed. Other general rubbish can be disposed of in a landfill. If a recycling programme exists for the reuse of such materials they can be separated from the pharmaceuticals prior to their disposal in the landfill. WHO/EDM/PAR/99.2

Recommended disposal methods by sorting category :

Recommended disposal methods by sorting category Solids, semi-solids and powders Anti-infective drugs, controlled drugs and antineoplastics If it is not possible to return these to the manufacturer or adequate incineration is unavailable then encapsulation or inertization is recommended before discharge to a landfill. Anti-infective drugs and anti neoplastics are encapsulated to delay release to the environment and avoid high concentrations. Controlled drugs should be immobilized under supervision of the pharmacist, the police or a judicial representative, depending on the local regulations.

PowerPoint Presentation:

Liquids Pharmaceuticals with no or low toxicity Pharmaceuticals that can be classed as readily biodegradable organic material include liquid vitamins that may be diluted and flushed into a sewer. Harmless solutions of different concentrations of certain salts, amino acids, lipids or glucose may also be disposed of in sewers.Other liquid pharmaceuticals (except controlled drugs, anti neoplastics or anti-infective drugs) Small quantities of other liquid pharmaceuticals, which are not controlled substances, anti infective drugs, or anti neoplastics, can be flushed into sewers. If there are no sewers or there is no functioning sewage treatment plant, liquid pharmaceuticals can be first diluted with large volumes of water and poured into large watercourses, providing they are immediately dispersed and diluted by the flowing river water. Liquid pharmaceutical waste may be disposed of using the cement encapsulation procedure (see Section 2.3), high temperature incineration or in cement kilns (see Section 2.8). It is not acceptable to discharge liquid pharmaceuticals, diluted or not, into slow moving or stagnant surface waters.

Ampoules :

Ampoules These can be crushed on a hard impermeable surface (e.g. concrete) or in a metal drum or bucket using a stout block of wood or a hammer. Workers doing this should wear protective equipment, such as eye protection, boots, clothing and gloves. The crushed glass should be swept up, placed in a container suitable for sharp objects, sealed and disposed of in a landfill. The liquids released from the ampoules should be diluted and disposed. Ampoules should not be burnt or incinerated as they will explode, possibly causing injury to operators and damage to the furnace or incinerator. Melted glass will also clog up the grate of a furnace or incinerator if the operating temperature is above the melting point of glass. Volatile liquids in small quantities can be allowed to evaporate in the open air.

Anti-infective drugs :

Anti-infective drugs Anti-infective drugs should not be discarded in an untreated form. Generally they are unstable and are best incinerated, and if that is not possible encapsulated or inertized . Liquid anti-infective drugs may be diluted in water, left for two weeks and disposed to the sewer. Controlled substances Controlled substances must be destroyed under supervision of a pharmacist or the police depending on national regulations. Such substances must not be allowed into the public domain as they may be abused. They should either be rendered unusable, by encapsulation or inertization, and then dispersed among the municipal solid waste in a landfill, or incinerated

Antineoplastics :

Antineoplastics Anti neoplastic drugs, previously called cytotoxics or anti-cancer drugs, have the ability to kill or stop growth of living cells. They are used in the chemotherapy of cancer which is usually performed in specialized treatment centres. It is extremely unlikely that they would form part of an aid donation in emergencies. However, if unwanted and discharged into the environment they can have very serious effects, such as interfering with reproductive processes in various life forms. Their disposal must therefore be handled with care. Anti neoplastics should be segregated from other pharmaceuticals and kept separately in clearly marked containers with rigid walls9. They should ideally be safely packaged and returned to the supplier for disposal.

Antineoplastics :

Antineoplastics Special treatment for antineoplastics For antineoplastics drums should be filled to 50% capacity with drugs, after which a wellstirred mixture of lime, cement and water in the proportions of 15:15:5 (by weight), should be added and the drums filled to capacity. A larger quantity of water may be required sometimes to attain a satisfactory liquid consistency. The drums should then be sealed by seam or spot welding and left to set for 7 to 28 days. This will form a firm, immobile, solid block in which the wastes are relatively securely isolated. The drums are then placed at the working face of a landfill which has been lined with an impermeable layer of clay or membrane.

Disinfectants :

Disinfectants In general disinfectants do not have an expiry date. They can be stored and gradually used over time so there is no real need to dispose of them. Large quantities of disinfectants must not be flushed into the sewer, as they may kill the bacteria in a sewage works and so stop the biological treatment of the sewage. Similarly large quantities should not be put into watercourses since the disinfectants will damage aquatic life. Small quantities of diluted disinfectant may be disposed of by discharge to a sewer providing the operation is supervised by a pharmacist and the quantities are strictly controlled to set limits. The guideline control proposed is 50 L total /day, with the disposal spread over the whole working day.

PowerPoint Presentation:

If possible, disinfectants should be used, for example for toilet cleaning in hospitals. Some disinfectants with strong bactericidal and antiviral activity, such as Lysol (50% cresylic acid), may have an expiry date. If this date has past, the material can still be used for general disinfection purposes at an appropriate dilution decided by a pharmacist, or disposed of in a chemical waste disposal facility or a cement kiln.

Aerosol canisters :

Aerosol canisters Disposable aerosol canisters and inhalers should not be burnt or incinerated, as high temperatures may cause them to explode, possibly causing injury to operators and/or damage to the furnace or incinerator. Provided they do not contain poisonous substances they should be disposed of in a landfill, dispersed among municipal solid wastes.

PowerPoint Presentation:

Rule of the three R’s: " Reduction, Reuse and Recycling ", based on the premise that the best waste is no waste. Waste is used to recover materials that can be put to subsequent use and the consumption of new raw materials is therefore avoided.

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