Disposal procedures of expired and unserviceable pharmaceuticals in Lesotho M Ramathebane, Bastiaan Remmelzwaal 1

Presentation outline Background Introduction Methodology Findings Conclusions Recommendations 2

Introduction Standard operating procedures for disposal of medicines as document should be available in all the health facilities. It helps to guide disposal of medicines and medical supplies when needed. Disposal of these item should be recorded and reports be kept in the facilities for later use. When followed disposal procedures will assist in avoiding unnecessary exposure of medicines by humans and animals that are not supposed to be exposed to such medicines 3

Methodology The objective of the study was to assess the availability of standard operating procedures for disposal of medicines, and how medicines are disposed in the health facilities. The study was carried out in 145 clinics and data was collected, captured and analyzed. Tables were generated and results discussed. 4

Example of unserviceable stock 5

Standard operating procedure 6

Disposing of medicines and unserviceable stock 7

Findings The main findings showed that standard operating procedures are available in the health facilities even though some still did not have them. Despite the availability of standard operating procedures, many health facilities are still not carrying out disposal of medicines but send them to the hospitals, and District Health Management Teams for disposal. Disposal methods used include: burn, burn and bury, dissolve and pour into the main drainage systems. 8

From Literature According to Kreisberg (2007 medicines may have certain effects on marine, animals and humans such as growth retardation in children and embryonic changes. For example it was found that Fluoxetine enhances the release of ovary- stimulating hormones in crayfish (Kulkarni G. 2007). While Selective While Selective Serotonin Reuptake Inhibitors may elicit aggressive behavior in lobsters, causing subordinates to engage in fighting against the dominant member, and reducing the propensity to retreat (Huber, et al 1997). 9

10 Studies carried out in the UK showed levels of many commonly used medicines in water, the medicines were disposed from the homes of patients, and this was found to affect marine life and environment (Bound J. P., and Voulvoulis N., 2005). Medicines have differing characteristics, some medicines become inactive metabolites, while other become active metabolites with longer half lives, and there are those that remain the same after expiry, or use and when these substance enter the environment or water they cause unknown damage. It is important especially in Lesotho where the country worries more about the availability of medicines, not the effects of medicines on the human and environment. This leads to excessive availability of medicines on the streets including antibiotics and other prescription medicines.

Conclusions It is concluded that disposal of medicines are properly guided, however disposal is not carried out in all the health facilities. Disposal methods are known but sometimes not followed. 11

Recommendations It is recommended that training of disposal of expired and unserviceable stock should be carried out and standard operating procedures should be available in all the health facilities 12

References Bound J. P. and Voulvoulis N Household Disposal of Pharmaceuticals as a Pathway for Aquatic Contamination in the United Kingdom. Environmental Health Perspective. December; 113(12): 1705–1711. Braund R., Peake B M., and Shieffelbien L Disposal practices for unused medications in New Zealand. Environment International, 35: 952–955. Huber R., Smith K., Delago A., Isaksson K., Kravitz E. A Serotonin and aggressive motivation in crustaceans: altering the decision to retreat. Proceedings of the National Academy of Science. 94: Kreisberg Joel Healthcare, Water and the Environmental Consequences of Pharmaceutical. Accessed on 9/8/12. Kulkarni G. K. Nagabhushanam R., Amaldoss G., Jaiswal R. G., Fingerman M In vivo stimulation of ovarian development in the red swamp crayfish Procambarusclarkia (Girard) by 5-hydroxytryptamine. Invertebrate Reproduction and Development. 21(3): Ministry of health and Social Welfare Good Practice and Code of Conduct. 36p. Ministry of Health and Social Welfare Manual for Drug Supply Management at Hospitals. 67p. Ministry of Health and Social Welfare Standard Operating Procedure for Drugs Supply Management. 149p. 13