From NSAIDs to proton pump inhibitors: how to dispose of drugs to protect the environment

Also drugs they pollute the environment and our every little behavior makes a difference. «After being taken in by humans they end up in wastewater through urine And I did both in unchanged form, and of metabolitethat is, as a product transformed by the organism becoming a totally or partially inactive molecule” explains Elisabetta Poluzzi, professor of Pharmacology at the University of Bologna. But medicines can contaminate soil, rivers, lakes and seascausing damage to plants and animals, even when we dispose of them improperly, eliminating them through the toilet, sink and rubbish bin at home, rather than placing them correctly in the appropriate bins outside pharmacies or in recycling centers.

90 active ingredients analyzed

For the first time the Italian Medicines Agency (Aifa), in the latest report on the use of medicines in Italyreferring to 2022, dedicated a chapter to the environmental impact of the medicines we take. 90 active ingredients were analyzed (selected from those with the highest consumption, those with the highest environmental toxicity and those monitored by the European Watch list system) belonging to 28 therapeutic classes. «We calculated the relationship between the estimated concentration of the drug in surface waters, released through urine and feces, and the toxicity value of the substance for aquatic organisms and from the reconstructed scenario — illustrates Elisabetta Poluzzi — . For half of these classes at least one active ingredient with a high or moderate environmental risk was detected».

In particular some of the most used in our country, which fall into the category of non-steroidal anti-inflammatories
«they are highly harmful to the ecosystem, causing cellular damage to fish, with adverse effects on respiration, growth and reproductive capacity». The presence of antibiotics in water also represents a serious threat. «It contributes to the development and diffusion of bacterial resistance to these drugs, which are essential to defeat infections in humans – explains Poluzzi – and altering the environmental microbiota, that is, the set of microorganisms, especially bacteria, present in the soil and water, the role that certain bacteria have in the transformation of some substances that plants and insects feed on is modified, endangering their survival”.

What to do and what not to do

Each of us can do our part to reduce the environmental impact of medicines. «Avoiding stockpiling and taking them when not necessarythe

or and following the correct procedures for disposing of expired or unused packages” recommends the pharmacologist. She concludes: «Environmental risk should become an indicator of the sustainability of the use of medicines, like benefit, clinical risk, cost and accessibility».

In case of expired or unused medicinesit is necessary to separate the packaging (box and information leaflet) from the container of the medicine (blister, bottle, sachet) and place the former in a differentiated manner in the paper bins and the latter in the appropriate bins for the collection of medicines located outside pharmacies or at the ecological islands.

If, however, the drug has run outthe box and the leaflet must be thrown into the paper bin, the empty blister into the plastic bin (or aluminium, depending on the Municipality).

In case of liquid formulationsdo not rinse the residues of the medicine and throw the bottle or vial in the plastic or glass container depending on the material.

If the medicine has expireddo not empty the contents and place the container in the specific bins for medicines.

The tubes, if empty, must be disposed of in aluminum, if they still contain medicine in dedicated bins at pharmacies and landfills. Syringes and medicated plasters (such as those for back pain) go in the undifferentiated collection. To find out the collection points for medicines, consult the website of your municipality or that of the local waste company.

There are 14 “classes” to pay more attention to

Among the 28 therapeutic classes investigated for environmental impact in the latest Aifa report, the 14 classes in which active ingredients with high or moderate risks for the ecosystem were observed are: anti-inflammatories, antihypertensives, antidepressants, proton pump inhibitors, antidiabetics, antibiotics, antiparasitics, oncology drugs, hormonal contraceptives, antihistamines, antifungals, antiasthmatics, immunosuppressants and antivirals for HIV.

«It would be important to extend the analysis to all active ingredients on the market in Italy, not only for human but also veterinary use, to create a national map of the environmental risk of drugs on the basis of which to design interventions to contain it, such as the development of technologies to limit its reaching the environment, also working on prescriptive improvement” declares Elisabetta Poluzzi, professor of Pharmacology and editor of the chapter on the environmental impact of drugs in the Italian Agency report of the drug.

A handbook for storing medicines in the right way

Assosalute (the association that brings together companies producing self-medication drugs, those for which a prescription is not needed) has drawn up a handbook for the correct conservation of medicines. The first habit is to carefully read the storage instructions on the information leaflet. If they are not there, the general rule is to store medicines in a cool, dry place at a temperature no higher than 25 degrees, avoiding direct exposure to heat sources. In the case of formulations that require storage in the fridge (such as insulin), use a thermal container when traveling. Avoid strong temperature changes. During the summer, prefer solid formulations (capsules or tablets). If the medicine changes its appearance (colour, consistency, smell), consult your doctor or pharmacist to understand whether to take it or not. In case of eye drops and creamswhich once opened must be used within a certain time, mark the opening date on the package.

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