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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]

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.

References

  1. ^ a b c Pomerantz, JM (23 April 2004). "Recycling expensive medication: why not?". MedGenMed : Medscape general medicine. 6 (2): 4. PMC 1395800. PMID 15266231.
  2. ^ a b Connelly, D. (5 July 2018). "Should pharmacists be allowed to reuse medicines?". The Pharmaceutical Journal. A Royal Pharmaceutical Society Publication. 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). doi:10.3390/s20113080.
  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). doi:10.3390/s20113080.
  5. ^ Bekker, C.L. "What does it cost to redispense unused medications in the pharmacy? A micro-costing study". BMC Health Serv Res. 19 (1). doi:10.1186/s12913-019-4065-6.
  6. ^ Bekker, C.L. "Redispensing of unused HIV Post-exposure prophylaxis therapy for medical exchange students". Travel Med Infect Dis. 29: 82-83. doi:10.1016/j.tmaid.2019.02.005.
  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. ^ a b 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. "Willingness of patients to use unused medication returned to the pharmacy by another patient: a cross-sectional survey". BMJ open. 9 (5). doi:10.1136/bmjopen-2018-024767.
  14. ^ Alhamad, H. "How do people conceptualise the reuse of medicines? An interview study". Int J Pharm Pract. 26 (3): 232-241. doi:10.1111/ijpp.12391.
  15. ^ Mcrae, D. "The redistribution of medicines: could it become a reality?". Int J Pharm Pract. 24 (6): 411-418. doi:10.1111/ijpp.12275. hdl:10369/7993.
  16. ^ Bekker, C.L. "Redispensing of medicines unused by patients: a qualitative study among stakeholders". Int J Clin Pharm. 39 (1): 196-204. doi:10.1007/s11096-017-0424-8.
  17. ^ "The ROAD to sustainable medication use: redispensing unused oral anticancer drugs". Dutch trial register. Retrieved January 31, 2021.
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