E-drug: Disposal of expired drugs
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Dear e-druggers,
In Bolivia, one of the world's cleanest countries, we have a new very
strict legislation to environment protection. Ambient authorities ask us
about regulations of safety of disposal expired medicines. In our
knowledge, drugs are in general biological substances with no toxicity
for the environment, not requiring special conditions for disposal.
Can anybody help us about special regulations, special risks or special
conditions for disposal expired drugs??
Thanks and happy new year for all.
Dr. Francisco Rossi
Project Manager Essential Drugs Programme
PAHO/WHO La Paz, Bolivia
frossi@salud.ops.org.bo
[Comment: I fear it is not that easy. There have been a number
of e-drug messages on disposal of expired drugs and medical
supplies on the e-drug forum recently. Below some of them
(and some abbreviated). Hilbrand Haak, E-drug moderator.]
E-DRUG: Hazardous drugs in developing countries
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BMJ No 7122 Volume 315, Editorial Saturday 13 December 1997.
"Hazardous drugs in developing countries"
E-DRUG: Unethical drug donations?
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According to today's issue of the New England Journal of
Medicine (Dec 18, 1997 Vol. 337, No 25. Berckmans P, Dawans V,
Schmets D, et al. Inappropriate Drug-Donation Practices in Bosnia
and Herzegovina, 1992 to 1996) at least half the drugs donated
during the war in Bosnia were unusable, and there is evidence the
relief effort may have been used to dump outdated supplies. For
details go to the journal's website http://www.nejm.org.
E-DRUG: Disposal of unwanted drugs and clinical waste
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De Montfort University (Leicester - UK) is developing a low-cost,
simple technology, high-temperature incinerator. Designed originally
for combustion of clinical waste, unwanted pharmaceuticals have now
been included in the project at ECHO's instigation.
The design is based on a single combustion chamber with secondary
combustion of waste gases. It ensures that with proper use the
combustion temperature remains above 850 deg.C. At or above this
temperature, the incinerator can burn up to 50kg waste per hour,
depending on the calorific value of the material and whether it is
dry or wet.
The prototype is fuelled by ordinary fire wood, but gas and liquid
fuel models will be developed in the future. Depending on local
costs, the full construction ready-for-use should cost less than
1000 pounds sterling.
Tests on the wood-fired prototype have proved that:
anatomical material, dressings, pharmaceuticals, are completely
reduced; objects of mild or stainless steel (injection needles,
containers) are totally or partially reduced and rendered
unusable; glass objects are partly melted, removing all sharp
edges; resulting ash or debris is non-hazardous, low-volume
and easily disposed of.
The entire project is funded by UK Dept. for International
Development and the pilot phase is virtually complete. Field
trials and a Demand Survey will be carried out during the next
twelve months. Two sites have already been identified for
trials of clinical waste combustion. In view of concerns about
disposal of unwanted drugs and sharps, ECHO has been
asked to identify from the 'essential drugs' community a
further two to four sites for trials where combustion of
unwanted pharmaceuticals and sharps will be a major focus.
Such sites must be in accessible areas and with access to expert
engineering help (eg. at a university) so that any field
modifications to the design can be correctly carried out.
Participants are also required for the Demand Survey. The need
for such an incinerator is very evident from past correspondence
but the Demand Survey is designed to find out who actually will
be able to spend money on setting up and running the incinerator
and to check out environmental and safety considerations as well.
The trials and survey will be restricted, for management reasons, to
a small number of countries - Cameroon, Malawi, Tanzania, Zimbabwe,
Bangladesh, India, Nepal. Anyone in these countries who is
interested in either the Field Trials or the Demand Survey, or is
just interested to know more, should contact me direct by e-mail as
soon as possible. A two-page summary of the project, with a
(not-to-scale) drawing of the incinerator, is available.
When the Trials and Survey are complete (towards the end of 1998) it
is expected that the design will be made available and that the
components will be marketed by ECHO in a kit format to supplement
materials which can be sourced locally. The construction is simple
but the measurements are crucial - the incinerator should not be
constructed without the approved design.
Carolyn Green, Sen. Pharmaceutical Adviser
ECHO International Health Services
Ullswater Crescent, Coulsdon, Surrey CR5 2HR, UK
Fax 0044 181 668 0751
Tel 0044 181 660 2220
e-mail greencm@echohealth.org.uk
E-DRUG: Guidelines for Drug Disposal: Request for comments on first draft
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Dear e-druggers,
The WHO Action Programme on Essential Drugs (DAP) is co-ordinating a
process to establish a consensus on guidelines for disposal of
unwanted drugs. The original draft was written for the WHO Office for
Humanitarian Assistance in Bosnia Herzegovina to assist the local
authorities dispose of an estimated 800 metric tonnes of unwanted
drugs stockpiled throughout the country. The WHO European Centre for
Environment and Health, Nancy Office, France, the WHO Regional Office
for Europe, Copenhagen and Pharmaciens sans Frontires have all
contributed to the guidelines which were subsequently lightly edited
for a wider audience.
The guidelines are intended for middle and low income countries or
for use in the aftermath of major man-made and natural disasters when
a proportion of donated drugs are found to be unhelpful (the second
disaster). It is hoped that the advice will assist officials
responsible for pharmaceuticals in a ministry of health, in the drug
regulatory authority, regional health authorities, and directors of
health facilities when faced with the problem of disposal of unwanted
and out of date drugs.
All comments and assistance would be greatly appreciated. Currently
technical comments have been invited from a wide group of
international experts and further observations and help is welcome.
The text is available on the WHO/DAP website at
http://www.who.ch/programmes/dap/DAP_Homepage.html
For hardcopy or an e-mail attachment please contact me at the address
below. In your request please state whether you would prefer hard copy
or an e-mail attachment. The document consists of 22 pages of which
one page, containing a flow chart for the sorting process, cannot be
The closing date for comments is mid January 1998.
Please send replies directly to:
Dr Robin Gray
WHO Action Programme on Essential Drugs
20 Avenue Appia
CH-1211 Geneva
Switzerland
fax: (41) 22 791 4167
e-mail: grayr@who.ch
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