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      Expired Medication: Societal, Regulatory and Ethical Aspects of a Wasted Opportunity

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          Abstract

          A massive volume of expired medications amasses annually around the world because of pharmaceutical overprescription, combined with overproduction. The accumulation of pharmaceutical waste imposes ecological, economic and social/ethical burdens. Managing this presumed “waste” has developed into a global challenge due to the absence of specific regulations, unreasonable behavior of the patients, and an improper understanding of the concept of “expired medications” in general. This paper summaries, first, the recent literature reporting practices related to the disposal of unused medications. In this context, 48 papers from 34 countries with a total of 33,832 participants point towards a significant lack of public awareness regarding the appropriate disposal of such biologically potent chemicals. These findings are corroborated by a local survey on the disposal practices of unused medicines among pharmacy students at Saarland University. The regulatory aspects surrounding this topic, often based on the official guidelines for the disposal of expired medications and local waste management strategies, are then discussed in light of these findings. Finally, a closer inspection of the epistemic values of expired medications and different strategies for managing expired medications have been reviewed.

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          Most cited references83

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          Occurrence, fate, and removal of pharmaceutical residues in the aquatic environment: a review of recent research data

          The occurrence and fate of pharmaceutically active compounds (PhACs) in the aquatic environment has been recognized as one of the emerging issues in environmental chemistry. In some investigations carried out in Austria, Brazil, Canada, Croatia, England, Germany, Greece, Italy, Spain, Switzerland, The Netherlands, and the U.S., more than 80 compounds, pharmaceuticals and several drug metabolites, have been detected in the aquatic environment. Several PhACs from various prescription classes have been found at concentrations up to the microg/l-level in sewage influent and effluent samples and also in several surface waters located downstream from municipal sewage treatment plants (STPs). The studies show that some PhACs originating from human therapy are not eliminated completely in the municipal STPs and are, thus, discharged as contaminants into the receiving waters. Under recharge conditions, polar PhACs such as clofibric acid, carbamazepine, primidone or iodinated contrast agents can leach through the subsoil and have also been detected in several groundwater samples in Germany. Positive findings of PhACs have, however, also been reported in groundwater contaminated by landfill leachates or manufacturing residues. To date, only in a few cases PhACs have also been detected at trace-levels in drinking water samples.
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            Household Disposal of Pharmaceuticals as a Pathway for Aquatic Contamination in the United Kingdom

            Pharmaceuticals are produced and used in increasingly large volumes every year. With this growth comes concern about the fate and effects of these compounds in the environment. The discovery of pharmaceuticals in the aquatic environment has stimulated research in the last decade. A wide range of pharmaceuticals has been found in fresh and marine waters, and it has recently been shown that even in small quantities, some of these compounds have the potential to cause harm to aquatic life. The primary pathway into the environment is the use and disposal of medicines; although much of the research in the area currently focuses on the removal of pharmaceuticals during sewage treatment processes, disposal via household waste might be a significant pathway requiring further research. To investigate the household disposal of unused and expired pharmaceuticals as a source of pharmaceutical compounds in the environment, we carried out a survey and interviewed members of 400 households, predominantly from southeastern England. We used the information on when and how they disposed of unfinished pharmaceuticals to construct a conceptual model to assess the pathways of human pharmaceuticals into the environment. The model demonstrated that disposal of unused pharmaceuticals, either by household waste or via the sink or toilet, may be a prominent route that requires greater attention.
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              The environmental side effects of medication.

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                Author and article information

                Journal
                Int J Environ Res Public Health
                Int J Environ Res Public Health
                ijerph
                International Journal of Environmental Research and Public Health
                MDPI
                1661-7827
                1660-4601
                27 January 2020
                February 2020
                : 17
                : 3
                : 787
                Affiliations
                [1 ]Division of Bioorganic Chemistry, School of Pharmacy, Saarland University, 66123 Saarbruecken, Germany; faez.nahas1@ 123456gmail.com (F.A.); s8pryebo@ 123456stud.uni-saarland.de (P.Y.); s8ahabdi@ 123456stud.uni-saarland.de (A.Y.A.)
                [2 ]UTCBS (Chemical and Biological Technologies for Health Group), Faculté de Pharmacie de Paris, Université de Paris, CNRS, INSERM, 75006 Paris, France; louise.fliedel@ 123456parisdescartes.fr
                Author notes
                Author information
                https://orcid.org/0000-0002-3931-1936
                https://orcid.org/0000-0002-6235-6331
                https://orcid.org/0000-0002-1965-4253
                https://orcid.org/0000-0001-5976-6594
                Article
                ijerph-17-00787
                10.3390/ijerph17030787
                7037917
                32012703
                4ce0f16d-7cc8-45c6-ab59-2a56add64a1b
                © 2020 by the authors.

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

                History
                : 30 December 2019
                : 20 January 2020
                Categories
                Review

                Public health
                expiration date,expired medications,pharmaceutical waste,waste management
                Public health
                expiration date, expired medications, pharmaceutical waste, waste management

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