Many are not aware that unused medicines and expired drugs can be sent to MoH’s facilities or to community pharmacies for disposal
by AUFA MARDHIAH
ANY surplus or expired medication should be appropriately disposed of to avoid harm to both humans and the environment.
This, however, is often overlooked or ignored, especially with over-the-counter (OTC) medicines being affordable and easily available.
Large supplies of OTC medicines like paracetamol, for example, have been in almost all homes to treat Covid-19-like symptoms during the peak of the pandemic until now and most of the unused medicines would expire and be thrown out with the rest of household trash.
Malaysian Pharmacists Society president Amrahi Buang said there are several ways to dispose of expired drugs.
“The public can send unused and expired drugs to the Health Ministry’s (MoH) facilities or to the community pharmacies for disposal,” he told The Malaysian Reserve (TMR), highlighting that MoH’s Pharmaceutical Ser vices Division had initiated a programme called “Return Your Medicines” in 2010.
According to the programme’s website, patients can use the service provided to return any unused or excess medications to MoH for safe disposal.
Besides that, these medications can also be returned to any MoH hospital or health clinic’s pharmacy counter or drug return box.
Amrahi said that ultimately, the problem circles back to being educated in health and medication, which is lacking within the population, and to educate the public the industry needs a mediator.
As such, he pointed out that pharmacists must be at the forefront as guardians of medicine.
“Instead of working in silos, community pharmacists are strongly encouraged to start working collaboratively not just among other pharmacists, but also with the industries in the ecosystem to educate, implement and practise safe medication disposal throughout,” he said.
Alpro Foundation CEO Ostwin Paw concurred that in addition to understanding what constitutes unused or excess medicine, leaders in the industry must kickstart the conversation on the impact and risks of unsafe medication disposal methods on the environment.
On that note, Malaysian Community Pharmacy Guild president Foon Hwei Foong said that if certain medications are not disposed of properly, they can create harm to both human health and the environment.
“Crushing medications and flushing them down the toilet was considered the normal disposal behaviour among patients and consumers about 15 years ago.
“If unwanted medication that has been disposed of in landfills is absorbed by water streams, there are chances that it will eventually lead back to the water that we drink,” she said, adding that the consequences would be severe if psychotropic drugs end up in the water systems.
Similarly, Monash University Malaysia School of Pharmacy lecturer Dr Saw Pui San said improper disposal of antibiotic medicines could cause the public to develop antibiotic resistance if they somehow consume the water that contains antibiotic medicines.
“Furthermore, contraceptive medicine which was irresponsibly discarded could also cause sterilisation of fishes in the ecosystem,” she said.
To ensure excess or expired medications are properly disposed of, Alpro Pharmacy chief pharmacist Lim En Ni revealed that the firm has started a “Safe Medication Disposal” campaign in 2021 in a joint effort with Johnson & Johnson, GSK plc, Duo- pharma Biotech Bhd, Bayer AG, Viatris Inc and Menarini Group.
“We launched the campaign by placing dedicated medication disposal bins at all Alpro Pharmacy outlets nationwide to collect excess medicines to be disposed of ethically without polluting the environment.
“To date, we have safely disposed of more than 1,000kg of medication waste,” Lim said, adding that the campaign had garnered more than 100,000 signatures from the community pledging support for Alpro Pharmacy.
Meanwhile, commenting on the issue of whether or not the medicine supply in Malay- sia is adequate to cater to the people, Amrahi said medicine security should be a national agenda besides food.
“The Logistics Division of MoH’s Pharmacy Services Programme is the department that closely monitors medicine supplies in the country. However, due to panic buying and hoarding, there was a period during the peak of the Covid-19 pandemic that healthcare facilities and pharmacies faced insufficient supplies,” he said, adding that pharmacists could suggest alternatives wherever possible to be used for treatment.
For this, Lim said due to the high demand for OTC medicines, their pharmacists would inform patients about brand substitution and alternative medication with the same indication.
“Additionally, they also offer compounding service to make medicine to order, based on a prescription that meets the specific needs of the patients,” she added.
In terms of medicine pricing, Malaysian Medical Association president Dr Muruga Raj Rajathurai said the price of common medicine in Malaysia is still quite affordable.
“However, it may vary in comparison to neighbouring countries as the cost may be high in Singapore and low elsewhere. Other than that, the costs of innovators or newly-developed medicines are also high, and these affect medicine pricing,” he said to TMR.
On the price difference between medicines in public and private health facilities, he said this is due to the public sector send- ing out tenders for its medicines and buying in large volumes.
Agreeing with Dr Muruga Raj, Amrahi said medicine prices in Malaysia are affordable compared to neighbouring countries due to a price watch under MoH’s Pharmacy Services Programme, as well as the Malaysian National Medicines Policy’s objectives, which are to promote equitable access to safe and effective essential drugs of good quality.
However, he said the price difference between the public and private health facilities is due to medicine procurement under Treasury Instructions (TI).
“The procurement of medicines in the public sector has been done under TI. The concessionaire to Pharmaniaga Bhd is responsible for ensuring fair pricing for selected items, while the remainder is for open tender under TI’s standard operating procedures.
“Nevertheless, pool procurement between MoH and university hospitals under the Higher Education Ministry has managed to control medicine pricing for the people,” he said.
Lim, on the other hand, said medicine prices in Malaysia are determined by free-market economics without any control by the government.
“According to the 2019 Medicine Price Index, Malaysia ranked 48th out of 50 countries on prices of common medicines treating conditions like heart disease, asthma and high blood pressure with prices lower than Indonesia but higher than Thailand.
“MoH has plans in doing price control for medicine from upstream to downstream. However, not much information is being circulated as it is still in the preliminary discussion phase,” she said to TMR.
Furthermore, she said the prices of the medicine are cheaper in the public sector because it is usually procured through concession supply and national tenders or directly from pharmaceutical companies and distributors.
“Whereas in the private sector, the procurement is done separately across facilities from multiple sources, namely the manufacturers, importers, wholesalers and distributors,” she explained.
Other than the sources, she noted that medicines are usually procured in bulk by the public sector to cater to more than 2,500 MoH-managed health and community clinics. Meanwhile, in the private sector, the quantity of medicines procured is much lesser.
“MoH has also started to explore the possibility of group procurement for selected medication on behalf of both private and public sectors. However, to date, there are no solid plan from the authorities yet,” she added.
- This article first appeared in The Malaysian Reserve weekly print edition