Skip to main content

Issues around household pharmaceutical waste disposal through community pharmacies in Croatia

International Journal of Clinical Pharmacy volume 36, pages 556–563 (2014)Cite this article

Abstract

Background Croatian regulations mandate pharmacies to receive unused medicines from households. Pharmacies are considered as producers and holders of pharmaceutical waste and are obliged to finance this service. Model where pharmacies are responsible for financing disposal of unused medicines without reimbursement is not common in Europe. Present service was not tested before implementation. Objective To investigate the elements of the pharmaceutical waste disposal service provided by pharmacies, and to gain insight into the factors that might influence the effectiveness of the service. Setting All pharmacies in the city of Zagreb. Method Each pharmacy was asked to weigh the collected waste from the public during a period of 30 days, between June 1st and July 10th of 2011, absent from any media advertisement and answer a specifically designed questionnaire that was exploring possible connections between the amount of collected waste, type of pharmacy ownership, discretion while disposing, location of the container, appropriate labeling and to compare the amount of collected waste between neighborhoods. Main outcome measure Quantity of collected unused medicines from the public. Results Of 210 pharmacies, 91 participated completing the questionnaire (43 % response rate). The total amount of collected waste was 505 kg. Pharmacies owned by the city of Zagreb had higher response rate (74 %) than privately owned pharmacies (36 %), and collected significantly higher amount of waste. Anonymity when disposing influenced collected quantity, while labelling and location of the container did not. There were differences in the amount of collected waste between neighborhoods due to the demographic characteristics and number of pharmacies per capita. Conclusion The effectiveness of the pharmacy service of collecting unused medicines in Croatia shows a number of weaknesses. The amount of collected medicines is below the European average. Functioning of the service seems to be negatively influenced by the type of pharmacy ownership, distribution of pharmacies and lack of anonymity when disposing unused medicines. Additionally, type of ownership is connected with financial burden for pharmacies. Governmental bodies should examine current legislation regulating pharmaceutical waste disposal, particularly financial responsibility for providing the service, in order to increase pharmacies’ compliance. Advertising of the service may increase awareness of the importance of proper disposal of unused medicines.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

References

  1. Kümmerer K. Pharmaceuticals in the environment. Annu Rev Environ Resour. 2010;35:57–75.

    Article  Google Scholar 

  2. Heberer T. Occurrence, fate and removal of pharmaceutical residues in the aquatic environment: a review of recent research data. Toxicol Lett. 2002;131:5–17.

    CAS  PubMed  Article  Google Scholar 

  3. Hannah R, D’Aco VJ, Anderson PD, Buzby ME, Caldowell DJ, et al. Exposure assessment of 17 α-ethinylestradiol in surface waters of United States and Europe. Environ Toxicol Chem. 2009;28:2725–32.

    CAS  PubMed  Article  Google Scholar 

  4. Caldwell DJ, Mastrocco F, Hutchinson TH, Lange R, Heijerick D, et al. Derivation of an aquatic predicted no-effect concentration for the synthetic hormone, 17 α-ethinylestradiol. Environ Sci Technol. 2008;42:7046–54.

    CAS  PubMed  Article  Google Scholar 

  5. Carlsen E, Giwercman A, Keiding N, et al. Evidence for decreasing quality of semen during past 50 years. BMJ. 1992;305:13–60.

    Article  Google Scholar 

  6. Kümmerer K. Antibiotics in the environment—a review—part II. Chemosphere. 2009;75:435–41.

    PubMed  Article  Google Scholar 

  7. Kümmerer K. The presence of pharmaceuticals in the environment due to human use—present knowledge and future challenges. J Environ Manag. 2009;90:2354–66.

    Article  Google Scholar 

  8. Bound JP, Voulvoulis N. Household disposal of pharmaceuticals as a pathway for aquatic contamination in the United Kingdom. Environ Health Perspect. 2005;113:1705–11.

    PubMed Central  PubMed  Article  Google Scholar 

  9. Ruhoy IS, Daughton CG. Beyond the medicine cabinet: an analysis of where and why medicines accumulate. Environ Int. 2008;34:1157–69.

    CAS  PubMed  Article  Google Scholar 

  10. Ahel M, Jeličić I. Phenazone analgesics in soil and groundwater below a municipal solid waste landfill. In: American Chemical Society. Pharmaceuticals and Personal Care Products in the Environment. Washington: ACS Symposium Series 791; 2001. p. 100–115. ISBN: 0-8412-3739-5.

  11. Ahel M, Terzić S, Tepić N. Organic contaminants in the Jakusevec landfill and their impact on groundwater quality. Arh Hig Rada Toksikol. 2006;57(3):307–15.

    CAS  PubMed  Google Scholar 

  12. Terzić S, Senta I, Ahel M, Gros M, Petrović M, Barcelo D, Müller J, Knepper T, Martí I, Ventura F, Jovančić P, Jabučar D. Occurrence and fate of emerging wastewater contaminants in Western Balkan Region. Sci Total Environ. 2008;399:66–77.

    PubMed  Article  Google Scholar 

  13. Terzić S, Ahel M. Organic contaminants in Croatian wastewaters. Arh Hig Rada Toksikol. 2006;57:297–306.

    PubMed  Google Scholar 

  14. Croatian Ministry of Environmental and Nature Protection. Pravilnik o gospodarenju medicinskim otpadom [Ordinance on Medicinal Waste Management]. Croatian Official Gazette No. 72/07.

  15. Guirguis K. Medicines collected for disposal by outreach pharmacists in Australia. Pharm World Sci. 2010;32:52–8.

    PubMed  Article  Google Scholar 

  16. Tong AYC, Peake BM, Braund R. Disposal practices for unused medicines around the world. Environ Int. 2011;37:292–8.

    PubMed  Article  Google Scholar 

  17. Seehusen DA, Edwards J. Patient practices and beliefs concerning disposal of medicines. J Am Board Fam Med. 2006;19:542–7.

    PubMed  Article  Google Scholar 

  18. Kümmerer K, Hempel M. Green and sustainable pharmacy. Berlin: Springer; 2010. Part III, Use and Disposal of Pharmaceuticals; p. 179–201. ISBN: 978-3-642-05198-2.

  19. Zakon o otpadu [Waste Act]. Croatian Official Gazette No. 178/04 and 111/06.

  20. Štimac D, Čulig J, Šostar Z, Bolanča M. Lijekovi kojima je istekao rok trajanja i njihovo javnozdravstveno značenje [Unused/Expired drugs and their importance for public health]. Pharmaca. 2007;45(0031–6857):81–8.

    Google Scholar 

  21. Štimac D, Čulig J, Šostar Z, Bolanča M. Opasni otpad: zbrinjavanje starih lijekova [Hazardous waste: unused drugs disposal]. Gospodarstvo i okoliš. 2007;85:160–4.

    Google Scholar 

  22. European Environment Agency 2001. Pharmaceuticals in the Environment. Results of EEA Workshop. EEA Technical Report No 1/2010. Denmark: ISBN: 978-92-9213-063-3.

  23. ZAGREB.HR: Official website of the City of Zagreb. Osnovni podaci o gradskim četvrtima [Basic information about neighborhoods] 2012 [Internet] Accessed in March of 2014: http://www.zagreb.hr/default.aspx?id=12915.

  24. Croatian Chamber of Pharmacists. Register of Pharmacies. June, 2011.

  25. Zakon o ljekarništvu [Pharmacy Act]. Croatian Official Gazette No. 121/03, 142/06, 35/08, 117/08.

  26. Croatian Chamber of Pharmacists. Internal documents: minutes from the meetings of the Commission for technical and professional issues. 2008, 2009. Located at: Croatian Chamber of Pharmacists, Martićeva 27, Zagreb, Croatia.

  27. Čogelja Čajo G, Osrečki V, Tomić S. Utjecaj lijekova na okoliš [Pharmaceuticals and their impact on the environment]. Kem Ind 2010; 59(7–8):351–354.

  28. Zakon o lijekovima [Medicinal Products Act]. Croatian Official Gazette No. 113/08.

  29. York Health Economics Consortium/The School of Pharmacy University of London. Evaluation of the Scale, Causes and Costs of Waste Medicines. Final Report. ISBN 978 090 293 620 1.

  30. Krupiene J, Dvarioniene J. Pharmaceutical pathways to the environment in Lithuania. Environ Res Eng Manag. 2007;41(3):33–9.

    Google Scholar 

  31. Marcelić S. Zagrebačke četvrti i stupanj obrazovanja. [Zagreb’s neighborhoods and the level of education] [Internet] Accessed in March of 2014: http://www.grupa22.hr/zagrebacke-cetvrti-i-stupanj-obrazovanja/.

  32. Vitale K, Palian M, Jonjić D, Milić M, Sović S, Džakula A. Patients’ practice and knowledge of pharmaceuticals disposal: example from some rural areas of Croatia. In: Vitale K. (ed.) Environmental and Food Safety and Security for South-East Europe and Ukraine. NATO Science for Peace and Security Series. Springer, 2012. p. 213–217. ISBN: 978-94-007-2955-1.

  33. ADIVA—Health through Advice. [Internet] Accessed in March of 2014: http://www.adiva.hr/#!.

  34. Vitale K, Džakula A, Šuljić P, Todorović G, Vuletić S, Čović A. Who empowers women towards healthier lifestyles? Example from western Croatia. Coll Antropol. 2009;33(1):165–70.

    PubMed  Google Scholar 

  35. Pharmaceutical Group of European Union. Fact Sheet: Waste Management. 2006. Ref No. : 06.07.04E 009FS.

  36. Pharmaceutical Group of European Union. Fact Sheet: Services provided in and by community pharmacies. 2008. Ref No: 10.02.10E 004FS.

  37. Malović A, Huml D. HLJK o gospodarenju medicinskim otpadom [Croatian Chamber of Pharmacists about medicine waste management] Bilten HLJK 2008; 2008(3/4):191–193. Accessed in March of 2014: http://www.hljk.hr/LinkClick.aspx?fileticket=ghLwzmJ4niM%3d&tabid=69&mid=545.

  38. PGEU Fact Sheet: Community pharmacies services. 2012. Ref No: 12.07.30E 011FS.

  39. Health Canada. Environmental Impact initiative. Pharmaceutical Disposal Programs for the Public: a Canadian Prospective. November 2009. [Internet] Accessed in March of 2014: http://www.enviroadvisory.com/pdf/Takeback.pdf.

  40. Strategija gospodarenja otpadom Republike Hrvatske [Waste management strategy of Republic of Croatia]. Croatian Official Gazette, 130/05.

  41. Kusturica MP, Sabo A, Tomić Z, Horvat O, Solak Z. Storage and disposal of unused medicines: knowledge, behavior, and attitudes among Serbian people. Int J Clin Pharm. 2012;34:604–10.

    PubMed  Article  Google Scholar 

  42. Štimac D, Čulig J, John V. Propisivanje statina u Zagrebu (2001–2006) i njihova uloga u sekundarnoj prevenciji kardiovaskularnih bolesti. [Statin prescribing in the City of Zagreb (2001–2006) and their role in secondary prevention of cardiovascular events]. Acta Med Croatica. 2009;63(2):173–7.

    PubMed  Google Scholar 

  43. Štimac D, Čulig J, Vukušić I, Cattunar A, Stojanović D. Quality of the cardiovascular drugs prescribing in Zagreb during the period 2001–2004. Medicinski glasnik Ljekarske komore Zeničko-dobojskog kantona. 2009;6(1):118–24.

    Google Scholar 

  44. Polić-Vižintin M, Tripković I, Štrban-Štok Z, Štimac D, Čulig J. Analiza indikatora morbiditeta, mortaliteta i potrošnje lijekova u Zagrebu. [Indicators of morbidity, mortality and drug utilization in the city of Zagreb] Med Jadertina. 2006; 36(1–2): 31–40. Accessed in March of 2014: file:///C:/Users/owner/Downloads/polic_vizintin_et_all.pdf.

  45. Bošković J, Čulig J, Leppee M, Huml D. Pharmacist’s advice could improve the patients’ medicine adherence in chronic diseases. ESCP-GSASA 2009 Symposium on Clinical Pharmacy, Abstractbook/Beney, Johnny—Geneva: European Society of Clinical Pharmacy (ESCP). 2009. 31–31.

Download references

Acknowledgments

We thank The Croatian Chamber of Pharmacists for assistance in data collection and all pharmacies who participated in this study.

Funding

The study was funded by the non-governmental organization “PIN Partnership-Information-Networking for Health”, Zagreb, Croatia.

Conflicts of interest

The authors have no conflicts of interest to declare.

Author information

Affiliations

  1. School of Medicine, School of Public Health “Andrija Štampar”, University of Zagreb, Rockfellerova 4, 10 000, Zagreb, Croatia

    Danijela Jonjić & Ksenija Vitale

Authors
  1. Danijela Jonjić
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ksenija Vitale
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Danijela Jonjić.

Appendix: Questionnaire

Appendix: Questionnaire

  1. 1.

    Information about the collection of pharmaceutical waste

Please specify:

  • Are citizens providing pharmaceutical waste in the containers anonymously, or handing over to the pharmacist or pharmaceutical technician?

  • Are the containers for pharmaceutical waste located in the customer area or behind the counter in the pharmacist’s area?

  • Please indicate what is written as the label for the pharmaceutical waste containers in your pharmacy.

  • The amount of pharmaceutical waste collected from households during the period from 1st of June 2011 to 10th of July 2011: _____________________________________ (kg)

  1. 2.

    Pharmacy neighborhood and ownership type

  • Pharmacy neighborhood location (please circle the appropriate letter):

a. Črnomerec i. Sesvete
b. Trešnjevka North j. Donja Dubrava
c. Trešnjevka South k. Gornja Dubrava
d. Trnje l. Peščenica—Zitnjak
e. Downtown m. New Zagreb—East
f. Uppertown n. New Zagreb—West
g. Podsljeme o. Maksimir
h. Medvescak p. Podsused-Vrapče
  s. Stenjevec

  • Form of pharmacy ownership (please circle the appropriate letter):

  1. a.

    private independent pharmacy

  2. b.

    leased pharmacy

  3. c.

    private pharmacy chain

  4. d.

    pharmacy owned by the city of Zagreb

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Jonjić, D., Vitale, K. Issues around household pharmaceutical waste disposal through community pharmacies in Croatia. Int J Clin Pharm 36, 556–563 (2014). https://doi.org/10.1007/s11096-014-9936-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11096-014-9936-7

Keywords

  • Croatia
  • Disposal
  • Household waste
  • Pharmaceutical waste
  • Pharmacies
  • Unused medicines