Malaysia is highly dependent on its water sources, with 99% of the water supply for domestic use coming from surface water such as streams and rivers.
Research by the World Economic Forum has shown that the concentration of pharmaceuticals in waterways is reaching dangerous levels.
This is both detrimental to human health, as well as the world’s ability to deliver on the UN Sustainable Development Goal to provide clean drinking water and sanitation for all by 2030.
Malaysian Community Pharmacy Guild president Foon Hwei Foong recalled that about 15 years ago – prior to proper disposal systems and awareness of the serious implications caused by the improper disposal of drugs – just throwing them away with the rubbish, or crushing pills and flushing them down the toilet, was considered normal disposal behaviour among consumers.
However, medications disposed of in this manner will either end up in landfills, where the materials can leach into ground water and eventually make their way into the rivers that provide our drinking water, or straightaway enter our rivers via the sewerage system.
Indeed, Dr Saw Pui San, a lecturer from Monash University Malaysia’s School of Pharmacy, shared that there have been reports of contraceptive medicines disposed of in this manner causing sterilisation of fishes in the ecosystem.
She also emphasised how antibiotic resistance – considered as one of the top 10 global health threats facing humankind by the World Health Organization (WHO) – could be fuelled through the prevalence of discarded antibiotics leaking into our water systems.
in terms of regulations and practice in Malaysia, Malaysian Pharmacists Society president Amrahi Buang noted that the appropriate laws and policies are in place across all access points of medication distribution.
He opined that a lot has been done in terms of policies, beginning with the Malaysian National Medicines Policy, which clearly states the measurements and governance in place for medication safety.
However, the problem ultimately circles back to the lack of education in health and medication literacy among the public.
As such, Amrahi said that pharmacists have to be on the frontlines as the guardians of medicines.
Instead of working in silos, community pharmacists should be strongly encouraged to work collaboratively, not just with each other, but also with other healthcare stakeholders to educate on, implement and practice the safe disposal of medications throughout the health ecosystem.
After all, he said: "The pharmacy is the health hub of the community and pharmacists are the most accessible healthcare providers.”
Foon, Dr Saw and Amrahi were sharing their views at an industry roundtable on the topic of "Safe Medication Disposal Practices in Malaysia – Past, Present & Future" at Monash University Malaysia in Sunway, Selangor, in December (2022).
The three representatives from pharmaceutical companies at the roundtable agreed that all stakeholders should be working together and sharing the load and responsibility for safe disposal of medication.
However, both GSK Communications and Government Affairs director David Lin and Duopharma Ethical Classic Business general manager Alvin Seah said that the movement for safe medicine disposal would be more effective if distributed across the various stakeholders and parties, and not just reliant upon community pharmacies.
Meanwhile, Menarini Pharmacy & Consumer Health associate director Ng Yew Thin opined that doing it together means starting with education to get end consumers to begin working together with the industry to handle this problem.
Alpro Foundation chief executive officer Ostwin Paw agreed that in addition to understanding what constitutes unused or excess medicine, it is imperative for leaders in the industry to kickstart the conversation on the impact and risks of unsafe medication disposal methods on the environment.
Alpro Pharmacy chief pharmacist Lim En Ni shared how Alpro has safely disposed over 1,000kg of medication waste since it began its Safe Medication Disposal campaign, together with Johnson & Johnson, GSK, Duopharma, Bayer, Viatris and Menarini, in 2021.
The excess medicines were collected from the public through dedicated medication disposal bins in Alpro outlets nationwide.
She also announced that starting this month (January 2023), the public can also dispose of their unwanted inhalers in the bins.
The roundtable was organised by Alpro Pharmacy in conjunction with the first anniversary of their Safe Medication Disposal campaign.