Pharmaceutical Pollution and Disposal of Expired, Unused, and Unwanted Medicines in the Brazilian Context

Abstract

The occurrence of pharmaceuticals in the environment is an everyday recognized concern worldwide, and drugs as environmental contaminants have been detected in water and soil systems, posing risks to humans and wildlife. The presence of drugs in wastewater, groundwater, and even drinking water occurs in several countries, including Brazil, where the pharmaceutical market is expanding over the years. The adverse, harmful effects of pharmaceuticals in the environment range from the spreading of antimicrobial resistance and species survival to the interference with reproduction and increased cancer incidence in humans. Therefore, it is demanding to count on proper legislation to prevent these pollutants from entering the distinct environment compartments. In some developed countries, laws, directives, programs, and initiatives regarding drug disposal reach a mature status. In Brazil, federal laws dealing with drug residues’ management are recent, with flaws that might facilitate non-compliance with drug pollution issues. Besides, pharmacies and drugstores are not obligated to collect unneeded household medicines, while particular State laws aim to ordinate the disposal of drug residues regionally. In this review, we consider the current knowledge about pharmaceutical (drug) pollution, the recommendation and regulations on the disposal of useless medicines in some countries, and in the context of the expanding pharmaceutical market in Brazil. The awareness of emerging contaminants in the environment, besides the joint effort of authorities, consumers, and the general public nationwide, will be required to avoid pharmaceutical/drug pollution and achieve an eco-friendly environment and a sustainable society.

Occurrence, ecological risk assessment and prioritization of pharmaceuticals and abuse drugs in estuarine waters along the São Paulo coast, Brazil

“…Although the concentrations recorded for acetaminophen, diclofenac and orphenadrine in the five rivers of the MRBS were lower than those found in other international studies, the detection frequency of these compounds is consistent with the high non-prescribed sale of these drugs worldwide (Table 1 and S4 ) (Deen and Von Seidlein 2019 ; De Andrade Aragão et al 2020 ; de Freitas and Radis-Baptista 2021 ). In Brazil, the pharmacies and drugstores commonly sell acetaminophen, diclofenac and orphenadrine without medical prescription, which means that the consumption of these drugs is not controlled (Abrafarma 2017 ; CMED 2019 ; de Freitas and Radis-Baptista 2021 ). In the case of the MRBS (region with approximately 2.0 million inhabitants), the high consumption of these analgesic and anti-inflammatory drugs can be enhanced, since there are around 6500 pharmacies and drugstores in this region (Abrafarma 2017 ; CMED 2019 ; Ibge 2019 ).…”

“…Furthermore, self-medication of these PPCPs is a common practice among the Brazilian population (Arrais et al 2016 ; Mello et al 2022 ). For instance, acetaminophen was reported as the third most consumed drug in the Metropolitan Region of São Paulo, region bordering of the MRBS and with the highest gross domestic product in Brazil; this drugs is widely recommended for treatment against the fevers caused for dengue, Chikungunya and Zika (diseases still uncontrolled in Brazil), besides the fever caused by COVID-19 (disease that has already affected more than 20 million Brazilians) (Deen and Von Seidlein 2019 ; Scavone et al 2020 ; de Freitas and Radis-Baptista 2021 ). Moreover, acetaminophen and diclofenac (an anti-inflammatory broad-spectrum drugs) can be used to reduce the pain and inflammation caused for osteoarthritis and rheumatoid arthritis (disease that affects about 2 million Brazilians) (Abrafarma 2017 ; CMED 2019 ).…”

“…losartan + furosemide and atenolol + furosemide) (Dos Santos et al 2012 ; Ribeiro et al 2016 ; Ibge, 2019 ), this may explain the high frequency of detection of antihypertensives, diuretic drugs and β-blocker in the five rivers of the MRBS (Table 1 ). Furthermore, pharmacies and drugstores have not adopted the unit-dose systems (UDSs) and policies of the reverse logistics (Pereira et al 2017 ; De Andrade Aragão et al 2020 ; de Freitas and Radis-Baptista 2021 ). This means that the population of Brazilians acquire more pills than prescribed because packages are sold sealed, which impedes fractioning (Abrafarma 2017 ; CMED, 2019 ; De Andrade Aragão et al 2020 ).…”

Pharmaceutical Waste Management Practices in Pharmacies and Medicine Stores: Evidence from Bamenda Health District, Cameroon.

“…The accumulation of antibiotics and other antimicrobial agents in the environment can contribute to Antimicrobial Resistance (AMR) which is the constant evolutionary modification in viruses, bacteria, fungi, and other pathogens against naturally occurring and synthetic antibiotics, antivirals, and antifungals (WHO, 2011 by National Collaborating Centre for Infectious Diseases2021).According to United Nations Environment, growing AMR linked to the discharge of drugs and particular chemicals into the environment is one of the most worrying health threats of today. AMR accounts for an estimated 700,000 deaths per year worldwide and by 2030 will represent up to US$ 3.4 trillion in gross domestic product (GDP) loss (WHO Expert Committee on Specifications for Pharmaceutical Preparations Fifty-fourth report, 2020).The adverse harmful effects of pharmaceuticals in the environment range from the spreading of AMR and species survival, to the interference with reproduction and increased cancer incidence in humans (Freitas & Radis-Baptista, 2021).…”

Luteolin normalizes blood pressure via its antioxidant activity and down-regulation of renal Angiotensin II receptor and Mineralocorticoid receptor expressions in rats co-exposed to Diclofenac and sodium fluoride

“…Diclofenac (Dcf) and many other Non-selective antiinflammatory drugs (NSAIDs) are among the most widely prescribed drugs for analgesic and anti-inflammatory purposes. Residues of these drugs are increasingly detected in environmental matrices from their discharge as effluents from drug manufacturing companies or inappropriate disposal (Freitas and Radis-Baptista, 2021).…”