Disposal of expired drugs and the perception of residents in the municipality of Pombal PB

: This research aimed to conduct a survey of the disposal and collection of expired drugs in pharmacies and drugstores in the city of Pombal - PB, and verify the perception of residents on this subject. The methodology used consisted in the application of two questionnaires, one for the establishments, and the other for the residents, and later, the data were processed. Of the pharmacies that answered the questionnaire, 50% said they received the drugs and intended for a private company specialized for incineration, and the other 50% said they did not perform such action. About the habit of keeping medicines at home, 95% of the interviewees stated that they store medications in the residence, and of these, 91% reported taking all care to leave it out of reach of children. Regarding the disposal of expired drugs, the majority discards in the common waste (68%) or in the sink/toilet (23%). In the matter, the majority (91%) stated that they had not received any instruction on the disposal and storage of expired medicines. Even if not receiving information on the subject, it is clear that most are aware of the risks of irregular disposal. It is concluded that most of the interviewees are aware of the negative impacts, but still perform the inadequate disposal, probably because there is no greater orientation of government agencies. It is necessary and urgent compliance with the laws by the establishments, and greater dissemination to the population.


INTRODUCTION
The growth of the population, coupled with a greater production of the pharmaceutical industry, has boosted the consumption of medicines in recent years. The drug market moves billions of reais, in production, distribution and consumption by the whole society ( To make matters worse, Blankenstein (2017) reports that water treatment technology cannot fully reverse chemical contamination, because even after advanced purification treatments, contaminants remain and can be found in small concentrations on the surface and in smaller concentrations in the groundwater.
According to the author, the human metabolism does not process all the ingested medication, i.e., a portion will be excreted by the patient, also becoming a generator of water and soil contamination.

Causes of drug waste generation
Medeiros, Moreira and Lopes (2014) report that part of the medicines prescribed and purchased by the population end up accumulating in homes, forming the so-called "Home Pharmacy". These drugs are often stored incorrectly, exposed to high temperatures or in humid environments, and end up not being Fischer and Freitas (2011) report as causes of unused medicines, and consequently, waste generation: overprescription (doctor prescribes more than necessary for the treatment), self-medication (the use of medicines without prescription, or use of medicines without any intervention by a doctor or other qualified professional), distribution of free samples (distributed by manufacturers laboratories to medical professionals as a form of advertising) and inventory management (good inventory management reduces the risks of detour, deterioration of medicines and loss by expiration).

Actions to minimize the generation and irregular disposal of medicine residues
Among the actions to minimize the generation of drug waste, Borrely et al (2012) mention the adoption of the possibility of fractional sales, in which the package will contain only the correct amount for the treatment, avoiding possible leftovers, i.e., the drugs will be purchased in the ideal amount for the treatment. Along the same line, Blankenstein (2017) presents the reformulation of packages, so that they are sold by daily doses (instead of unit packages), as a possibility to reduce the volume of drugs stored at home, and facilitate reuse. Intervention during treatment, checking whether the patient is using the medication as prescribed or if its consumption is still necessary; as well as, improved nutrition, physical exercise and stress reduction, are ways to reduce consumption, and consequently the disposal of Assemblies, such as that of Minas Gerais.

Impacts of irregular disposal
Among the pharmacological classes that require greater attention, with regard to incorrect disposal, we have the antibiotics, which according to Bila, Dezotti (2005)

Description of the study area
The study was conducted in the municipality of Pombal (Figure 1  Have you ever received any information about the disposal and storage of expired medications? 8. to the best of your knowledge, name three negative consequences of the irregular disposal of expired medications.

Collection in drugstores and pharmacies in Pombal -PB
The 15 pharmacies in the city were visited for the application of the questionnaires, but 5 units refused to participate (FIGURE 2A); and those that agreed to participate informed the number of businesses they have in the city, as shown in figure 2B, among which 2 expressed having more than one unit. Of the pharmacies that answered the questionnaire, it can be seen that 5 (50%) do not receive, and 5 (50%) receive the expired drugs, as shown in figure 3. Of the establishments that informed they receive, all informed that the collected material is sent to a specialized private company for incineration.  Figure 4 shows that 95% (21) live in urban areas, and 5% (1) live in rural areas. What's your sex?

A B
Regarding age, it can be seen that the research sample is quite diverse, ranging from 17 to 65 years old. Most are concentrated in the 25 to 34 age bracket (63.5%), followed by the 45 to 54 age bracket (13.6%), and followed by the 15 to 24 age bracket (4.5%) and the 65 to 74 age bracket (4.5%). There were no respondents in the 55 to 64 age group, as per figure 5. Regarding the storage of medicines, as can be seen in figure 6A, 95% of the sample population stated that they store medicines at home, and a large portion (91%) are careful to store the medicines out of the reach of children (FIGURE 6B), which shows that they are aware of how dangerous it can be to allow this contact, however, it demonstrates that there is still carelessness in a small portion (9%).  Are stored medications out of reach of children?

Yes No
A B It appears that most of the population still discards the medications in the regular trash (68%), followed by those who discard them in the sink or toilet (23%), as shown in Figure 7. A small portion of the interviewees reported disposing of them at collection points (5%) and another portion declared to give them to the neighborhood health agent. Among those who reported returning at collection points, all said they delivered at places other than where they bought the medicines. Regarding the knowledge about the disposal and/or storage of medicines at home, the vast majority (91%) reported never having received any information, such as the importance of correct disposal, the risks arising from incorrect disposal or the care that should be taken when storing at home. This information presented by figure 8, indicates that there is a need for greater dissemination on the subject, in order to make the population aware of this issue.  Despite the majority declaring not to have received information about the incorrect disposal of medicines, it can be seen that this sample population has a solid awareness of the risks that this practice can cause, according to figure 9. The most mentioned negative consequences were pollution/contamination of water bodies (21%), health problems in the population (17%), and pollution/contamination of the environment (15%). They also mentioned pollution/contamination of the soil (12%), intoxication of animals and plants (12%), risk for children (11%), contamination, pollution, intoxication (6%) without specifying the type and/or what affects them, and 6% reported not knowing the consequences of the irregular disposal of expired drugs.

CONCLUSIONS
The results show that most of the interviewees are aware of how the irregularly discarded expired drugs can harm the environment and public health, and even so, they discard this material improperly, probably because there is not a greater guidance from government agencies.
It is necessary and urgent that the pharmaceutical establishments comply with the current law, with the availability of collection points for the expired drugs, as well as a greater dissemination among the population, which could induce their proper disposal.
The fact that half of the pharmacies interviewed do not comply with the state law that requires them to perform the collection of expired drugs, and continue operating normally, coupled with the absence of awareness campaigns, on radio stations, TV and social networks, by the public, demonstrates a disregard with this issue.