Pharmaceutical Waste Disposal: Current Practices in Tirana, Albania Jason Bruno, Samantha Eaton, Jeremy Hemingway, and Elizabeth Towle
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Pharmaceutical Waste Disposal: Current Practices in Tirana, Albania Jason Bruno, Samantha Eaton, Jeremy Hemingway, and Elizabeth Towle i Pharmaceutical Waste Disposal: Current Practices in Tirana, Albania An Interactive Qualifying Project Report submitted to the Faculty of Worcester Polytechnic Institute in partial fulfillment of the requirements for the Degree of Bachelor of Science in cooperation with The Environmental Center for Development Education and Networking Submitted on December 15, 2016 Submitted by: Submitted to: Jason Bruno Jonida Mamaj-Hafizi, Project Coordinator, Samantha Eaton Environmental Management Practices, Jeremy Hemingway Environmental Center for Development Elizabeth Towle Education and Networking Project Advisors: Professor Peter Christopher Professor Robert Hersh This report represents the work of four WPI undergraduate students submitted to the faculty as evidence of completion of a degree requirement. WPI routinely publishes these reports on its website without editorial or peer review. For more information about the projects, please see http://www.wpi.edu/Academics/Projec i Authorship The members of this team contributed equally to the report and the project. All members wrote parts of the draft for each section, and then edited the report as needed. The questionnaire used in the interviews was developed by the whole team. Chapters were divided up into multiple sections and then distributed equally to all the members of the team. When a member finished writing their section, he/she then read over and edited the sections written by other members of the group. This writing and editing process was followed throughout the duration of this report. Before any documents were submitted, the group read the chapter out loud together. One member would read, two members would make suggestions, and the fourth member would write them down. Roles were changed after every subsection. Acknowledgements Our team would like to thank all individuals, organizations, and groups who contributed to the success of this project. Special thanks to: Our advisors Professor Peter Christopher and Robert Hersh for revisions and feedback. The Environmental Center for Development Education and Networking (EDEN Center) for sponsoring the project. Jonida Mamaj-Hafizi, the Project Coordinator of the EDEN Center for her guidance and support. Eralda Bushi, who helped us schedule the volunteers. Lira Hakani, who acted as our translator and liaison to the treatment companies. The rest of the employees at the EDEN Center for letting us use their office space. All of the volunteers who served as translators during all of our interviews. All of the pharmacists, distributors, and other interviewees for giving us invaluable perspectives. All of the other individuals who assisted us in this study. Finally, we would like to thank WPI for providing us the amazing opportunity to participate in this project. ii Abstract Abstract Managing pharmaceutical waste effectively can reduce risks to the environment and public health. In collaboration with the EDEN Center, an Albanian environmental NGO, our study assessed and analyzed the current pharmaceutical waste management system in Tirana. We interviewed ten percent of the over 730 pharmacies in Tirana as well as other stakeholders to identify the current practices, challenges, and opportunities for improvement. Our study concluded that pharmacists would benefit from more information regarding laws, treatment companies, and their environmental impact. We also recommend additional incentives and regulations be implemented by the government, and a further study be conducted to expand upon our findings. iii Executive Summary Background company is usually paid to remove and manage the waste Environmental Impact properly. While pharmaceutical drugs have had profoundly positive effects, they have caused major environmental issues. Pharmaceutical Waste Management in Albania Through improper disposal, medicines are found in water As pharmaceutical waste management reform has been supplies in varying concentrations and pose risks to the increasing globally, many organizations have undertaken the environment and to human health. Antibiotics are among the task of assessing and improving disposal practices in their own most common and most harmful drugs found in the water countries. This can be seen in Albania as well, with the research supply. Though present in just trace levels, they allow bacteria to and initiatives developed by the Environmental Center for develop and spread antibiotic resistance, which makes bacterial Development Education and Networking (EDEN Center, 2014). In infections more challenging to treat (Neu, 1992). Endocrine 2015, the EDEN Center completed a research document on the disruptors, like hormonal birth control, are also dangerous when disposal of all medical waste across the country. In this study leaked into the environment, especially for wildlife. The major they found a significant lack of information concerning the dangers include developmental malformations, interference with disposal of pharmaceuticals (EDEN Center, 2016). After the reproduction, increased cancer risk, and disturbances in the report on medical waste was completed, the EDEN Center immune and nervous system function (Norris, 2005; Gilbert, reached out to us for assistance in examining pharmaceutical 2011). waste management in the capital city of Tirana. Pharmaceutical Waste Management Institutions for Pharmaceutical Distribution, To reduce these risks, pharmaceutical waste must be Regulation, and Disposal sorted and specially treated in one of several ways. Popular The city of Tirana has 730 pharmacies, most of which are methods include the use of lined landfills, incineration, return to privately owned and very small, distributed amongst the 11 the manufacturer for chemical recycling, or encapsulation in administrative units. The districts that we focused on were Ish- cement (World Health, 1999). Pharmacies often do not have the Blloku, the Center, and Ali Demi. These pharmacies are presided resources or expertise to achieve this independently, and thus over by the Order of the Pharmacists, the Ministry of Health, the contract with a treatment company (Smith, 2002). This treatment Ministry of Environment, and many smaller governmental bodies. The Council of Ministers is the primary legislative body iv that established the required disposal practices of pharmacies. These laws state that pharmaceutical waste must be destroyed Objectives by an organization with the proper environmental license (For Assess the current practices and policies for Hazardous Waste Management, Chapter 4 Articles 12-13, 2006). pharmaceutical waste management in Tirana; Therefore the pharmacies must contract with a treatment Uncover the challenges that are preventing effective company to dispose of their waste. pharmaceutical waste management; There are a few private treatment companies that have Identify stakeholders’ roles and perspectives in the the certification from the government to handle the treatment of pharmaceutical waste management system; pharmaceutical wastes. Unfortunately there have been some Demonstrate the need for more information on the scandals involving these waste removal companies, where some subject of pharmaceutical waste management; have been implicated in dumping waste into the environment rather than treating it correctly (Fraud, 2015). These actions have Methods weakened the credibility of treatment companies and We examined the practices of approximately 10% of the discouraged pharmacies from working with them. Alternatively, pharmacies in Tirana using a structured questionnaire with both pharmacies can give their waste to the National Center for Drug closed and open ended questions. Pharmacies were interviewed Control, which then contracts with a treatment company to in three of the eleven administrative units of Tirana, whose handle the waste from various pharmacies. different locations and demographics were analyzed for their There was limited information in the literature regarding effects on the practices of the pharmacies. These respondents reasons why pharmacies may not obtain contracts to manage were fully informed that all of their answers would be kept their waste. Possibilities we considered included: avoiding completely confidential and that the information gathered was disposal costs; lack of training or knowledge; and distrust in the only intended to improve the waste management system. We treatment companies. However, no relationship has been used a multi-method approach consisting of interviews with the established between any of these factors and the practices of assistance of volunteer translators, direct subject observations, pharmaceutical waste disposal in Tirana. Our research attempted and the analysis of government and private records. The most to fill the gaps in the current understanding of these causes. important interview questions asked were: v Does this pharmacy produce pharmaceutical waste, and if so, how much? Results Does this pharmacy have a contract with a treatment company? Current pharmaceutical waste disposal practices How often does the Ministry of Health Inspector visit this and their causes pharmacy? What challenges do you face with pharmaceutical waste Our study approached 74 pharmacies, approximately disposal, and what recommendations do you have to 10% of those in Tirana, of which almost 20% of pharmacies declined to participate in our study.