Disposal practices, risk perceptions, and quantification of potential active pharmaceutical ingredients (APIs) from used human medicine in upper citarum river Basin

Contaminants of emerging concern (CECs) have gained attention among water quality scholars and professionals. These contaminants are detected in environmental monitoring samples but have not been regularly monitored or regulated (Diamond and Burton Citation2021). Although the impacts of CECs are not always clear or well documented, there are concerns over their potential human health and ecosystem impacts (Awuchi and Amagwula Citation2021). This paper focuses on active pharmaceutical ingredients (APIs), a group of CECs that can potentially affect the human physiological system, even at low levels of exposure (Maruya et al. Citation2016). Currently, there is a rising global trend of pharmaceutical consumption, including antibiotics (Van Boeckel et al. Citation2014; González Peña et al. Citation2021). If not properly managed and treated, APIs contained in human medicine can enter aquatic ecosystems through various landfills and sewage (Rogowska and Zimmermann Citation2022). Humans’ consistently rising use of pharmaceuticals indicates that the active substances and their primary metabolites will be continuously discharged into the aquatic system (Boxall et al. Citation2012). Studies have highlighted the significance of pharmaceutical waste problems. In the U.S., approximately two-third of prescribed medicine were not consumed and disposed on the trash or via sinks (Law et al. Citation2015). However, the rate of consumption and wastage of medicine is not currently well documented in many low-and-middle-income countries (Sapkota and Pariatamby Citation2023). The rise of medicine use is particularly significant since the COVID-19 era, and medicine waste is becoming more concerning (Alemu et al. Citation2023; Han et al. Citation2023).

Exposure to the presence of APIs in aquatic ecosystems can have harmful effects on aquatic organisms (Meador et al. Citation2016; Brumovský et al. Citation2017; Yeh et al. Citation2017; Jorgenson et al. Citation2018) and human health (Pomati et al. Citation2017). The harmful effects that APIs can cause are not always immediately visible; some APIs have hidden effects and are difficult to detect, such as delayed effects and bioaccumulation effects (Daughton and Ternes Citation1999; Cleuvers Citation2003; Fent et al. Citation2006; Vörösmarty et al. Citation2010; Meador et al. Citation2016; Yeh et al. Citation2017). More than 1500 APIs have been registered and used worldwide (Al-Khazrajy and Boxall Citation2016; Aubakirova et al. Citation2017). However, knowledge regarding APIs’ risks in the waters is still very limited (Berninger et al., Citation2016).

The objectives of this research are two-fold: (1) identify the prevalent disposal methods of pharmaceutical waste and explore sociopsychological factors affecting disposal behaviour among household consumers; (2) quantify medicine usage and estimate health risks associated with household pharmaceutical disposals. Pharmacies are included in the survey to complement data regarding top medicine sold within the last six months, contributing to the data on household sectors and exploring pharmacy workers’ perceptions. Studies in Malaysia and Ethiopia recorded a high awareness and attitude toward the adverse impact of household pharmaceutical waste on the environment and public health but poor practices to ensure proper disposal (Ahmad Khan and Ahmad Citation2019). In China, respondents showed a positive attitude but exhibited inadequate awareness and poor practice (Yu et al. Citation2019). A similar study showed that young people exhibited higher awareness and were more supportive of eco-pharmacovigilance interventions. The awareness is recorded to be lower in Indonesia, and a significant proportion of participants report a lack of prior exposure to information pertaining to proper practices of medicine disposal (Alfian et al. Citation2021).

Despite the growing body of literature that highlights the environmental and public health risks posed by APIs (e.g. Cunningham et al. Citation2009; Pal et al. Citation2010; Stuart et al. Citation2012; Sengar and Vijayanandan Citation2022; Spilsbury et al. Citation2024), there is still a significant gap in translating awareness into practice. Previous studies, such as those in Palestine (Nairat et al. Citation2023); Jordan (Muflih et al. Citation2023); and Portugal (Veiga et al. Citation2023), have primarily focused on general public attitudes, awareness, and existing practices. Moreover, research on this topic within the Indonesian context is limited (e.g.Kusuma et al. Citation2023; Zairina et al. Citation2023). Most studies indicated a lack of comprehensive data on the disposal practices and awareness levels of both consumers and pharmacy workers and often overlooked the nuanced socio-psychological drivers that influence disposal behavior. Moreover, pharmacy workers, being healthcare practitioners with direct access to both prescription and over-the-counter drugs, have a distinct advantage in interacting with the patients and community and have the opportunity in shaping appropriate medication disposal procedures. Pharmacy workers have been identified as important actors that can provide advice on proper management and disposal of unused medicine (Alfian et al. Citation2023, Citation2024; Michelin et al. Citation2023). Nevertheless, their function has received limited study attention, particularly in terms of their ability to act as intermediates between pharmacological knowledge and consumer behaviour. It is essential to address this gap in order to design effective interventions that encourage ecologically sustainable disposal practices.

This study adds to this body of knowledge and results in two potential implications: as an input to the advanced exposure assessment model of active pharmaceutical ingredients (APIs) and to inform policy interventions and educational initiatives regarding the proper disposal of medicine. The results will be used to build inventory and estimate the use and disposal of APIs in Bandung Regency, Upper Citarum River Basin (UCRB). The later is tailored to the local context, which is currently underrepresented in the existing literature.

source :

https://www.tandfonline.com/doi/full/10.1080/09603123.2024.2445162#d1e241