Almost every home in Kenya has a mini-pharmacy that is discreetly tucked away in cupboards or closets catering to our various health needs. Homes with children often boast of shelves adorned with bottles or inconspicuous envelopes of cold and flu medications, painkillers, fever-reducing drugs, and antibiotics.

Others may showcase prescription drugs for tuberculosis, cancer, high blood pressure, diabetes, and other congenital diseases and lifestyle conditions.

Amidst the convenience and necessity of these drugs lies a silent contributor to environmental concerns–the aftermath of drug disposal. Few pause to consider the fate of these emptied containers after the trash bags leave their houses.

The repercussions of improper medicine disposal are far-reaching, extending beyond the boundaries of homes and into the broader ecosystem. Based on interviews conducted on a WhatsApp group with over 350 residents of Roysambu constituency, common practices for medicine disposal include binning them, flushing them down the toilet, burning, and disposing them in a pit latrine.

Fresh Gathondu, a resident, stresses the need to raise awareness and educate the community about the dangers of improper pharmaceutical waste disposal. He believes that creating awareness is crucial, as it encourages active community participation in finding solutions. Instead of imposing solutions, Gathondu supports open dialogue meetings that allow the community to understand the problem and contribute to effective solutions.

Judy Gatimu, a resident, takes her unused or expired drugs to the nearest dispensary for disposal. She credits this habit to valuable lessons from her mother, a Girl Guide leader and teacher. Judy notes there is a widespread lack of information on proper medicine disposal. Even those with knowledge face challenges, as not all facilities are equipped to accept pharmaceutical waste for proper disposal.

Environmental Scientist Joseph Kurauka explains that pharmaceuticals primarily enter the environment through patient use, passing through our bodies and reaching waterways. The manufacturing of drugs and the improper disposal of unused medicines also contribute to trace levels of pharmaceuticals in rivers, lakes, soil, and occasionally in drinking water. Concerns also arise regarding biomagnification, where pharmaceuticals may be absorbed by food crops.

“Environmental exposure to active pharmaceutical ingredients can have adverse effects on the health of ecosystems and humans,” he says.

Dr Betty Mulinge, a pharmacist specializing in pharmaceutical waste disposal, highlights the dangers of poor disposal of antibiotics into the sewer system, which can contaminate rivers and lakes. This contamination, if present in drinking water, may lead to antibiotic overdose and anti-microbial resistance. Additionally, it poses risks to aquatic ecosystems and can compromise food safety.

“In hospitals, pharmaceutical waste is incinerated at temperatures exceeding 1,000 degrees Celsius to ensure complete combustion. The incineration chambers are equipped with air pollution control devices to capture and neutralize any pollutants generated during the process”, she says.

Caleb Nyagah from Green Matrix Kenya, a National Environment Management Authority (Nema)-licensed Environmental Impact Assessment expert, says that hazardous waste should only be handled by Nema-licensed experts at disposal sites. Further, a combustion certificate should be given showing quantity burned and temperatures used during incineration.

According to Erastus Karani, a public health professional in the Ministry of Health, over 8,500 deaths were linked to anti-microbial resistance (AMR) and 37,300 deaths associated with AMR due to pharmaceutical residues in 2019.

Research findings highlight significant health issues associated with pharmaceutical waste in the environment. These can include acute and chronic damage to aquatic life within the food chain, reproductive damage, behavioural changes, and inhibition of cell proliferation. Additionally, recorded cases include immunity and blood disorders, renal failure, and toxicity to animals and birds. The contamination of drinking water and food sources, coupled with the risk to scavengers like hyenas and vultures, underscores the profound impact of pharmaceutical waste.

“Designing campaigns utilising the national school health policy, implementation guidelines in schools, community health promoters at the village level, public health officers, and electronic/print media could effectively communicate the importance of proper medicine disposal”, says Mr Karani.

Environmental researcher Felix Blair Odhiambo, a lecturer at Daystar University, points to existing gaps in current research regarding pharmaceutical waste and its impact on environmental health. Mr Odhiambo insists on the need for further research to delve into the community’s level of awareness, the consequences of inadequate waste management, the types of frequently disposed drugs (whether prescribed or over-the-counter), and identifying the primary contributors to pharmaceutical waste disposal.

Additionally, Mr Odhiambo highlights research published by the Pharmaceutical Society of Kenya focusing on biodegradables and best practices for pharmaceutical waste. The research explores the connection between poor waste disposal of pharmaceutical products and issues such as climate change, natural disasters, and virus resistance.

“Research findings on the consequences of pharmaceutical waste disposal can offer crucial guidelines for households, patients, and healthcare facilities. Proposed research initiatives could inform amendments to the Nema Act regarding pharmaceutical disposal.

“Institutions like Gertrudes Children’s Hospital, which already has a disposal policy, can serve as a model. Pharmacies should adopt dispensing practices based on patient needs to reduce the accumulation of unused medicines. Implementing public education campaigns about the adverse effects of improper medicine disposal is also essential,” he says.

Lab & Allied Chief Pharmacist Simon Muigai stresses the importance of recycling packaging materials in the pharmaceutical industry for sustainability and effective waste management. While the recycled materials may not be used directly in medicines, they can find utility in various other areas. Dr Muigai underscores the significance of extended producer responsibilities (EPRs), which encompass adherence to Nema guidelines for disposal.

Regarding ongoing initiatives within the industry to minimize environmental impact, Dr Muigai stresses the implementation of producer responsibility obligations (PROs) by Nema. PROs are legal obligations imposed on producers to oversee and manage the environmental impact of their products throughout the entire lifecycle. Sanctions are in place in case actors in the pharmaceutical industry fail to comply with these responsibilities.

Dr Stanley Ndwiga, a pharmacist and senior lecturer at the University of Nairobi, also stresses the need to return medicines to the pharmacies.

“Even when the medicine is expired, it’s still a poison. Let people not burn medicines; it is not recommended. Some medicines contain elements like sulfur, which may produce harmful by-products,” he says.

Dr Ndwiga, who sits on the technical working group at the Pharmacy and Poisons Board (PPB), maintains that pharmacy operators can assist patients in safe medicine disposal during counseling on medication usage. However, many of them lack information beyond providing the prescribed medicines.

The pharmacist emphasizes the importance of sustainable packaging and its environmental impact. Biodegradable packaging is recommended, especially considering that most medicines are prone to photodegradation, meaning they can be damaged by light. Currently, medicines are often packed in aluminum blister packs, adhering to current good manufacturing practices.