3 in 4 households surveyed discard unused medicine; Want government to change rules to facilitate chemists to sell smaller quantities, accept return within a month

June 13, 2023, New Delhi: After a long wait, the Consumer Affairs Ministry is reported to be working on a plan in consultation with pharmaceutical industry to have perforated medicine strips, mentioning the manufacturing and expiry dates on each segment, so that patients are able to buy required medicines without putting the pharmacists in a fix on how to sell the remaining medicine. The options reported to be explored with the industry is to either have QR codes on medicine strips or on each tablet “depending on the viability”.

The move has been initiated after the National Consumer Helpline (NCH) run by the Consumer Affairs Ministry received many complaints from consumers that the chemists were insistent on buying the entire strip, which was leading to wastage of excess medicines. The ministry along with top officials of the Drug Controller General of India (DCGI) has already held consultations with the representatives of the pharma and medical devices industry. The ministry is reported to have suggested that new cost effective technologies for printing QR code on each tablet or capsule should be explored for packaging medicines to help chemists sell required medicines as per the requirement of patients without any wastage or loss on either side.

Over 5 years back, in December 2017, the Food and Drugs Administration (FDA) had asked DCGI to reduce the size of packets so that patients can buy dosages as prescribed by the physicians. Chemists and doctors had then welcomed the proposed move, saying it will prevent wastage and abuse of medicines. Patients have for long been forced to buy entire packets of medicines because pharmacists were unable to cut the strips as it often resulted in the loss of crucial information like name of the medicine, batch number, manufacturing and expiry date.

This is one of the reasons why not all the medicines manufactured every year are consumed and a vast amount of medicines go unused or expire. Unsafe handling and disposal practices of unused and expired medicines results in environmental hazards which is a source of concern. Most people dump unused and expired medicines in garbage, while some make the effort to reach out to various medicine banks in their city before the best to use date.

“The persistence of environmental pollution in India continues as there are no properly defined laws for handling and disposal of medication wastes. Improper medication disposal methods are a significant factor contributing to the presence of medication compounds in the aquatic environment,” states a report ‘Review on the Status of Disposal Practices of Unused and Expired Medicines in India’ co-authored by Rashmi Zalpur and published in the International Journal of Innovative Science and Technology in March 2021.

The report posted online researchgate.ne states: “The contamination of pharmaceutical wastes have been introduced to the environment due to lack of knowledge and awareness in the general public regarding the safe disposal of unused and expired medicines combined with over production by pharmaceutical industries. Moreover, sensitization regarding the handling of medical waste has not been practiced among the municipal corporations.”

Based on the annual reports submitted by respective State Pollution Control Boards/ Pollution Control Committees (SPCBs/ PCCs) about 656 Tons/Day (TPD) of BMW was generated in the year 2020, out of which 590 TPD was collected and treated by the Common Bio-medical Waste Treatment facilities (CBWTFs), according to a Central Pollution Control Board (CPCB) report released in March 2022. Further, about 84.61 TPD of incrementalCOVID-19 BMW was generated between May 2020 to February 2022 in the country from healthcare facilities, quarantine centres/ camps, sample collection centres, laboratories, home care/ home isolations centres engaged in treatment, diagnosis and quarantine of COVID-19 infected or suspected patients.

In 2018, a joint study by ASSOCHAM-Velocity had projected that “India is likely to generate about 775.5 tons of medical waste per day by 2022 from the current level of 550.9 tons per day growing at compound annual growth rate (CAGR) of about 7%.” The problem of medical waste currently generated may not have reached the levels projected by the industry study titled ‘Unearthing the Growth Curve and Necessities of Bio Medical Waste Management in India-2018’, but the issues it had flagged remains true. The country needs a stringent monitoring and evaluation framework to ensure compliance, the study had stated.

Ecoideaz Ventures, which works with SMEs and NGOs to promote green initiatives, emphasizes on its website that “Since, the majority of Indians throw medicines down the drain, limiting the excess purchase of over-the-counter medicines is the first step to being environmentally responsible and saving money.”

Given that the subject of medicine wastage has been discussed regulalry on LocalCircles in the last 3 years, it decided to conduct a national survey to find out how citizens handle excess and expired medicines in their homes, the real source of the problem and what they consider could possibly be some viable solutions. The survey received over 33,000 responses from citizens located in 322 districts of India. 64% respondents were men while 36% respondents were women. 43% respondents were from tier 1, 32% from tier 2 and 25% respondents were from tier 3, 4 and rural districts.

3 in 4 households surveyed have been discarding up to 70% unused medicines purchased in the last 3 years

The first survey question asked respondents “On an average basis these last 3 years, what percentage of the medicines you purchased ended up not getting used, expired and had to be thrown away?” Out of 10,964 respondents to this query, 21% indicated that they don’t discard any medicines and 4% did not give any clear response. Nearly one in three or 36% of total respondents stated that they throw out up to 10% of the medicines they purchase; 27% end up throwing up 10-30%; 6% discard 30-50% of unused medicines; and 6% throw 50-70%. In effect 3 in 4 households surveyed have been discarding up to 70% unused medicines purchased in the last 3 years.

50% of households surveyed feel “chemists sell a higher minimum quantity than what is needed”

The next question in the survey asked respondents “What are the key reasons that you end up with excess quantities of medicines”. The top reason cited was the minimum selling quantity that chemists and ePharmacy platforms have. Half of the 11,895 respondents to this query pointed out that “chemists sell a higher minimum quantity than what is needed”. Many of the respondents cited more than one reason thus 29% stated that “we stop taking the prescribed medicine after a few days/ getting better”; 18% shared that ePharmacies sell a higher minimum quantity than what is needed”; 7% cited other reasons. Besides the complaints of chemists and ePharmacies selling larger minimum quantities than required, this survey question also brings to fore a major concern of health experts – people stop taking prescribed medicine after a few days/ getting better. Beyond the waste of medicines and money, this tendency can lead to drug resistance, which is harmful for those with serious health issues.

7 in 10 households desire that chemists and ePharmacies should sell medicines in smaller quantities; they and the manufacturers should be mandated to take back unwanted but not expired medicines within a month of being sold

​The final crucial question in the survey was “what according to you should be done so that medicine wastage in your household can be reduced​​?” Nearly, 11,000 responded to this query with 7 in 10 households desiring that chemists and ePharmacies should sell medicines in smaller quantities and they and the manufacturers should be mandated to take back unwanted but not expired medicines within a month of being sold. The data shows that 27% of the respondents favour that “chemists and ePharmacies should be required to sell medicines in smaller quantities with the pharmaceutical manufacturers also mandated to take returns from them”; 43% want that “consumers should be permitted to return any unused or sealed medicine quantities within a month with pharmaceutical manufacturers also mandated to take returns from them”; 22% want that “chemists, ePharmacies & pharmaceutical manufacturers should work as is & instead every district should have a hospital where people can donate unused medicines”; 6% felt other solutions are needed; and 2% of respondents were uncertain.

In summary, the survey gathers what percentage of the total medicine purchased goes unused or expires and brings to fore some crucial reasons why that happens. The most crucial reason being the supply side problem of consumers having to purchase more quantities of medicines than required. Thus 7 in 10 households desire that chemists and ePharmacies should sell medicines in smaller quantities and they and the manufacturers should be mandated to take back unwanted but not expired medicines within a month of being sold. LocalCircles hopes to share the survey results with the policy makers and the local authorities so that not only are the consumer interests protected by putting in place a return policy for unused medicines and also the minimum quantity sold to customers.

LocalCircles will escalate the findings of this study to the key stakeholders including the Department of Consumer Affairs so they can be incorporated in the effort to have medicine packaging which minimises waste and enables sales of smaller quantities of medicines to consumers.