SINGAPORE — As Singapore looks to contain rising healthcare costs, it should look at ways to curb medication waste, said Nominated Member of Parliament Irene Quay at the recent debate on the Ministry of the Environment and Water Resources’ budget.

The cost of wasted drugs is significant.

Estimates by a local hospital show that the drug wastage cost detected during a pharmacist’s home visit was S$663 per patient, said Ms Quay in her Parliament speech.

“Hypothetically speaking, if a pharmacist is given the resource to visit 10 patients a week over a one-year period to perform a full reconciliation, the total potential drug savings can amount to at least S$329,000, with S$176,000 and S$153,000 of savings in subsidies and out-of-pocket savings, respectively,” said Ms Quay, who is president of the Pharmaceutical Society of Singapore.

Medication reconciliation is the process of comparing a patient's medication orders to what he has been taking, to avoid issues such as duplication or adverse drug events.

Here’s what you need to know about the issue.

KEY SOURCES OF WASTE

Medication wastage can be due to over-prescription and oversupply.

According to a survey conducted this year at the National Cancer Centre Singapore (NCCS) on 175 patients and caregivers, the most common reason for unused medication in their households was that their health conditions had resolved. More than four in 10 respondents cited the reason, while 37 per cent of them said the medication had expired.

The investigators of the study include two pharmacists and a final-year National University of Singapore (NUS) pharmacy student, said Associate Professor Lita Chew of NUS’ pharmacy department.

WHY DOES IT MATTER?

Besides incurring “huge costs”, the wastage of medication has implications for the environment, said Ms Quay.

Hazardous and controlled substances may be part of medication waste, but few are aware of the proper ways to dispose of medication.

In the survey of 175 patients and caregivers at NCCS – conducted from Jan 22 to Feb 1 – nearly 86 per cent said they were not aware of recommended disposal practices.

Three in four throw unused medication into the trash bin.

According to a guide on the Pharmaceutical Society of Singapore’s website:

• Antibiotics, vaccines and anti-cancer medicines – which are also widely used to treat certain chronic conditions – are among drugs that cannot be disposed of at home.
• Consumers should pack these medicines into a bag and return them to the pharmacy, the guide stated.
• Medicines that can be thrown out with other household waste should be put in trash bags and sealed tightly, after personal data such as one’s name has been removed.

In her speech, Ms Quay said drugs that are used to treat cancer have the ability to alter DNA and cause chromosome damage.

Antibiotics that are improperly thrown away “can enter our ecosystem and promote resistance to bacteria and (fungi), leading to increased rates of infections that are difficult to treat”, she said.

Ms Quay asked if Singapore’s waste-water treatment facilities are capable of filtering out drugs.

HOW DID THE AUTHORITIES RESPOND?

Minister for the Environment and Water Resources Masagos Zulkifli said in Parliament that drugs disposed of in sinks or toilets will be “substantially removed through the water reclamation process”.

“Our NEWater technology is so reliable that the reverse osmosis process will effectively remove any remaining pharmaceutical compounds, when treated used water is channelled into the NEWater production” he said.

“(National water agency) PUB’s constant monitoring showed that pharmaceutical compounds were not detected in our drinking water.”

Senior Minister of State for the Environment and Water Resources Amy Khor said: “Generally, household drugs can be safely disposed of together with household waste. All our household waste is collected and safely incinerated before the ash is landfilled at Semakau Landfill.”

HOW TO REDUCE WASTE?

• We can look to countries like Canada and the United States, which have special government services offering to take back and dispose of unused and expired drugs, suggested Ms Quay.
• When patients are prescribed new medication, they should be given no more than two to four weeks’ supply to prevent wastage in the event of adverse effects, or if the medication proves unsuitable or ineffective, she said.
• Medication that is only used when necessary should be given in small quantities, with more purchased when necessary.
• The authorities can consider having patients collect long-term medication in instalments, said Ms Quay. The Health Ministry could consider funding the charges for home deliveries or self-collection lockers to encourage the collection of long-term medication in instalments, instead of collecting large supplies at one go, she said. “This may turn out to be more cost-effective in the long run.”

At NCCS, stickers on Ziploc plastic bags for cytotoxic drugs (to destroy cancer cells) and controlled drugs (such as morphine) inform patients and caregivers to return unused medication to the pharmacy for disposal, said Assoc Prof Chew, head of the centre’s pharmacy department.

The NCCS is seeing an increasing trend of patients returning unused medication for disposal, she said.

Medication waste is “preventable healthcare waste” and everyone in the supply chain has a role to play, said Assoc Prof Chew.