We all have a cabinet at home entire of medication piled up from every doctor visit, from tablets, and capsules, to drops, and injections… there are different types of aids. Some are used regularly, and some are stored but are forgotten after the passing of the illness. In due time, these drugs are going to go bad, and at some point, you will have to clean out that cabinet and throw the expired ones away. However, have you ever asked yourself where do these go when you throw them in the trash?
Since they are a combination of many chemicals put together, have you wondered what the consequences and repercussions of the wrong disposal of these drugs, pills and so many more?
Our study aims to assess the disposal of expired medication in Lebanon. During this assessment, we should be able to identify any malpractice or obstacles that get in the way of an appropriate disposal process, and if so, propose an appropriate recommendation to improve the procedure at hand.
Since there are many queries on how this disposal process works in Lebanon, we as chemists conducted an investigation and followed the trajectory of the expired medications from the moment you throw them away until their final destination.
Our journey started by visiting people who deal with pharmaceutical products daily and then proceeded by talking to pharmacies in order to obtain some clarification on the typical procedure that takes place.
In summary, we discovered that 6 to 12 months before the expiry date, the supplier returns and trades the expired goods for new ones or exchanges them for money.
At any further point than this, the pharmacies are no longer responsible for the consequences of throwing away medicines carelessly, or how it might affect the environment.
Our investigation went on to help us understand that the exclusive distributor’s job consists of collecting all the expired goods and transferring them to the Ministry of Public Health (MOPH).
This means that the responsibility of disposing of the expired medications is then in the hands of the MOPH.
Usually, the correct and safest way to get rid of these products would be through incineration, which is well-known through research.
Unfortunately, given the fact that in Lebanon we do not have the proper tools and institutions, the MOPH ships these perished products to foreign companies that do; or at least this is what they are supposed to do.
As an alternative to this, the MOPH suggested starting an industry of incineration in Lebanon.
Alas, we are in a country where plans never go as planned, hence why nothing has happened to this day. Consequently, $1.3 billion worth of medications are stocked, according to the Ministry of Finance, in warehouse number 9 at the port of Beirut waiting to be exported.
$1.3 billion of expired medicine, stocked in a warehouse with neither the proper conditions nor the appropriate safety measures.
Sadly, this was still the case when the unfortunate explosion happened in the Beirut port. One of the most powerful non-nuclear explosions of the 21st century led to the death of 190 victims, leaving 300,000 homeless people, and 6,500 injured. However, its repercussions did not end there. Lebanon and its people will continue to feel the aftereffects of this explosion, not only mentally, but indirectly through the deterioration of their health. Despite the obvious effects of the explosion on the air we breathe and the water we drink, we must also worry about the $1.3 billion worth of chemicals that are now integrated into our already extremely polluted air and water.
It is for all these reasons that we chose to study how this further contamination affects our health.
As we mentioned earlier, the blast that occurred on the 4th of August burned down the Port of Beirut to ashes, wiping away everything surrounding it. As we were informed by the military forces, the medications were stored in warehouse number 9, most of which were dumped into the ocean.
From a scientific point of view, what could happen when a large amount of chemicals is present in the water?
To make it easier for us, we chose to conduct this study specifically on Panadol which has become a necessity in every household. The reason behind this is simple: it’s an easy fix to very common illnesses such as fever and pain, two symptoms that have been shown to cause deterioration in quality of life.
Scientifically speaking, Panadol belongs to a group of medications called “analgesics” and “antipyretics” which respectively mean pain and fever relievers.
Therefore, we, as chemists, designed a protocol in order to randomly collect samples and analyze the percentage of Panadol present in them.
We divided Beirut into semi-circles as shown in the picture below (Picture A), where we took water samples from the area near the port, and from buildings a couple of miles from the explosion.
Panadol, also called “paracetamol” has a molecular formula of C8H9NO2, and its structure is as follows:
We can notice the pie bonds (in red) and lone pairs (in yellow), which means we can detect this molecule using ultraviolet spectroscopy. In fact, UV spectroscopy is a technique used to determine the concentration of a given compound in a solution of a mixture, based on the absorbance at different wavelengths.
After choosing the technique we were going to use, we proceeded to the preparation of our standard. We took 20 tablets of paracetamol, weighed them, and powdered them.
The following step included taking 100 mg of the powder sample, putting it in a 100 ml volumetric flask, then adding 15 ml of methanol since this compound does not interfere with the spectroscopic measurement. Finally, we added 85 ml of water and homogenized it.
UV absorbs between 200 and 400 nm. Therefore, after putting our standard in the machine, we could determine that the maximum absorbance of paracetamol is equal to 243nm.
In order to convert the lambda, we got, and to get to know the concentration of paracetamol in our sample, we use Beer’s law (A= ϵbc)
where A: absorbance
ϵ: molar absorptivity
b: length of light path
c: concentration
If we obtain a concentration of paracetamol in water which is <30 mg/L, then we are set, adding that it doesn’t pose any health risk.
However, if we find that the concentration of paracetamol is between 30 and 300 mg/L, this can cause multiple repercussions on one’s health like diarrhea, vomiting, nausea, stomach cramps, and much more.
In fact, we only did our experiment on Panadol, but imagine the gravity of this situation when more than a thousand different medications were thrown into the ocean.
In conclusion, Lebanese disposal of expired medication is still fictitious, and we identified many defects in the process of preservation with its huge impact on the Lebanese health system.
It’s time to act and mobilize all required resources to implement a proper and effective mechanism of preservation. Following the data that we gathered, we recommend the following:
- Implement a process of incineration in Lebanon which will guarantee that medications are disposed of with the least pollution effects possible.
- If the incineration cannot take place in Lebanon, then the warehouse containing the medication, waiting to be exported, should be specific to the safety data sheet, which includes every chemical product and its protective measures for handling and storing it.
Our recommendations represent an initial step in order to improve our quality of life.
This explosion emphasized the pollution crisis and the corruption that has been happening for years, but change is never impossible, it is inevitable.
References:
Reuters, 2020, Beirut Port blast death toll rises to 190, from https://www.reuters.com/article/us-lebanon-crisis-blast-casualties-idUSKBN25Q08H
Behera et al., 2012, UV-Visible Spectrophotometric Method Development And Validation of Assay Of Paracetamol Tablet Formulation, International Journal of pharmaceutical sciences and research, from https://ijpsr.com/bft-article/uv-visible-spectrophotometric-method-development-and-validation-of-assay-of-paracetamol-tablet-formulation/?view=fulltext
Healthcare solutions, 2015, Discover the Importance of Medical Waste Incineration, from https://www.stericycle.com/blog/healthcare-solutions/may-2015/discover-the-importance-of-medical-waste-incinerat.
Copy edited by Lana Salloum
