There is a need to have a drug incinerator for the safe and efficient destruction of expired prescription drugs or confiscated narcotic substances in the country.

This was raised during a workshop on the review of intellectual property legal and policy coherence to promote access to health technologies, including medicines in Bhutan in Thimphu on June 5.

The Jomotsangkha-Martshala’s member of Parliament (MP), Pelzang Wangchuk, raised the issue on the disposal procedure of expired medicines in the country.

Drug controller with the Drug Regulatory Authority (DRA), Kinga Jamphel, said that the authority had initiated discussion on having a drug incinerator at a national level. “We will soon meet with the National Environment Commission.”

He said that expired medicine is a medicine that has become inactive or which would not have the same potency as a medicine that is not expired.

As per the Medicine Act, no expired medicine should be dispensed or given to any patient.

Kinga Jamphel said that there is a standard procedure for disposing off expired pharmaceutical waste approved by the National Environment Commission.

“There are different disposal methods depending on the medicine,” he said. Some medicines are encapsulated and buried under the ground so that there is no harmful effect to other living creatures while some medicines have to be incinerated at a temperature of more than 1,000 degree Celsius.

The drug controller said that since there is no drug incinerator in the country, expired pharmaceutical drugs are currently incinerated in a cement factory in Pasakha, Phuentsholing. “Some factories did not entertain our request.”

He said that currently, the cement factory allows the authority and the ministry to incinerate the expired medicines. “The factory might not incinerate the expired pharmaceutical drug anytime saying the medicines affect the quality of cement.”

Private pharmacies in the country pay a certain amount to the DRA for the disposal of medical waste while the pharmaceutical waste from the hospitals is disposed by the health ministry’s Department of Medical Supplies and Health Infrastructures (DMSHI).

Kinga Jamphel said the authority ensure that the expired medicines at the pharmacies are not sold and its disposal does not affect the environment. “The health facilities or pharmacies should keep the expired medicines separately from the stock and apply for disposal to the authority or the ministry.”

In the last two years, expired pharmaceuticals worth Nu 2.81M (million) from health centres in the country was disposed.

This year, the ministry has received expired medical waste worth Nu 0.15M for disposal to date, which is 0.11 percent of the ministry’s approved budget.

An official with DMSHI, Som Bahadur, said that changes in morbidity pattern, variation in prescribing pattern and guidelines, supply received with short shelf life from the suppliers (75 percent shelf life is acceptable), and maintaining emergency stock for certain cases like snake bites and poisoning are some of the reasons for the expiry of medicines.

He said a buffer stock of 30 percent vital, 20 percent essential and 10 percent necessary medicines are maintained at medical supply distribution division in Phuentsholing to top up health centres. An anticipating epidemic, outbreak and disaster preparedness also attribute to the expiry of medicines.

Director general of the department of medical services, Dr Pandup Tshering, said the ministry also has a mechanism in place like demobilisation system to ensure that medicines do not expire.

He said every pharmacy in the country are asked to continuously monitor their stock. “We mobilise the medicine that is nearing its expiry date to the nearest health centres.”

Dechen Tshomo