(People's Daily Health Client Reporter Hou Jiaxin) "The release of the "Implementation Plan for Saving Drug Resources and Curbing Drug Waste" is another milestone progress in the process of curbing drug waste in the mainland!" On December 30, Professor of the Department of Pharmaceutical Management and Clinical Pharmacy, School of Pharmacy, Peking University, Shi Luwen, director of the International Research Center for Pharmaceutical Management of Peking University, lamented to the People's Daily health client reporter that curbing drug waste has always been a problem that the industry has been concerned about and appealed to by the general public, and now we have finally ushered in a plan specially formulated to curb drug waste.
On December 29, the National Health Commission, the State Administration for Market Regulation and other five departments issued a notice (http://www.nhc.gov.cn/yzygj/s7659/202312/14733914d4fa450e91aa2b77c086a679.shtml) on the "Implementation Plan for Saving Drug Resources and Curbing Drug Waste". Organize and implement specific work measures and requirements.
On April 24, the person in charge of the Medical Management Office of the Department of Medical Administration of the National Health Commission clearly pointed out at a meeting that the focus of rational drug use in 2023 is first of all to "formulate policies related to curbing drug waste and guide all localities to reduce drug waste". Eight months later, the "Implementation Plan for Saving Drug Resources and Curbing Drug Waste" came into being.
For the first time, it provides guidance for curbing drug waste from the whole life cycle
In Shi Luwen's view, this "plan" is of great significance, for the first time from the whole life cycle to curb drug waste to make clear provisions, in the specific implementation of the division of labor in accordance with the division of responsibilities with the cooperation of multiple ministries and commissions, can be said to be the mainland in recent years for the problem of drug waste of the most comprehensive and clear guidance.
"From the source to the end, this is the first time that the mainland has made clear guidelines for curbing drug waste from the whole life cycle. Shi Luwen said that some of the contents of the "plan" had previously appeared in different documents sporadically, making relevant provisions for drug waste. However, these contents have not been beaded into a thread, and the "Plan" issued this time will sort out these contents and make corresponding specifications and guidance according to the different stages of the whole life cycle of drugs, which is very worthy of attention.
On December 30, Jin Chunlin, director of the Shanghai Health and Health Development Research Center, told the People's Daily health client reporter that the two requirements in the "plan" are particularly noteworthy. Excessive drug packaging has been criticized, this time clearly put forward the implementation of appropriate packaging of drugs, requiring medical institutions to actively purchase and use large-package drugs, and guiding enterprises to produce drugs with suitable packaging according to the course of treatment; The "Plan" regulates the collection and destruction of waste drugs, especially mentioning the collection, transportation and handover of waste drugs.
The problem of pharmaceutical packaging has been concerned and discussed many times, and the labor cost and waste of packaging material resources caused by a large number of packaging are numerous.
In 2015, six major industry organizations including the China Pharmaceutical Packaging Association carried out the "National Medical Institution Drug Packaging Specification Survey" on 214 medical institutions above the second level in the country. The results show that the inpatient pharmacy of the tertiary hospital unpacks 3401 hours per week, and each hospital needs an average of two special people to unpack every year, and the waste of resources used in drug packaging is amazing, resulting in secondary environmental pollution.
Zhang Xiaodong, director of the Department of Pharmacy at Peking University Third Hospital, once told China Medical News, "The pharmacists in our pharmacy spend no less than one day a week unpacking drugs. Some hospitals have specially made unpacking tools for aluminum foil, and some hospitals have bought unpacking machines for tens of thousands of yuan. The excessive packaging of drugs not only overwhelms hospital pharmacies, but also causes great waste of resources and environmental pollution. ”
Sun Hongtao, chief physician of the Seventh Ward of Adult Cardiac Surgery of Beijing Fuwai Cardiovascular Hospital, also told the Health Times reporter that when he first worked, there was a blood shortage everywhere, and there were no special blood bags for children, all of which were 200cc/bag, and a child often only used about 50cc to be thrown away, these wastes were particularly distressing, and there were still many lives ending because they could not wait for blood.
"The state has always attached great importance to the standardization and management of drug packaging and packaging specifications, and the latest "plan" has made clear provisions, which I believe will bring substantial changes to drug packaging. Shi Luwen said.
A month ago, in response to the "Proposal on Providing Large-Packaged Drugs for Medical Institutions" put forward by the National Committee of the Chinese People's Political Consultative Conference, the official website of the State Food and Drug Administration also pointed out in its reply that in the next step, on the premise of ensuring the quality of drugs, the State Food and Drug Administration will strengthen the governance of excessive drug packaging and actively encourage holders to provide large-package drugs according to the needs of medical institutions.
Multi-department collaboration to put on the "hard brake" for drug waste
Household drug waste has been around for a long time. According to the White Paper on the Recycling of Expired Drugs in Chinese Households (2004-2014) released by Baiyunshan, "about 78.6% of households in mainland China have small medicine kits, and 90.1% of the respondents have the experience of discarding expired drugs at will. The mainland wastes 15,000 tons of expired drugs every year. ”
A survey conducted by Health Times also showed that about 85% of netizens said they had expired medicines left at home. In the question of "How much money is wasted of expired drugs every year?", about 46% of netizens chose 100~300 yuan. Considering that Weibo netizens are mainly concentrated in cities, according to the latest data released by the National Bureau of Statistics that year, the urban population is about 700 million, and if the family population is calculated as 3.5 people, it is converted into about 200 million urban families, and we conservatively estimate that each family wastes 100 yuan of drugs every year: 2×100×46% = 9.2 billion yuan, plus the national rural families, this figure is enough to exceed 10 billion yuan.
Many experts believe that at present, more and more families have developed the Xi of preparing medicines, coupled with the huge population of the mainland, the risk of family drug waste cannot be ignored. The causes of household drug waste exist at the consumer end and the sales side of drugs at the same time. The Plan also has corresponding clear provisions on the above two links.
"For clinical drug management under the guidance of doctors or pharmacists, the "Plan" emphasizes the drug use standards. Jin Chunlin introduced that the "plan" requires doctors to prescribe according to the patient's condition, including the appropriate dosage, frequency, course of treatment, etc. Prescriptions should generally not exceed 7 days, emergency prescriptions should not exceed 3 days, and for eligible chronic diseases, it can be appropriately extended to a maximum of 12 weeks.
In the absence of the guidance of a doctor or pharmacist, due to the lack of relevant medical knowledge, it is difficult for the general consumer to comprehensively consider the dosage and expiration date of each drug when purchasing drugs on their own, and when the epidemic spreads more intensively, it is easy to have extremely irrational drug hoarding behavior. In addition, promotional activities often lead to blind drug preparation. The reporter interviewed online and offline drug sales platforms and relevant institutions and found that common drugs are mostly promoted with "buy more and discount more".
For drug sales, the Plan prohibits the illegal sale of drugs, and prohibits the giving of prescription drugs or Class A non-prescription drugs to the public in the form of free drugs for the purchase of drugs or free drugs for the purchase of goods. Strengthen the management of pharmacists and pharmacy sales personnel, and non-in-service personnel of drug retail enterprises shall not engage in drug sales-related activities in the business premises. Online sales of drugs shall have the corresponding qualifications and conditions, and comply with relevant laws, regulations, rules and regulations.
"Different from the past, the "plan" involves a wide range of departments, and after each measure, the leading department and the division of responsibilities are clarified, which fully ensures that each link has rules to follow and departments to manage. Shi Luwen said.
In the process of curbing drug waste, there is still a need for continuous improvement and improvement
"The collection and destruction of discarded drugs has always been the focus of public attention. Shi Luwen said that the "plan" for the collection, transportation, handover, destruction and other processes of waste drugs have been standardized, and at the same time clarified the specific responsibilities of the Ministry of Housing and Urban-Rural Development, the National Health Commission, the Ministry of Ecology and Environment, and the State Food and Drug Administration, which is an unprecedented change.
Regarding the disposal of expired drugs, in February 2021, the State Food and Drug Administration said in response to questions from netizens that if expired drugs at home are not classified and collected, they can be discarded and recycled with domestic garbage after destroying the drug packaging box. If expired drugs at home are sent to regular collection points for unified recycling, they need to be harmlessly disposed of in a centralized manner to reduce the harm to the environment.
In recent years, many places have begun to recall expired drugs, and some local drug regulatory departments have set up expired drug collection points, and some pharmaceutical companies, hospitals, and pharmacies have also provided expired drug recall services to the public. For example, in 2022, Taiyuan City, Shanxi Province, launched the "Centralized Designated Recycling of Expired Drugs at Home" activity, setting up 153 designated collection points.
Jinchang market supervision map
"Although there have been some useful explorations at the local level, from a national perspective, mainland laws have not stipulated the standardized treatment of expired drugs at home, and there is still a lack of systematic and comprehensive legal regulations. Shi Luwen said that from this dimension, the implementation of the "plan" can be said to have taken a key step, but the follow-up still faces many problems such as specific implementation, which needs to be continuously improved and improved.
At the same time, a number of industry insiders also mentioned the convenience of medication. Jin Chunlin said that behind the people's psychology of hoarding medicines, they are often worried about the inconvenience of prescribing drugs and buying medicines, which makes them breed the idea of "hoarding medicines". In order to effectively change this, it is not only necessary to establish a stable and smooth circulation channel from the supply of drugs to provide more convenience for the people to purchase drugs, but also to strengthen the health awareness of the general public, so that everyone can spontaneously buy drugs on demand and avoid drug waste.
Extensive public education is also needed on how to store medicines at home and reduce waste. Zhang Xiaole, deputy chief pharmacist of the Pharmacy Department of the Third Hospital of Beijing Medical University, said that some commonly used internal medicines can be stored, such as antidiarrheal drugs, morpholine, cold medicines, and antipyretics. There are two kinds of cold medicines, the treatment of cold colds and hot colds, and the dosage is enough in a week. Antibiotics are not recommended. You can also store some topical medications, such as band-aids, plasters, etc. In addition, basic medical supplies should also be available, such as thermometers, cotton swabs, medical absorbent cotton, sterilized gauze, etc.
"The introduction of any policy is a step-by-step approach, and it cannot be achieved overnight, and the same is true for curbing drug waste. Shi Luwen said that from the current point of view, this work still has a long way to go. Now, we have taken a key step, and I believe that we will continue to walk more and more steadily.