某醫學中心藥品檢收分析

Medication Recycling Analysis in a Medical center

在美國，已經有至少33州政府法律允許回收藥品的再使用（medication recycling programs），在經過藥師的安全性確認後，由醫院、診所或義診時使用。如果是過期或無法使用之藥品，仍然需要經由特殊處理，不可當作一般垃圾丟棄，尤其是像抗生素、賀爾蒙製劑、化療藥物等，否則會污染及破壞自然環境。但是，在台灣，有超過六成五的民眾不知如何處理不需要的藥品而直接丟棄垃圾桶或沖入馬桶，只有有一成五的民眾會拿回醫院或診所回收。因此，如何建立民眾正確的用藥觀念，讓藥品在合理治療使用時發揮最大的效益，減少浪費與污染，已愈來愈受到重視。本研究收集自民國九十九年一月至六月期間，由來賓提供至本院藥局檢收之藥品。結果共回收295件來賓交付檢收之廢棄藥物，總計2,160筆藥品。其中經由藥師進行初步安全性確認評估後，具可回收使用價值之堪用藥品筆數為858筆（46％），金額約為407,794元，不具可回收使用價值之不堪用藥品筆數為1,008筆（54％），金額約為674,063元。依藥理分類排行之數量前三名為胃腸道作用藥品（20.2％）、心血管作用藥品（19.6％）與降血糖劑（16.5％），依藥品價格總額排行之前三名則為心血管作用藥品、降血糖劑與中樞神經作用劑。從研究結果中可以得知我國民眾就醫時，在使用藥物治療的計劃與實際服藥狀況有一定的差距。以本研究之單一回收機構來估算，透過藥品檢收方式，本院每年約丟棄了216萬元價值的藥品。從研究結果中顯示有高達83％的檢收藥品是來自於原本給藥的機構，而且通常為完整包裝或未拆封的藥品，有的甚至是連藥袋都原封不動退回。因此，若可透過相關檢收藥物或再利用計畫的擬定與執行，將可達到減少醫療浪費的目的。

In the USA, 33 states already passed laws permitting medication recycling programs. After proper safety evaluation by pharmacists, the recycled drugs can be reused by hospitals or clinics or properly disposed of if deemed unsuitable or expired. Especially for drugs such as antibiotics, hormonal products, chemotherapeutic agents and etc, if unrecyclable, they're chemical effects will be harmful and pollute the environment. In Taiwan, only 15% of people would take their unneeded medicines back to medical facilities for recycling. Over 65% of people would throw away the medicines into garbage bin or flush into toilets, because they lack the concept of medication recycling. These threw-away medicines would be a waste in medical resources and a cause of environmental contamination. For prevention of this potential problem, the correct concept of medication use and medication recycling was put into attention. In this study, data was gathered from unneeded medicines received by the hospital from visitors during January to July 2010. A total of 2160 items were received from 295 hospital visitors. After verification and safety assessment by pharmacists, 858 items (46%), with a value of NT$ 407,794 in total, were considered recyclable and can be reused. Other 1008 items (54%), with a value of NT$ 674,063 were considered non-recyclable and unusable. Based on pharmacological classification, the recycled medicines ranking from first to third were gastrointestinal drugs (20.2%), cardiovascular drugs (19.6%), and anti-diabetic agents (16.5%). Based on total value, the top three rankings were cardiovascular drugs, anti-diabetic agents, and central nervous system drugs. It was estimated that an equivalent of approximately NT$ 2.16 million of drugs were discarded by the hospital each year. This study result showed that about 83% of drugs received by the hospital were originally prescribed by the same hospital itself. And most of the drugs received were in their original packaging, untouched or unopened. These results showed that there existed a medication compliance problem after people received treatment plans from medical help. Therefore, establishment and execution of a plan, in which recycled medications can be reused, might be useful in reducing further waste of medical resources.