LCQ14: Use and disposal of drugs


Hong Kong (HKSAR) -      Following is a question by the Hon Chan Hak-kan and a written reply by the Secretary for Food and Health, Professor Sophia Chan, in the Legislative Council today (November 29):

Question:

     Regarding the use and disposal of drugs, will the Government inform this Council:

(1) of the quantity of antibiotics for human use imported to Hong Kong in each of the past three years;

(2) whether it knows the quantity of antibiotics prescribed by public hospital doctors in each of the past three years, broken down by the targeted bacteria (if applicable);

(3) whether it has compiled statistics on the respective numbers of patients who (i) were infected with antibiotic-resistant bacteria locally and (ii) developed serious complications after the use of drugs (and, among them, the number of those by whom the drugs used were antibiotics) in the past three years;

(4) whether it has studied the situation and impact of abusive use of antibiotics in the past three years;

(5) of the quantity of expired drugs received by the Government in each of the past three years and, among them, the quantities of those transported to the Chemical Waste Treatment Centre for handling;

(6) whether it has compiled statistics on the quantity of drugs discarded at landfills in each of the past three years; whether it has studied the impact of those drugs on the ecological environment;

(7) as some overseas cases have shown that discarding drugs casually at landfills or sewage pipes may pollute the ecological environment and the compounds concerned may enter human body through the food chain, thus posing health hazards, whether the Government conducted laboratory tests in the past three years to see if the water bodies of reservoirs contained antibiotics and hormone-related compounds; if so, of the outcome;

(8) whether it knows the current number of collection points in Hong Kong for unused drugs, and the quantity of drugs collected by those collection points in each of the past three years; and

(9) whether it will consider co-operating with private medical practitioners and owners of pharmacies in setting up collection boxes for expired drugs at clinics and pharmacies, in order to ensure that the drugs concerned are handled properly; if so, of the details; if not, the reasons for that?

Reply:

President,

     Having consulted the relevant government departments and the Hospital Authority (HA), my reply to the nine parts of the question is as follows:

(1) The Department of Health (DH) does not maintain the annual figures on the quantities of antimicrobials imported to Hong Kong. However, following the launch of the Hong Kong Strategy and Action Plan on Antimicrobial Resistance this year, the DH will continuously monitor antimicrobial use through different channels, including analysis of the data of supply of antimicrobials collected from wholesalers.

(2) The overall amount of antimicrobials prescribed by public hospitals from 2014 to 2016 is set out as follows:
 
Year Overall amount of antimicrobials prescribed for acute patients in acute hospitals
(defined daily dose per 1 000 bed days occupied)
2014 874.3
2015 890.0
2016 904.4
*Source: Clinical Data Analysis and Reporting System of the HA
(Note: In interpreting the statistics about the trend of antimicrobial use, we should take into account a number of factors such as population age, multiple comorbidities, changing disease patterns and treatment.  For instance, increasing complexity of medical conditions, wider use of immunomodulators/immunosuppressants and indwelling devices, and emergence of multi-drug-resistant organisms could affect the quantity of antimicrobials used.)

     HA currently adopts the Inter-hospital Multi-disciplinary Programme on Antimicrobial Chemo-therapy (IMPACT), which is jointly compiled by the Centre for Health Protection, the HA, the two universities, private hospitals and the Hong Kong Medical Association, as the guidelines on the use of antimicrobials so as to ensure more prudent and appropriate use of antimicrobials in public hospitals.

     As the treatment of patients with bacterial infection may involve more than one kind of antimicrobials, the HA would not be able to provide the quantity of antimicrobials prescribed by public hospitals broken down by targeted bacterium. 

(3) Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) is a type of antimicrobial resistant bacteria.

CA-MRSA infection is a statutory notifiable disease in Hong Kong. The number of CA-MRSA infection cases reported to the DH in the past three years is shown in the following table:
 
Year Number of reported cases
2015 1 047
2016 1 168
2017 (as of October 31) 1 059

     From 2015 to June 2017, the DH also received a total of 1 101 reported cases of adverse drug reactions, of which 30 cases involved patients who had taken antimicrobials.

(4) There are no statistics showing whether antimicrobials are being abused or not. In response to the recommendation of the Hong Kong Strategy and Action Plan on Antimicrobial Resistance, the DH already established the Working Group on Antimicrobial Resistance One Health Surveillance in October 2017.

The working group will monitor antimicrobial use through various channels, including analysing the trend of antimicrobial use in different sectors by making use of the data of supply collected from wholesalers, and monitoring antimicrobial use in medical institutions through the data collection platform of public hospitals and clinics. The DH will also explore ways to encourage private medical practitioners to participate in the surveillance programme.

     Moreover, antimicrobial resistance (including avoidance of antimicrobial overuse) has been identified as one of the thematic priorities of the Health and Medical Research Fund (HMRF) of the Food and Health Bureau. Researchers are welcome to submit applications for funding support through the annual open call of the fund.

(5), (6), (8) and (9) Based on the principle of safe use of drugs, hospitals and clinics under the HA will not re-use the drugs which have been prescribed and dispensed to patients.

In accordance with the Waste Disposal Ordinance (Cap. 354), waste medicine and injections generated by healthcare institutions such as hospitals and clinics are classified as chemical waste. The storage, collection, transport and disposal of such waste has to meet the stringent requirements laid down in the Waste Disposal (Chemical Waste) (General) Regulation (Cap.

354H). These control measures do not apply to the disposal of medicine and injections arising from households. Given the generally small quantities of household residual medicine and injections, they are currently being handled together with general domestic solid wastes.

The Government has no plans to provide household residual medicines collection services.

     The quantities of waste medicine and injections transported to the Chemical Waste Treatment Centre for incineration, or to landfills for disposal in the past three years are set out in the table below.
 
Year Quantity of unwanted or waste medicine and injections transported to the Chemical Waste Treatment Centre for incineration annually/(approximate percentage of overall treatment capacity)
(tonnes)
Quantity of unwanted or waste medicine and injections disposed of at landfills annually/(approximate percentage of overall disposal)
(tonnes)
2014 370 (3 per cent) 108 (0.002 per cent)
2015 504 (4 per cent) 0 (0 per cent)
2016 695 (5 per cent) 9 (0.0002 per cent)

     As illustrated by the above figures, the quantities of medicine and injections disposed of at landfills (note) are relatively small, and hence will not pollute the environment nor endanger public health.

     Furthermore, the DH has been educating members of the public about the correct use of medicines through its website, pamphlets and announcements in the public interest on television. When dispensing medicines, the DH staff will also remind patients that the medication should be taken in accordance with the doctors' instructions shown on the labels, and should not be discontinued at will. Patients having any questions concerning the medicines they are taking should consult their doctors for advice.

(7) Local water sources are collected from water gathering grounds (WGGs) which are under good protection.

The development in WGGs is strictly controlled to prevent pollution of water sources. The risk of water pollution in WGGs by landfills or through sewage pipes is minimal.

     According to the study report on Pharmaceuticals in drinking-water published by the World Health Organization (WHO) in 2012, the pharmaceutical residual concentrations detected in treated drinking water are usually well below 50 nanogram per litre (i.e. less than 1/1000 of the minimum therapeutic dose), suggesting a very low risk to human health.

Hence, the WHO does not consider it necessary to develop relevant guideline values and routine monitoring programmes for pharmaceutical residual concentrations in drinking water. Currently, the Water Supplies Department does not carry out routine monitoring programmes for pharmaceutical residues in drinking water. Nevertheless, it will continue to keep in view the latest international scientific evidence and developments in this regard, and review the requirements for monitoring the quality of drinking water in a regular manner to ensure its safety.

Note: The landfills have been designed and constructed as a secure containment facility incorporating multilayer composite liner systems that cover the entire surface area of the sites.

As the sites are lined, landfill gas and leachate generated within the landfills can be collected and treated. This ensures that there will not be any untreated discharges from the landfills causing environmental pollution.



Published on: 2017-11-29

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