What is recommended for handling waste associated with administration of long-acting injectable antipsychotics (LAIs)?

Each long-acting injectable (LAI) antipsychotic medication produces a variable amount of waste. The decanoates (FGAs) produce relatively little, especially if a 5 ml vial is used, which can last several months when the same ampule is used for multiple doses. For example, a patient on Haldol decanoate 100 mg/1 ml every four weeks, can use a 5 ml vial for nearly half a year.

The second generation (SGAs) LAIs come in kits, using more packaging and providing multiple needle options, thus creating more waste as the kits must be discarded. However, the extra needles can be collected and donated. MedShare, Samaritans Purse, and many other organizations accept donations of unused medical supplies.

Regarding injection supplies (which are often included with some of the kits), including gloves, gauze, bandages, and alcohol swabs, these are important to have on hand even in surplus. Some patients may be able to use the small circle bandages, just large enough to cover the needle injury, that come with the kits if in surplus. It is not clear that having the patient receive the injection from a pharmacist or visiting nurse (rather than in a psychiatric office or hospital) would reduce the overall waste.

An environmental sciences group examined the impact of LAIs on the earth and found reduction of psychiatric decompensations and hospitalizations to be significant. One can see how a monthly injection of antipsychotic can protect the environment by reducing travel to and from the pharmacy, reducing the risk of relapse with associated behavioral instability and possible hospitalization, and increasing the potential for quality of life with appreciation of and care for the environment. “The overall environmental burden was lower … [with LAI] treatment than treatment interruption because patients are kept more stable, which reduces the environmental burden due to hospitals. Moreover, the human health burden was outweighed by the human health benefit.”

[Note: The study referenced has funding from Janssen Pharmaceutica in Belgium.]

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