One of the major leaps undertaken by the Drugs Control Department of Kerala is the launching of nPROUD - a new Programme on Removal of Unused Drugs. Such an initiative would help mitigate these major concerns, including antimicrobial resistance (AMR) and the misuse of expired drugs, such as antibiotics, tablets, ointments, and inhalers.Key Highlights of nPROUD:

• The pilot project would be initiated in January 2025, covering the Kozhikode Corporation and Ulliyeri Panchayat, thereby impacting around two lakh households and many medical stores.

• Collection Process:

• Household-Level: Haritha Karma Sena and Kudumbashree volunteers will collect unused or expired drugs directly from homes free of cost while educating the public about AMR.

• Medical Stores: Equipped with blue bins, stores will serve as collection hubs. However, retailers, wholesalers, and hospitals will pay ₹40 per kg for disposal.

• Special Events: "Go Blue Day" events will enable pre-announced collection drives at strategic locations.

Processing and Disposal:
All drugs will be scientifically processed, incinerated, and treated through Kerala Enviro Infrastructure Ltd at Ernakulam for environmentally safe disposal, thereby avoiding the reuse of expired drugs.

National Expansion Initiatives:
This model of Kerala can be taken up on a national level only if the Union government amends drug laws and makes the state drug controllers take charge of unused drugs. Both the health departments of Delhi and Karnataka have already sought the model.

Changes and Responses:

• Role of Medical Stores: The All Kerala Chemists and Druggists Association (AKCDA) has raised concerns about storage capacity and the system’s impact on their existing practice of returning expired drugs to manufacturers via wholesalers.

• Programme Revival: Originally proposed in 2019, PROUD faced hurdles that limited its reach to parts of Thiruvananthapuram and Kollam. The revamped nPROUD now includes traceability measures and enhanced public engagement to ensure measurable outcomes.

Goals of nPROUD:

• Decrease the risk of AMR: Avoid reuse or misuse of expired drugs.

• Public Engagement: Raise awareness about proper disposal and AMR.

• Waste Traceability: All collected drugs shall be scientifically processed.

Statements from Officials:

• According to Assistant Drug Controller Shaji Varghese, the scheme would employ a gradual and controlled step-by-step approach before scaling up.

• A. N. Mohan, the AKCDA President, said there was a need for proper storage capacity in medical stores to make the initiative functional.

Looking Ahead:
Kerala's ambitious nPROUD initiative sets a new benchmark for the management of pharmaceutical waste and addressing the AMR crisis. With intentions for nationwide implementation, this model has the potential to transform India's methodology regarding drug disposal, thereby ensuring the safety of both environmental and public health.