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Medicamentos: do uso no cuidado da saúde individual ao impacto para a coletividade do descarte no meio ambiente

Por Roseane Garcia, coordenadora das Câmaras Técnica de Resíduos da ABES-SP e Temática nacional da ABES, e Ana Paula Rogers, coordenadora adjunta da Câmara Temática de Comunicação no Saneamento.
 
O primeiro cientista a aplicar as ferramentas de saúde ambiental foi Hipócrates (c. 460-c. 377 a.C.). Ele já apontava a importância de observar fatores ambientais e a saúde da população. Hipócrates, o pai da medicina, explicava o processo saúde-doença pela Teoria dos Miasmas, que afirma que as doenças são transmitidas pelo ar, águas e outros locais insalubres.

No século 19, houve a terceira pandemia de cólera, na qual milhões de pessoas em todo o mundo morreram pela doença provocada pela bactéria Vibrio cholerae.

Em 1854, em Londres, o médico inglês, chamado John Snow, pai da epidemiologia, criou um mapa para correlacionar os óbitos com o consumo de água contaminada distribuída através de um poço localizado na Broad Street, no bairro de Soho.

A Organização Mundial da Saúde (OMS) estabeleceu duas definições importantes: em 1946, saúde como “um estado de completo bem-estar físico, mental e social, e não apenas como a ausência de doença ou enfermidade”; e, mais recentemente (1993), Saúde Ambiental como: “todos aqueles aspectos da saúde humana, incluindo a qualidade de vida, que estão determinados por fatores físicos, químicos, biológicos, sociais e psicológicos no meio ambiente. Também refere-se à teoria e prática de prevenir ou controlar tais fatores de risco que, potencialmente, possam prejudicar a saúde de gerações atuais e futuras.”

No ano de 2004, as questões de saúde são incorporadas em uma publicação do Pacto Global, em parceria com o Banco Mundial chamada “Who Cares Wins”, como políticas de Environmental, Social and Corporate Governance (ESG), ou em português, Ambiental, Social e Governança (ASG) no campo da saúde ambiental devem ganhar força.

Em relação ao descarte, há muito a percorrer nas políticas públicas, já que há no Brasil cerca de 2.655 lixões ativos no Brasil para descarte de resíduos sólidos, representando 48% do total de municípios brasileiros. E hoje apenas  1.684 municípios atenderam às taxas ou cobranças para os serviços de manejo de resíduos sólidos urbanos, totalizando 30%.

No que concerne aos medicamentos e seu descarte no ambiente, a preocupação é grande quando são identificados fármacos nas águas destinadas ao abastecimento para consumo humano, decorrentes de lançamento de medicamentos, seja na forma de esgoto ou resíduos sólidos.

A Associação Brasileira de Engenharia Sanitária e Ambiental (ABES), que coordena a Comissão de Estudo Especial de Resíduos de Serviço de Saúde (ABNT/CEE-129), enfoca o problema dos resíduos produzidos nos domicílios no cuidado da saúde. Primeiro, porque são inadequadamente classificados como sem risco, embora o possuam. Segundo, pelo custo da coleta repassado para prefeituras.

Na Norma da ABNT NBR 16457/22, que trata da logística reversa de medicamentos de uso humano, não foram contemplados os medicamentos de uso animal, material perfurocortantes (seringas e agulhas), aerossóis e medicamentos de uso não humano, gerados nos domicílios.

Com as reuniões da norma finalizadas, os pontos não contemplados serão incluídos na nova norma de Resíduos de saúde resultantes do autocuidado no domicilio – Gerenciamento e descarte de dispositivos para administração de medicamentos injetáveis e seus complementos e para auto teste descartados pelo consumidor,  que incluem seringas, agulhas, canetas para aplicação de medicamentos, conjunto de infusão, reservatórios usados na bomba de insulina, lancetas, fitas reativas, sensores de glicose, pilhas e baterias e correlatos. Ademais, para completar a discussão vem ai a 1ª norma nacional sobre gerenciamento de Resíduos de Serviços de Saúde Animal e Resíduos de Interesse em Saúde Animal, em zona urbana e rural.

O incentivo à prática de descarte de medicamentos é benéfico à população. Por isso, a ABES, nesse contexto, engajou-se nas normas. Contudo, o ótimo trabalho de redação da norma, para ser mais frutífero, deve ser acompanhado de campanhas de esclarecimento e estímulo para a população, partindo de todos os níveis governamentais, com participação das diversas instituições e segmentos empresariais atuantes.

24 Comentários em Medicamentos: do uso no cuidado da saúde individual ao impacto para a coletividade do descarte no meio ambiente

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