"A RESILIENT AND SUSTAINABLE WORLD: CONTRIBUTIONS OF CLEANER PRODUCTION AND CIRCULAR ECONOMY" Beyond circularity: the reverse flows of medicines in Brazilian solidary pharmacies as collaborative consumption

Abstract

The reverse flows of medicines, although well documented in academic literature, are mainly framed as reverse logistics, aiming at optimizing supply chain operations and at promoting environmentally accepted practices regarding expired medicines.

Full text

“A RESILIENT AND SUSTAINABLE WORLD: CONTRIBUTIONS OF CLEANER PRODUCTION AND
CIRCULAR ECONOMY”
Florence/Pistoia – Italy – September 8th to 10th - 2021
Beyond circularity: the reverse flows of medicines
in Brazilian solidary pharmacies as collaborative
consumption
VIEGAS, C.V. a*, BOND, A.b,c, PEDROZO, E. A.a , SILVA, T.N. a, BERTOLO, R.J.d
a. Federal University of Rio Grande do Sul (UFRGS), Management School, Brazil
b. University of East Anglia, School of Environmental Sciences
c. School of Geo and Spatial Science, North-West
University Potchefstroom Campus, Private Bag X 6001, Potschefstroom 2520, South Africa,
e-mail: alan.bon@uea.ac.uk
d. Universidade Luterana do Brasil
*Corresponding author, cldviegas@gmail.com
Abstract
The reverse flows of medicines, although well documented in academic literature, are mainly framed as
reverse logistics, aiming at optimizing supply chain operations and at promoting environmentally accepted
practices regarding expired medicines. For unexpired medicines, the idea of recirculation has been slowly
embraced, although this initiative, associated with the Circular Economy in academic literature, does not
usually contemplate social issues and it is not typically applied to goods such as medicines. Currently, the
reverse flows of medicines for a new consumption cycle, in the form of redispensation, is a reality for sections
of population that face economic constraints. However, there remains some stigma in considering medicines
goods that can have a new life cycle under pharmaceutical supervision. In Brazil, the phenomenon of
municipal solidary pharmacies is spreading, where both unexpired and expired medicines can be properly
managed, achieving socioeconomic and environmental benefits. At the same time, the Federal Government
has recently enacted a Decree that makes mandatory the reverse logistics of all domestically used medicines,
regardless of the possibility of a new life cycle for these goods. In this paper, we briefly discuss the status
of medicines reverse flows in Brazil with respect to its classification, and conclude that it is a mix of Reverse
Logistics and collaborative consumption, rather than Circular Economy, in the cases of socioeconomically
useful returns. We also provide data from ongoing research into five solidary pharmacies in Southern Brazil,
evaluating their performance . We find that it is possible to realize positive socioeconomic returns, equivalent
to USD 1.19 per capita, in a medium-size municipality of Santa Catarina State, and to USD 1.36 per capita
in a small city of Rio Grande do Sul, both in 2019. According to pharmacists involved in redispensation, the
main barriers to increasing financial returns are: the lack of public knowledge about such establishments;
difficulties for data recording on inputs and outputs, mainly due the lack of electronic data resources and
integration; lack of governmental support for solidary pharmacies despite their being a public service that
collaborates with the Public National Health System (SUS). This research is limited both by the difficulty in

10th International Workshop | Advances in Cleaner Production – Academic Work
“A RESILIENT AND SUSTAINABLE WORLD: CONTRIBUTIONS OF CLEANER PRODUCTION AND
CIRCULAR ECONOMY”
Florence/Pistoia – Italy – September 8th to 10th - 2021
2
identifying other solidary pharmacies, and because many of those already known refused to provide
information.
Keywords: medicines reverse flows; reverse logistics; circular economy; collaborative economy.
1. Introduction
Reverse flows of medicines are relevant because these types of goods are harmful to the
environment (soil, water) and to public health if not properly discharged (Campos et al., 2017).
Usually, medicines are disposed of in domestic garbage bins or in toilets (Kotchen et al., 2009;
Seehusen et al., 2006), as many countries do not formalize public policies for the Reverse
Logistics (RL) of these products. It can be considered wasteful in several aspects: to the
consumers that do not fully use generally expensive products, and to the industry, that dedicates
many years of expertise to develop and deliver drugs to the market. According to Hogan and
Tangney (2018) from the concept-to-product, a commercial therapeutical medicine requires
around USD 3 billion. Thus, the garbage or sewerage destination for such products can be taken
as not only an ecological, economic and social assault, but also a knowledge wastage.
Furthermore, access to medicines is uneven, mainly because of the combination of high prices
and low income of the majority of the population. Around a third of the global population cannot
afford basic medicines (Duong et al., 2018). In Brazil, the prices of medicines for consumers are
1.9 to 13.1 times higher than those charged in Sweden, for example (Patterson and Carrol, 2019).
There are many difficulties in obtaining precise data with respect to how medicines expenses
impact the budget of the poor. According to Vieira (2018), medicines purchasing accounted for
around 22% of the poorer income in Brazil up to the 1990’s. Around 2008, this proportion had
lowered to 8.5% because the Federal Government created, in 2004, the Popular Pharmacy
program in order to subsidise access to basic medicines. However, this program was practically
paralysed around 2017 due to political upheavals in Brazil’s government. While no updated
research has been published on medicines affordability in the country, the combination of the
ongoing economic crisis with the pandemic since March 2020 has almost certainly worsened this
situation.
Since 2010, Brazil has had a National Solid Wastes Public Policy that facilitates the creation of RL
systems for sectors such as: electroelectronics; batteries; pesticide packaging; tires; and sodium,
mercury and mixed light lamps. However, no mention of medicines is provided in this policy
(Brazil, 2010). Nevertheless, in June 2020, the Federal government enacted Decree 10,388 which
aims at the regulation of the medicines RL. This decree, which has been in force since December
2020, is a result of negotiations carried out since 2014 between diverse stakeholders of the
medicines supply chain including industry, distributors, third party logistics, and retailers. It
targets the return of all types of domestic medicines (used, expired or unexpired) coming from
human consumption to the so-called correct destinations of controlled incineration, landfills, and
co-processing (Brazil, 2020). Nevertheless, there is a legislative gap regarding health solid wastes
in Brazil. The Resolution of the Health Surveillance (Anvisa) 304/2004 classified health wastes
without including medicines in this classification (Anvisa, 2004a); and the Resolution 306/2004
of the same agency forbids the coprocessing of health wastes (Anvisa, 2004b). Furthermore, the
Resolution of the Brazilian Environmental Council (Conama) 358/2005 classified all used
medicines as hazardous wastes that must be disposed of in appropriate landfills (Conama, 2005).
These multiple types of regulatory instrument makes the situation of used medicines, whether or
not expired, difficult to manage, because, in fact, the most robust instrument for a secure decision
making regarding RL is the law democratically adopted by federal legislatures rather than
resolutions or decrees enacted by the Executive power.
Meanwhile, there are many initiatives, in the Brazilian municipal public sector, promoting the
redispensation of unused or end-of-use medicines – those considered able to enter a new cycle
of consumption after inspection of professional pharmacists. Such initiatives, called “solidary

10th International Workshop | Advances in Cleaner Production – Academic Work
“A RESILIENT AND SUSTAINABLE WORLD: CONTRIBUTIONS OF CLEANER PRODUCTION AND
CIRCULAR ECONOMY”
Florence/Pistoia – Italy – September 8th to 10th - 2021
3
pharmacies”, also collect end-of-life medicines – those expired or not classified as suitable for a
new cycle of consumption after pharmacists’ inspections. This type of activity is happening not
only in Brazil, but in other countries, such as Greece, where a program called GivMed has, since
2010, provided redispensation of medicines considered suitable for consumption with the support
of a technological device (app) where donators and receivers present their offerings and demands,
respectively. The main difference between such systems and the Brazilian solidary pharmacies is
that GivMed does not accept expired or damaged products (GivMed, 2020).
Regardless of the existence of many solidary pharmacies in Brazil, no report is available about
the exact number of units they comprise, where they are placed, and how exactly they work.
Also, there are no studies about the socioeconomic and environmental impacts of such pharmacies
barring specific case studies (Bertolo et al., 2018). Some research on individual solidary
pharmacies were reviewed in a recent research project (Viegas, 2021), but the methodologies,
research questions, and scope they employed are very variable. This context hampers a proper
comparison and a real perspective on the consequences of such establishments in the context of
medicines reverse flows and respective environmental and socioeconomic impacts.
In fact, until recently, the idea of medicines recirculation in the frame of the Circular Economy,
was not found in academic literature. The bulk of the studies were, until then, focused on RL for
optimizing the supply chain operations from an economic perspective (Campos et al., 2017;
Nematollahi et al., 2018). Subsequent to the study of Viegas et al. (2019), attempting to classify
the reverse flows of medicines, others have been published supporting the idea of medicines
redispensation based on quality and security for the users (Hui et al., 2020a; Hui et al., 2020b).
Nonetheless, the Circular Economy (one of the taxonomies related to the reverse flows of
medicines) is still a concept strongly focused on ecological and economic aspects, and much
criticism has arisen due to the lack of social approaches in CE studies (Camacho-Otero et al.,
2018; Kirchherr et al., 2018). According to Adams et al. (2017), CE pays little attention to reuse
of products. Given such observations and the parallel evolution of the research on collaborative
consumption (Ertz et al., 2017; Ertz, 2020), it is likely that solidary pharmacies are, in fact, a
mixed model of reverse flows that embrace both RL and collaborative consumer practices rather
than a partial model of CE.
According to Ertz (2020), collaborative consumption refers to the circulation systems that link
obtainers and providers through a mediator rather than purchasers and sellers. This way of
naming those who need and those who own unneeded goods that can be of value elsewhere goes
beyond circularity because it is based on social exchanges more than on pure economic-ecological
aspects of sustainability. There are many forms of collaborative consumption, such as,
mutualization (sharing, leasing, renting, pooling), redistribution (donations, passing along), and
secondary markets (Ertz, 2020). Under this perspective, consumers are also co-producers, as
they can collaborate for a new consumption cycle, as in the case of medicines recirculation
mediated by solidary pharmacies. Besides, it is a way of enabling multiple lives schemes for
goods, as described by Ertz et al. (2017). Taking in to account these last considerations on
collaborative consumption, this research aims at providing preliminary results of ongoing research
about the performance of solidary pharmacies in Brazil.
2. Methods
Mixed methods were applied, involving literature review on RL, CE, collaborative consumption;
semi-structured interviews with pharmacists of solidary pharmacies, and secondary data
research. Qualitative and quantitative data were considered in five embedded case studies (Yin,
2014). A preliminary research on solidary pharmacies placed anywhere in Brazilian territory was
performed during May to August 2020, using the Google search engine as a tool. This identified
12 establishments in diverse municipalities, from which four did not respond after phone and e-
mail contact. From the remaining eight, three provided preliminary but incomplete information

10th International Workshop | Advances in Cleaner Production – Academic Work
“A RESILIENT AND SUSTAINABLE WORLD: CONTRIBUTIONS OF CLEANER PRODUCTION AND
CIRCULAR ECONOMY”
Florence/Pistoia – Italy – September 8th to 10th - 2021
4
by phone, and refused to return answers to a questionnaire sent through e-mail. Only five agreed
to complete the questionnaire. The results are shown in sequence (Figures 1, 2, and 3).
3. Results
City
Population size
(N) (1)
Average monthly
income in USD(2)(3)
Employed population
(%)(2)
Blumenau, SC State
361,855
587,31
45.3
Criciúma, SC State
217,311
526,55
36.9
Rio do Sul, SC State
223,112
526,55
41.0
Farroupilha, RS State
73,061
587,31
42.1
Flores da Cunha, RS State
31,063
567,05
44.4
Fig. 1 - Socioeconomic profile of municipalities that host the solidary pharmacies
(1) Brazilian Geography and Statistical Institute (IBGE) data, 2020.
(2) Brazilian Geography and Statistical Institute (IBGE) data, 2018. (3) These values were calculated based on the
minimum wage value established by Brazilian Federal Law in February 2020 = R$ 1.045, and based on the average
value of USD in 2020 (Jan-Dec) = R$ 5,16 (Brazilian currency), which corresponds to USD 202,52.
Data
Blumenau
Criciúma
Rio do Sul
Farroupilha
Flores da
Cunha
Opened since
Feb. 2008
Aug. 2006
Sept. 2017
July. 2015
Oct. 2020
Reference in
Law
Municipal Law
7223, 2008
No, it is a
partnership
between City
Hall, Red
Cross, and
UNESC
(Southern
University of
Santa
Catarina)
Municipal Law
5725, 2016
Municipal
Decree 5841,
2015
No municipal
law; it is
supported by
State Law
15.339, 2019
Service
frequency
Daily, from 7
AM to 6 PM
Daily, from 8
AM to 11:15
AM, and 12 PM
to 15:30 PM
Daily –
commercial
time
Daily, from 9
AM to 12 PM
Weekly
(Wednesday,
from 13:30 PM
to 16:30 PM)
Number of
employees
6 (1
pharmacist, 5
technical
nursing, payed
by the
municipality)
8 (1
pharmacist, 1
manager, 6
trainees payed
by the
university)
2 (1
pharmacist and
1 manager,
payed by the
municipality)
2 (1
pharmacist, 1
trainee, payed
by the
municipality)
5 (2
pharmacists, 3
trainees, payed
by the
municipality)
Collaboration
Physicians,
hospitals,
pharmaceutical
representatives
(distributors
and sellers)
donate free
samples or
intact
(unexpired)
medicines; the
pharmacy team
collects
medicines in
Students
donate straight
in the campus;
municipal basic
unities of
health and Red
Cross also
deliver
donations. A
team collects
free samples in
physicians’
clinics every
week.
Donations are
accepted from
anywhere,
there are
receipts for
medicines in
municipal basic
health units.
Donations are
accepted from
anywhere,
there are
receipts for
medicines in
municipal basic
health units.
Donations are
accepted from
anywhere,
there are
receipts for
medicines in
municipal basic
health units.
Other solidary
pharmacies
also donate,
and a specific
channel for
physicians’

10th International Workshop | Advances in Cleaner Production – Academic Work
“A RESILIENT AND SUSTAINABLE WORLD: CONTRIBUTIONS OF CLEANER PRODUCTION AND
CIRCULAR ECONOMY”
Florence/Pistoia – Italy – September 8th to 10th - 2021
5
clinics on a
weekly basis.
Population can
also donate in
basic health
units of the
municipality
donations is
being created.
Constraints
Population and
physicians do
not know about
the work of the
solidary
pharmacy; lack
of public
awareness.
The pharmacy
has no
automated
system to
account inputs
and outputs
(the inventory
is manually
managed).
Difficulties for
advising
patients,
mainly after
the pandemic
outbreak; lack
of national law
for regulation
of the solidary
pharmacies.
Donated
medicines
come too close
to expiration
term.
There is not an
electronic data
interchange
service
between
solidary
pharmacies,
and between
these
pharmacies
and users.
Transportation
of medicines
between
pharmacies
could be
improved; lack
of national law
for regulation
of the solidary
pharmacies.
There are
difficulties
related to the
public
awareness of
the solidary
pharmacy
work; lack of a
national law for
solidary
pharmacies.
Perspective
of Federal
Reverse
Logistics
Regulation
This is a good
initiative, but
there are not
means for its
effectiveness.
This is a way
for a correct
destination of
expired
medicines, and
it fills mainly
the
environmental
issue. We have
not legislation
for domestic
medicines
disposal.
The new
Decree can
help to
properly
address solid
wastes from
the
pharmaceutical
industry.
It is not noticed
any result of
this Decree, as
the pharmacies
keep working
as usual.
However, if this
Decree become
effective, many
medicines that
could be reused
will be
discharged.
The reverse
flow is as
important as
the access to
medicines. The
devolution of
expired or not
used medicines
to the
pharmacies is
also pivotal for
discourage the
self-
medication, for
the correct
destination of
such wastes,
avoiding soil
and water
contamination.
Training
Pharmacists
that act in
public sector
need special
training
because they
perform
differently
compared to
commercial
and hospital
pharmacists.
It is necessary
to train
pharmacists for
redispensing.
Pharmacy
students at the
University
undergo
mandatory
internship in
the solidary
pharmacy.
There is no
need for special
training as the
work in solidary
pharmacy is
the same as
the work on
other
pharmacies.
Special training
for working in
solidary
pharmacies is
necessary
because the
routines of
such places are
different from
the commercial
pharmacies.
It is necessary
a training for
this type of
work because
the social role
is what we look
for, and it is
different from
the focus on
knowledge of
clinic drug.
Fig. 2 – Summary of the solidary pharmacies services and pharmacists’ perspectives

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“A RESILIENT AND SUSTAINABLE WORLD: CONTRIBUTIONS OF CLEANER PRODUCTION AND
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Data
Blumenau
Criciúma
Rio do Sul
Farroupilha
Flores da
Cunha
Donations
(kg or unities)
No available
data
No available
data
No available
data
314,736
unities2
(2019)
No available
data
349,9342
(2020)
Donations
(USD)
No available
data
407,763.78
(2016)
No available
data
117,187.66
(2019)
No available
data
369,299.23
(2017)
115,744.08
(2020)
Redispensation
(kg or unities)
No available
data
No available
data
No available
data
274,6902
(2019)
No available
data
279,7892
(2020)
Redispensation
(USD)
82,136.79
(Sept-Nov
2019)
289,983.35
(2016)
No available
data
99,544.45
(2019)
No available
data
No data
(2020)
315,612.19
(2017)
83,953.34
(2020)
258,968.03
(2019)
Costs for
correct
destination
(USD)
66,076.00
(2019)
No available
data
No available
data
1,918.60
(2019)
No available
data
50,801.64
(Jan-Sept.
2020)
No available
data
Amount sent to
correct
disposal (kg)
1,386 (2019)
1,087 (2017)
No available
data
108,10
(2019)
94 (Sept 2020-
Feb 2021)
985,5 (Jan.
Sept. 2020)
1,056.4 (2019)
345,80
(2020)
Number of
benefited
persons
100 (daily)
(2019)
15,261 (2016)
59 daily
80 daily
(average –
2019 and
2020)
3,908 (2019)
(15 daily)
10 weekly
(2020)
32 (daily)
(Jan.-Sept.
2020)
15,157 (2017)
58 daily
3,387 (2020)
(13 daily)
Wage costs
4,064.25
(2019)
No available
data
1,550.39
(2020)
19,264.17
(2019)
No available
data
5,080.16
(2020)
Fig. 3 – Summary of quantitative data on donations, redispensation, and costs
1 Data about Ciricúma – years 2016 and 2017: source Feuser et al. (2018).
2 Unities refer to individual quantities as pills and capsules, or intact bottles.
4. Discussion
The pharmacies that participated in the research are from Rio Grande do Sul (Farroupilha, Flores
Cunha) and Santa Catarina (Blumenau, Criciúma, Rio do Sul) States, in Southern Brazil. Those in
Rio Grande do Sul represent municipalities with significantly lower populations, but presenting
the same or higher average monthly income, compared to those in Santa Catarina (Fig.1). Data
on the employed population show that Circiúma is at a disadvantage with respect to the other
municipalities, but it is necessary to highlight that the current situation (2021) is likely to be

10th International Workshop | Advances in Cleaner Production – Academic Work
“A RESILIENT AND SUSTAINABLE WORLD: CONTRIBUTIONS OF CLEANER PRODUCTION AND
CIRCULAR ECONOMY”
Florence/Pistoia – Italy – September 8th to 10th - 2021
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worse for all cities in terms of employment compared with 2018 (time of the last available data).
The demographic profile of these municipalities is relevant in order to contextualise the solidary
pharmacy in terms of the dwellers that depend on the Public Health System (SUS).
From the presented data, it is possible to realise a significant data asymmetry among the solidary
pharmacies, mainly with respect to the data on donations and redispensation (Fig.3), as many
solidary pharmacies have neither technological support nor personnel dedicated to medicines
accounting.
The longest established pharmacy is Criciúma’s, beginning as an outcome of a partnership
between the City Hall, the local Red Cross, and the Southern University of Santa Catarina
(UNESC). In Blumenau, the solidary pharmacy opened in 2008, the same year that the
municipality and others in the neighborhood suffered an intense flood and landslides that resulted
in an increasing number of homeless persons.
All pharmacies but Criciúma’s are ruled by municipal or State law, which indicates an important
level of formalization of the services they offer. They operate on a daily basis, except Flores da
Cunha’s pharmacy, and employ more than one person besides a pharmacist. The wage costs and
costs for correct destination of medicines wastes are all supported by the respective municipality,
or by the university (in the case of Criciúma), which shows the commitment of the public
authorities and researchers regarding the ecological aspects of medicines end-of-life.
Another relevant point is about collaboration of physicians with the solidary pharmacies, as these
professionals can provide intact free samples to obtainers – it is reported specifically in the cases
of Blumenau, Criciúma, and Flores da Cunha.
The main constraints reported are the lack of public knowledge on the work of solidary pharmacies
(Blumenau, Flores da Cunha), difficulties for keeping and improving inventory control systems
(Blumenau, Farroupilha), inexistence of a national law to regulate the solidary pharmacies (Flores
da Cunha), difficulties for advising patients (Criciúma), mainly after the pandemic outbreak, and
logistics issues based on many donations being close to expiration (Rio do Sul).
Reverse logistics as implemented by the Federal Government (Decree 10,388) is considered to
be an appropriate and effective destination for medicines wastes by pharmacists of Criciúma and
Rio do Sul, but is not considered to be effective by Blumenau solidary pharmacist. The
pharmacists of Farroupilha consider RL to be a way of jeopardising the work of the solidary
pharmacies, as many medicines that could re-enter consumption will be wasted.
All pharmacists except Rio do Sul’s agree that special training is necessary for professionals that
work in redispensing medicines because of the social nature of the solidary pharmacies.
It is very difficult to compare the performance of the pharmacies because they have insufficent
available records, and the limited data display no historic sequence. In order to enable a more
realistic perspective of the socioeconomic and environmental services they provide, data were
considered on the number of persons benefitting and the number of total dwellers (as for per
capita comparison).
Taking into account the monetary amount redispensed per benefited person, Farroupilha had USD
25.47 in 2019 (12.57% of the Brazilian minimum wage), and 24.79 (12.24%) in 2020. Criciúma
had USD 19.00 (9.38% of the Brazilian minimum wage) in 2016, and USD 20.82 (10.3%) in
2017.
Donations per capita (considering the whole population) reached USD 1.12 (2016) and USD 1.70
(2017) in Criciúma, and USD 1.60 (2019) and USD 1.58 (2020) in Farroupilha.
In terms of redispensation, the monetary amount per capita (whole population) was USD 1.33
(2016), USD 1.45 (2017), and USD 1.19 (2019) for Criciúma, and USD 1.36 (2019) and USD
1.15 (2020) for Farroupilha.
Costs for correct discharge of end-of-use medicines, based on the whole city population,
represented USD 0.18 in Blumenau (2019) and USD 0.02 (2019) in Farroupilha.
Wages costs in terms of whole population per capita were very low in the municipalities: USD
0.011 (2019) and USD 0.014 (2020) in Blumenau; USD 0.007 (2020) in Rio do Sul, and USD
0.26 (2019) in Farroupilha. For this last municipality, in 2019, discounting the costs of correct
discharge (USD 0.02) and wages (USD 0.26) per capita, the real dispensed value represented
USD 1.08 per capita.
Regarding the physical amounts sent to the hazardous wastes landfills, Blumenau had 4 x 10-3 kg
per capita (whole population) in 2019; Criciúma had 5 x 10-3 kg in 2019; Farroupilha had 1.5 x

10th International Workshop | Advances in Cleaner Production – Academic Work
“A RESILIENT AND SUSTAINABLE WORLD: CONTRIBUTIONS OF CLEANER PRODUCTION AND
CIRCULAR ECONOMY”
Florence/Pistoia – Italy – September 8th to 10th - 2021
8
10-3 kg in 2019, and 5 x 10-3 kg in 2020.
5 Final remarks
Solidary pharmacies are a powerful tool for Brazilian municipalities improving the extent of the
pharmaceutical assistance and providing inclusion of significant portions of the population that
cannot otherwise afford medicines. They help the Brazilian Public Health System (SUS) in many
ways. Firstly, when a very expensive or rare medicine is prescribed, and a person has no means
to afford it, SUS can be legally required to obtain such medicine through public procurement,
albeit additional costs may be incurred where individuals feel compelled to sue SUS to force them
to obtain the necessary medicines. As many solidary pharmacies have a strong collaboration
network, they can easily mobilise the community in order to identify such types of medicines and
provide them far cheaper. It helps SUS to reduce the costs of procurement of expensive
medicines, and avoids the costs of court cases where individuals have had to sue SUS to force
them to meet these legal obligations. Secondly, many solidary pharmacies accept redispensation
in exchange for medical prescriptions from private and public physicians – these latter one
working for SUS. At the same time, these pharmacies contribute to the correct redispensation of
end-of-use medicines, reducing the environmental impact of wastage. Such establishments
perform several roles in the medicines supply chain, as: RL enablers; recirculation agencies in the
case of goods that can enter a new consumption life (Ertz et al., 2017); as solidary economy
leaders (Ertz, 2000), because they mobilise other supply chain stakeholders to donate.
Regardless of the relevant role, solidary pharmacies are not well known, and there is not yet a
comprehensive picture about their placement, their detailed routines and how they deal with the
conventional dispensation system, as ordinary pharmacies and professional reverse logistic
agents. It is clear that solidary pharmacies are going beyond the limits of the Circular Economy
context (Adams et al., 2017), once they are focused on socioeconomic and environmental aspects
of end-of-use and end-of-life medicines.
This research faced several limitations, mainly with respect to identification and successful
feedback from the solidary pharmacies. As for future studies aimed at improving this type of
research, it is recommended to increase the sample size of pharmacies, to understand the
mechanisms that underpin the difficult information management (records on inputs and outputs),
and to explore the relationships between such pharmacies and other so-called formal echelons of
the supply chain, such as, industry, distributors, retailers, associations of physicians, pharmacists,
as well as public health authorities at all levels (municipal, State, and Federal). It is also advisable
to include consumers’ associations in this arena, taking into account that poverty eradication,
reduction of inequalities, and responsible consumption and production are somehow linked to the
work of solidary pharmacies and are portrayed among the 17 objectives of sustainable
development.
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10th International Workshop | Advances in Cleaner Production – Academic Work
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CIRCULAR ECONOMY”
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CIRCULAR ECONOMY”
Florence/Pistoia – Italy – September 8th to 10th - 2021
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