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3. Expired Medications: Lebanon Sitting on a Health and Environmental Time Bomb

Joe Salloum, president of the Lebanese Order of Pharmacists, sounds the alarm: expired medications are piling up in pharmacies, threatening both public health and the environment. But behind the warning, the reality is more complex than it seems…

"An expired medication can be just as dangerous as a counterfeit one," says Joe Salloum.
A shocking statement, almost a cry of alarm, meant to shake the authorities and shine a spotlight on a long-neglected problem. Yet behind this deliberately dramatic tone, scientific reality calls for more nuance: an expired medication is not always toxic, but it can become ineffective, and in some cases harmful for certain molecules. Moreover, its improper disposal creates an environmental problem of national scale.

A Shocking Warning… That Requires Nuance

A counterfeit medication is falsified: it may contain the wrong substance, the wrong dose, or even toxic compounds.
An expired medication, on the other hand, is authentic but past its validity date. In the vast majority of cases, it is not immediately dangerous, but its effectiveness may be reduced. For some critical treatments, this reduced efficacy can have serious consequences, and in some cases, certain molecules can even degrade and become harmful.

An expired drug, therefore, is not always a poison… but it is never harmless.

What Happens When a Medication Expires?

The impact depends on three key factors: the molecule itself, the pharmaceutical form (tablet, syrup, injection…), and the storage conditions.

For solid tablets like paracetamol, ibuprofen, or antihypertensive drugs, the effectiveness often remains around 80 to 90% for a few months after the expiration date. But when it comes to life-saving treatments, even the slightest loss of potency can be critical. An expired antibiotic may fail to treat an infection and encourage bacterial resistance. Insulin or injectable treatments lose their effectiveness very quickly, with serious consequences for diabetics or patients receiving intravenous therapies. As for antiepileptic drugs or cardiac medications, the impact can be life-threatening.

Even more concerning, some medications can actually become dangerous. Older tetracyclines, for example, are known to cause severe kidney damage. Antibiotic suspensions can promote the growth of bacteria and molds. Eye drops (collyres) present a real risk of serious eye infections.

Finally, not all medications age the same way. Simple tablets and dry capsules are generally stable if stored properly. In contrast, syrups, creams, eye drops, injectable solutions, vaccines, chemotherapy drugs, and insulin deteriorate much more quickly.

A Headache for Lebanese Pharmacies

In theory, Article 53 of the Pharmacy Practice Law requires pharmaceutical companies to take back expired products and destroy them. In practice, however, the system is severely inadequate.

Laboratory agents are required to collect up to four boxes of non-refrigerated medications and two boxes of refrigerated ones. On paper, this seems reasonable. In reality, pharmacists are left with residual stocks that no one collects. Lacking storage space and logistical solutions, these stocks pile up in already saturated areas.

Faced with this deadlock, some pharmacists discreetly opt for the simplest solution: getting rid of these drugs on their own. Officially, no one admits it. Unofficially, several sources confirm that expired medications often end up in trash bins, sinks, toilets… or even directly in the environment.

An Invisible Environmental Danger

These practices have silent but severe consequences. Chemical molecules seep into groundwater, contaminate soils, and disrupt ecosystems. Some substances can also cause hormonal imbalances in both humans and animals. Even more worrying, improperly discarded medications can be recovered from landfills and illegally reintroduced into the market.

Cyclamed and Recyclamed: Two Distinct Realities

In France, expired medication management has been handled since 1993 by Cyclamed, a national collection system under the supervision of the Ministry of Health. Patients return their expired medications to pharmacies, secured containers are collected, and the products are incinerated at over 1,200°C. The energy generated is then reused for urban heating. Entirely funded by pharmaceutical companies, this system ensures the destruction of over 9,000 tons of medications annually, with full traceability.

In Lebanon, the situation is very different. Cyclamed has no operational role locally. Large pharmaceutical companies work with Recyclamed, a company specializing in the treatment and decontamination of hazardous and toxic waste. When expired stocks must be destroyed, the importer must first obtain an export authorization from the Ministry of Health. Once approved, Recyclamed organizes the shipment of medications to France, where they are incinerated in certified facilities, in coordination with the Ministry of Environment.

This process is rare, expensive, and reserved for large companies. It happens only once every two to three years, and Recyclamed is currently in the process of renewing its operating license in Lebanon. For the majority of pharmacies, however, no long-term solution exists.

Aborted Attempts at a Local Solution

Several initiatives have been launched to create a national system, but all have failed. The NGO Arcenciel handles certain hospital waste but does not process expired pharmacy drugs. The company Cedar Environmental developed an innovative technology to solidify tablets and recycle them into eco-friendly panels, but the project remains blocked at the Ministry of Health. A test program to incinerate expired medications in Holcim cement kilns was also halted after residents protested against toxic emissions.

The result: no sustainable system, no coordination, and growing stockpiles of expired medications.

A Silent Pollution Crisis

Lebanon now faces a triple threat.
First, a health risk: ineffective or expired treatments may circulate on the black market.
Second, an environmental risk: soils, groundwater, and biodiversity are threatened by long-term contamination.
Third, an economic burden: pharmacies are financially weakened by unsellable stocks and the lack of compensation mechanisms.

Joe Salloum summarizes the severity of the situation:
"The law exists. It simply needs to be applied. The health of patients and environmental safety can no longer wait."

In a country where hospitals lack resources and essential medications are becoming scarce, every box counts. Without a national disposal system, and without coordination between the State, pharmaceutical companies, and pharmacies, Lebanon will remain sitting on a health and environmental time bomb.