Behavior, preferences, and willingness to pay for measures aimed at preventing pollution by pharmaceuticals and personal care products in China

Assessment of knowledge and disposal practices of unused and expired household medicines in a community in Liberia

Background

Expansion of pharmaceutical industries and improved availability of pharmaceuticals across the world have contributed to an increase in drug usage and accumulation in homes. Improper disposal of expired and unused medications has several consequences such as environmental pollution, and childhood poisoning.

Objectives

The aim of the study was to assess the knowledge on disposal as well as disposal practices of unused and expired household medicines in the Parker Corner Road Community in Brewerville, Liberia.

Methods

This study was a cross-sectional survey conducted among 162 residents of Parker Corner Road Community using face-to-face interviews. Outcomes measured were knowledge of disposal as well as disposal practices of unused and expired household medicines. The data collected were analysed using descriptive statistics.

Results

Majority of respondents (55.6%) were female and 23.5% had university education. 71% of the respondents reported that they had not received any information on safe disposal practices while 64.2% admitted that they often did not read and follow disposal instructions. The most popular disposal practices were disposal of the drugs along with household waste (61.1%) and flushing them down the toilets or sinks (25.3%). Majority of the respondents (82.1%) were aware of the health effects arising from improper disposal of unused and expired medicines while 64.2% usually read medicine disposal instruction on the package. Only about 3% of them knew of expired medication take-back system and 33.3% knew nothing about medication expiration date.

Conclusion

The study revealed insufficient knowledge as well as inappropriate disposal practices of unused and expired medicines among residents of Parker Corner Road Community in Brewerville. There is need to organize a public enlightenment programme on safe, appropriate use, as well as disposal of unused and expired medicines.

Modeling Predictors of Medication Waste Reduction Intention in Algeria: Extending the Theory of Planned Behavior

COVID-19 caused an increase in the demand for medications, which led to an increase in pharmaceutical waste and there is no doubt that this contributes to environmental pollution. Hence, it became necessary to search for how to protect and improve the environment by encouraging the behavior of medication waste reduction. Accordingly, this study aims to investigate the factors affecting intentions to reduce medication waste. Considering this, we develop an extended theory of planned behavior (TPB) framework by incorporating the constructs of moral obligation, environmental awareness, and medication waste risk perception. Using the convenience sampling method and based on a self-administered questionnaire, a total of 225 usable responses were collected in five Algerian cities. The results showed that positive attitudes (β = 0.316, p < 0.001), moral obligation (β = 0.291, p < 0.001), environmental awareness (β = 0.227, p < 0.001), perceived behavior control (PBC) (β = 0.151, p = 0.001), greater perceived risks (β = 0.127, p < 0.001), and subjective norm (β = 0.096, p < 0.05) significantly and positively influence the medication waste minimization intention. Furthermore, our analyses revealed that the extended TPB model explained 73.40% of the intention variance. In conclusion, we have explored the intentions, and there may be a gap between intent and actual behavior. Therefore, we recommend future studies to examine the factors affecting the actual behavior of medication waste reduction and to investigate environmental ethics and religious commitment as predictors of waste reduction intentions.

Safe Disposal of Unused Medicine among Health Professions Students at Makerere University: Knowledge, Practices and Barrier

Background

Environmental contamination with antimicrobial agents is one of the leading drivers of antimicrobial resistance (AMR) worldwide. However, scarce data exists concerning the factors fueling unsafe disposal of medicines globally. This study aimed to assess for the knowledge, practices, and barriers concerning safe disposal of unwanted medicines among health professions students (HPS) at Makerere University, Uganda.

Methods

We conducted a cross-sectional study using an online assessment tool sent through WhatsApp groups and E-mail addresses of undergraduate HPS at the College of Health Sciences Makerere University, Uganda between 1stFebruary and 16thMarch 2022.Good knowledge was defined as a score of 80% of the knowledge domain questions on a standardized questionnaire.

Results

We enrolled 205 participants, 135 (65.9%) were male, with a median age of 23 (range: 19 -43) years. Overall, 157 (76%) participants had good Knowledge. The mean knowledge score was 63%. About half (n=102, 49.8%) of the participants had unused medicines kept at their respective residential places, mainly antibiotics (27%, ×/102) and analgesics (21 %, ×/102). The most common method of medicine disposal was dumping into household garbage (n=103, 50.2%). Only 37 (18%) of participants had ever used the take-back method of medicine disposal. The most reported barriers for safe disposal were inadequate knowledge and insufficient advice from the dispensers concerning safe disposal practices. Year of study was the only factor significantly associated with knowledge about safe disposal of medicines, (adjusted Odds Ratio: 9.7, 95%CI 2.3 - 40.5, p= 0.002), with participants in higher academic years having more knowledge than those in lower years.

Conclusion

Despite a good knowledge level among the participants, the practice of safe disposal of unused medicines remains suboptimal in this population. Strategies aimed at enhancing safe disposal practices such as giving proper instructions to medicine buyers by dispensers regarding disposal practices are recommended to abate the growing burden of AMR.

Analysis of the chloride ion removal mechanism from simulated wastewater by discarded vitamin tablets

Vitamin (VM) tablets are often discarded or incinerated as medical waste, and untreated highly chlorinated wastewater is discharged, polluting the environment. In this study, Cu²⁺ was reduced by vitamin C (VC, a component of VM), and the precipitate formed by the reaction of its product with Cl^- in water was used to remove Cl^- from simulated wastewater. This allows for the resourceful use of waste VM, while also achieving the goal of dechlorinating wastewater. Meanwhile, the effect of various parameters on dechlorination was studied, and the dechlorination mechanism was analyzed. According to the results, the removal rate of Cl^- increased first and then decreased with pH, removal time and reaction temperature. Using VC in VM to dechlorinate simulated wastewater, the removal rate of Cl^- was 94.31% under optimum conditions: pH 2.5, temperature 30 °C and reaction time 10 minutes. According to the dechlorination process, it can be inferred that Cu²⁺ is reduced to Cu⁺ by VC, and Cu⁺ and Cl^- coprecipitate to remove Cl^-. Therefore, it is feasible to use discarded VM to treat high concentration chlorine-containing wastewater.

Willingness to Pay for Implementation of an Environmentally Friendly Pharmaceutical Policy in Finland-A Discrete Choice Experiment Study

The use of pharmaceuticals is their main pathway to the environment, making the public a major stakeholder in environmentally friendly pharmaceutical policies, including an environmental classification system for medicines. We studied the Finnish adult population's (n = 2030) preferences and willingness to pay (WTP) for an environmentally friendly pharmaceutical policy by means of an online survey employing a discrete choice experiment (DCE). We also studied the relative importance of the policy attributes, namely, the environmental impact, geographical scope, available information about the environmental impact of a pharmaceutical, and the effect of the respondents' general environmental attitudes on the WTP. The total annual WTP of the Finnish adult population ranges from 37 million to 134 million euros, depending on the attribute levels. Moreover, the environmental attitude of a respondent had a significant impact on the WTP. Generally, the environmental impact of the policy was the most important attribute, the geographical scope of the policy the second, and information about the environmental impact of pharmaceuticals was the third most important attribute. However, the most environmentally friendly respondents preferred information as the second important attribute. This study provides insights into the environmental valuations of the public to be used in preparing new pharmaceutical policy measures.

Pharmacy students' knowledge and practices concerning the storing and disposal of household medication in Saudi Arabia

INTRODUCTION

Pharmacists, and thus pharmacy students, must participate in promoting awareness about proper storage and disposal of expired or unused medications. This study aimed to determine Saudi Arabian pharmacy students' knowledge and personal practices regarding storing and disposing of household medications.

METHODS

This was a descriptive, cross-sectional, questionnaire-based study of pharmacy undergraduates or postgraduates across Saudi Arabia. The online survey was distributed to a convenience sample of participants and supplemented with snowball sampling on social media.

RESULTS

Of 807 pharmacy students who viewed the questionnaire, 464 students completed it (response rate 57.5%). Common reasons for keeping medications included having left-over medication (74%) and self-discontinuation of therapy (63.5%). The majority of students (79%) stored their medication in a bedroom or kitchen. Gender-specific variables revealed a gender difference in storing and disposing of these medications. Many students reported previously discarding medicines in the garbage (89%) or giving them to someone else to use (22%). More than half of the sample (60%) had not received any information on how to store or dispose of medications.

CONCLUSIONS

The current practice and knowledge of Saudi Arabian pharmacy students regarding storage and disposal of household medications was inappropriate. Concerned authorities (e.g., Ministry of Health, Ministry of Education) should provide proper education to all students on the safe storage and disposal of medications, which may necessitate curriculum reform.

Is Disposal of Unused Pharmaceuticals as Municipal Solid Waste by Landfilling a Good Option? A Case Study in China

Properly disposing of unused pharmaceuticals is essential to minimize emissions of active pharmaceutical ingredients (APIs). The aim of this study was to determine whether disposing of unused pharmaceuticals in household solid waste is a cost-effective way of attenuating pharmaceutical emissions. We calculated attenuation rates (ARs) for unused pharmaceuticals by performing mass balance calculations for disposal to landfill. The results indicated that the average ARs for disposal as household solid waste reached 63% to 100% for our investigated pharmaceuticals at the worst scenario, indicating that disposal as household solid waste strongly attenuated emissions of APIs. Disposing of unused pharmaceuticals as household solid waste could be a cost-effective disposal method from the view of reducing APIs emission, but should be used with caution.

Improper disposal practice of unused and expired pharmaceutical products in Indonesian households

Background

Improperly disposed medicines could adversely affect the environment and increase the risk of drug misuse or accidental poisoning.

Objective

To evaluate the disposal practices of unused and expired medicines among the general population in Bandung, Indonesia.

Method

This was a descriptive cross-sectional survey conducted among 497 respondents in Bandung, Indonesia. Data were collected through interviews using a prevalidated structured questionnaire. Descriptive statistics were calculated using the Statistical Package for Social Science (SPSS) version 23. Ethics approval was obtained.

Main outcome measure

General public knowledge and attitude regarding unused and expired medication disposal practice.

Results

Approximately 95% of the respondents had unused medicines stored in their homes, with nonsteroidal anti-inflammatory drugs (NSAIDs), vitamins/nutritional supplements, and antibiotics were the most common types of medicines left unused. The majority of the respondents checked the expiration date of the drugs before purchasing (72.8%). The most common disposal method of unwanted medicines was throwing away in household garbage (82.1%). A significant percentage of them never received information about proper medication disposal practice (79.5%). Furthermore, more than half of the respondents were unaware that unsafe medication disposal practices could harm the environment and population health (53.1%).

Conclusion

Disposal of unwanted pharmaceutical products through environmentally unsafe route was prevalent among the respondents. There is also a lack of awareness of the impact of improperly disposed of medicines for the ecosystem. These findings call upon the strategies to strengthen the pharmaceutical waste management program.

Identifying targets of potential concern by a screening level ecological risk assessment of human use pharmaceuticals in China

The pollution of pharmaceuticals has attracted a lot of concerns during recent years. The goal of this study was to identify targets of ecological concern considering human use pharmaceuticals marketed in China. We constructed a database for 593 active pharmaceutical ingredients (APIs) by collecting their information on use and emission (e.g. production, human excretion, and removal by wastewater treatment) to calculated predicted environmental concentrations (PECs) by using an adapted European Medicines Agency method. PECs were comparable to the reported measurements for most APIs, demonstrating that the adapted method is reliable for the prioritization practice. Then PECs were compared to toxicity thresholds of three aquatic taxa (algae, daphnia, and fish). As a result, a total of 31 APIs, which were potentially risky and should be taken into consideration in future studies, were identified. Three APIs would pose a high risk with risk quotient (RQ) greater than 10. Six APIs were identified with moderate risks (1 < RQ < 10), and four of them were not reported before: rifaximin, griseofulvin, amikacin, and niclosamide. Of the 22 APIs with low risks (0.1 < RQ < 1), 17 have never been monitored previously in China and even worldwide. This study has yielded some probable antibiotics that should be considered as monitoring targets in China in the future.

Status of public-private partnership recognition and willingness to pay for private health care in China

OBJECTIVES

The Chinese government has been increasingly engaging and interacting with the private sectors to initiate public-private partnerships (PPPs) to enhance the capacity of the health care system. Thus, the availability of private health services and copays are increasing. However, Chinese residents appear to be more accustomed to public health care because it has long been the dominant health service provider in China. Therefore, learning how the Chinese recognize PPPs, whether they would like to use private health services and how much they are willing to pay out of pocket are important for policymakers.

METHODS

A bibliographical search was performed through PubMed in Medline, the Chinese National Knowledge Infrastructure and key government websites using a combination of keywords from seminal papers on PPPs and then sequentially added "willingness to pay (WTP), health, and private." The papers selected were closely related to PPPs and WTP for health care in China, and then, over 100 peer-reviewed literature, opinion, or commentary papers and postgraduate theses on the particular topics were carefully reviewed.

RESULTS

Out of 139 papers closely related to WTP for private health care, 37 were extensively reviewed and substantially analyzed. The results corroborate that Chinese residents are generally willing to pay for high-risk disease screening, improved therapies, and health insurance, although the WTP intentions and the amounts they are willing to pay are different among distinct populations for the various types of health services. The results also present conditions that the responders are not explicitly willing to pay for or are willing to pay additional fees for their health promotion. Education level, family per capita income, self-reported health status, and dwelling districts (such as urban or rural residents) are the main factors that affect cost-sharing intention.

CONCLUSIONS

PPPs are increasingly recognized as an effective means to mobilize resources in the private sector to relieve the pressure/burden placed on the public system during medical reform in China. Responders in China are generally willing to pay reasonable fees out of pocket for primary health care services or for improved therapies; however, cost-sharing intentions are affected by multiple factors. Health-related policymakers should learn the general health concerns/demands of the residents and their WTP status to perfect the design of PPPs for the benefit of the majority population in China.

Medication disposal practices: Increasing patient and clinician education on safe methods

Recent research suggests that the nation’s water supply is contaminated with trace pharmaceuticals that exert a negative environmental and public health impact. Incorrect medication disposal methods (e.g. flushing medications down the toilet or drain) are a significant factor contributing to the presence of medication compounds in the aquatic environment. In this commentary, we provide a summary of the existing data on pharmaceuticals in the nation’s water as well as the role of improper medication disposal methods on water contamination. We discuss statistics on improper medication disposal practices among patients and clinicians as well as recent advances in proper medication disposal methods as a solution to this problem. Currently, many patients and clinicians are not aware of proper medication disposal practices. We summarize the importance of patient and clinician education in advancing environmental-safe medication disposal methods.