Investigating Research Gaps of Pharmaceutical take back Events: An Analysis of take back Program Participants' Socioeconomic, Demographic, and Geographic Characteristics and the Public Health Benefits of take back Programs

Do pharmacists counsel customers on the disposal of unused or expired household medications? A national survey among 1,596 pharmacists in Indonesia

Introduction

Pharmacists play a vital role in counseling customers on proper medication disposal, yet their consistency in providing such information is often lacking. This study aimed to assess pharmacists' awareness of appropriate disposal practices for unused and expired household medications. Additional objectives included evaluating whether pharmacists offer disposal information during counseling, measuring their willingness to receive medication waste from the public, and identifying associated factors.

Methods

A national cross-sectional online survey employing convenience sampling was conducted among pharmacists working in hospitals, pharmacies, clinics, or community health centers (CHCs) in Indonesia, using a validated questionnaire to assess awareness, information provision, and willingness to receive medications for disposal. Binary logistic regression, with 95% confidence intervals (CI) and odds ratios (OR), explored potential associations between factors and outcomes.

Results

This study involved 1,596 pharmacists across 37 Indonesian provinces. Most pharmacists were women (80.4 %), aged 31-40 years (49.3 %), with a pharmacist professional background (93.8 %), working in CHCs (41.2 %), and practicing for 1-5 years (51.0 %). More than half were unaware of guidelines for returning medications to health facilities. While 69.9 % never counseled customers on disposal practices, 64.9 % expressed willingness to receive unused and expired medication from the public. Pharmacists practicing for at least six years were more likely to provide disposal information during counseling (OR: 2.54; 95 % CI: 1.44-4.47). Conversely, those in clinics (OR: 2.16; 95 % CI: 1.29-3.62), CHCs (OR: 2.07; 95 % CI: 1.45-2.95), or hospitals (OR: 2.00; 95 % CI: 1.27-3.14) were more likely to be unwilling to receive expired and unused household medication.

Conclusions

The study reveals that most pharmacists, particularly those with limited practice duration, lacked awareness regarding the importance of proper medication disposal and did not provide counseling on appropriate medication disposal to patients. To address this issue, there is a pressing need for intensified education intensified education at the undergraduate level, continuous training for pharmacists, and a clear policy and practical guidelines, particularly targeting pharmacists in clinics, CHCs, and hospitals, to facilitate the acceptance of unused and expired household medications.

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.

Enhancing environmental sustainability through a household pharmaceuticals take-back program in Jordan

Most homes have unwanted, discarded, unused, or expired pharmaceuticals. These pharmaceuticals can pose health risks if they are not properly disposed of. Active pharmaceutical ingredients have been detected in water resources at an alarming level globally and recently in Jordanian waters. Unfortunately, no programs or regulations are addressing this problem in Jordan. This study aims to provide a comprehensive evaluation of the stakeholders' potential involvement in establishing a pharmaceutical take-back program in Jordan. The study was designed to determine the focal points of establishing a pharmaceutical take-back program using a qualitative cross-sectional approach and using a force field analysis to put together a plan for a successful program in Jordan. The study conducted three surveys using structured questionnaires and interviews with officials to evaluate the attitude toward the pharmaceutical take-back program, awareness of environmental impacts, and current conditions of household pharmaceuticals in Jordan. The questionnaires were assigned to the public, pharmaceutical manufacturers, and pharmaceutical warehouses. The interviews were conducted with the Ministry of Environment, pharmaceutical manufacturers, and pharmaceutical warehouses. Most of the pharmaceutical producers (85% manufacturers and 94% warehouses) refused to participate voluntarily in the program due to the extra cost incurred. On the other hand, the public and the Ministry of Environment were supportive of establishing the program. The study revealed that there is a lack of awareness among the public toward household pharmaceuticals. About 77% of the public questionnaire respondents reported they had not received any information on how to dispose safely of their unwanted pharmaceuticals. Also, about 61% reported that they have concerns that household pharmaceuticals might contaminate the water resources in Jordan. Following the questionnaires' analysis, the study determined the main forces against establishing a pharmaceutical take-back program as the unwillingness of producers to participate, weak logistic support, lack of public awareness, and low public participation. A force field analysis (FFA) was conducted based on the forces determined from the questionnaires. Accordingly, the study recommends developing a comprehensive legislation and regulatory framework for household pharmaceuticals' recovery, establishing a monitoring entity, securing funds, and implementing a long-term awareness and education plan to support the establishment of a pharmaceutical take-back program in Jordan.

Household Pharmaceutical Waste Disposal as a Global Problem-A Review

The negative effect of the pharmaceuticals presence (persistence?) in various components of the environment is a global problem today. These compounds are released into the environment as a result of, inter alia, their use and improper disposal. Therefore, it is important to reduce excessive drug consumption and to develop a system for the collection of unused/expired pharmaceuticals. The effectiveness of actions in this area is inextricably linked with the need to educate society on how to deal properly with unwanted medications. The aim of the study was to show that the inappropriate handling of unused/expired drugs by society is an important problem in waste management systems, and it impacts the state of the environment. Forty-eight scientific articles published between 2012 and 2021 were taken into account that discussed the systems in various countries for the collection of unused/expired pharmaceuticals. This literature review shows that the main method of disposing of unused/expired medications, according to respondents from different countries, is either by disposing of them in household waste or flushing them into the sewage system. This is also the case in countries with systems or programs for the return of redundant drugs, which indicates that these systems are not sufficiently effective. This may be influenced by many factors, including the lack or ineffective education of the society.

Effectiveness of environmental health and loss framing on household pharmaceutical take-back schemes

Pharmaceutical pollution poses an emerging environmental and public health problem. Together with increasing medicine use and pharmaceutical manufacturing effluents, improper disposal of household pharmaceutical waste significantly adds to this issue, despite pharmaceutical take-back schemes having been established in many countries. Even where take-back schemes are available return rates remain low. Previous studies have used only survey and interview methodologies and therefore merely described the situation. This study goes further, exploring not only the effects of the availability of information on pharmaceutical take-back schemes but also the effects of the framing of information provided to individuals on their intentions and reported behaviours to collect unused and/or expired household pharmaceuticals and return them to a pharmacy. The data were collected throughout three preregistered, randomised experiments with representative samples (N = 3754). The results show that tapping into individuals' pre-existing conception of the problem and psychological biases through the delivery of environmental health, loss framing information highly increased the odds of returning household pharmaceutical waste. This result is long-lasting (Studies 2 and 3), is found in various European countries (Study 1), and remains robust in all studies. Based on the results, we suggest that, in the context of household pharmaceutical waste management, psychologically informed, proactive approaches combined with targeted local action and services can reduce the psychological and practical barriers to pro-health and pro-environmental behaviour. The findings are used to support a policy recommendation that is cost-efficient, easy to use, and effective.

Trends in Childhood Poison Exposures and Fatalities: A Retrospective Secondary Data Analysis of the 2009-2019 U.S. National Poison Data System Annual Reports

Despite significant prevention efforts, childhood poison exposures remain a serious public health challenge in the United States. This study aimed to assess annual trends of pharmaceutical vs. non-pharmaceutical poison exposures in the US among children 0-19 years and compare the odds of death by children's age group. Poison exposure and fatality data were retrospectively extracted from 2009 to 2019 National Poison Data System (NPDS) annual reports for children in all reported age groups. Overall, there was a significant reduction in the annual population-adjusted poison exposures in children (annual percentage change = -2.54%, 95% CI = -3.94% to -1.15%, p < 0.01), but not in poisoning-related fatalities. Children 0-5 had similar odds of dying from exposure to non-pharmaceuticals vs. pharmaceuticals. The odds of children 6-12 dying from non-pharmaceuticals vs. pharmaceuticals was 2.38 (95% CI = 1.58, 3.58), χ² = 18.53, p < 0.001. In contrast, the odds of children 13-19 dying from pharmaceuticals vs. non-pharmaceuticals was 3.04 (95% CI = 2.51, 3.69), χ² = 141.16, p < 0.001. Suicidal intent accounted for 40.63% of pharmaceutical deaths in children 6-12, as well as 48.66% of pharmaceutical and 31.15% of non-pharmaceutical deaths in children 13-19. While a significant decline in overall childhood poison exposures was reported, a decrease in poisoning-related fatalities was not observed. Children in different age groups had contrasting relative odds of death from pharmaceutical and non-pharmaceutical exposures. Among older children, a greater proportion of poisoning-related deaths was due to intentional suicide. These findings provide evidence of age-specific trends in childhood poison exposure risk and directions for future poison prevention efforts and behavioral health partnerships.

Material convergence issue in the pharmaceutical supply chain during a disease outbreak

Purpose

Pharmaceutical donations are a practical approach to increase medicine availability during disasters such as disease outbreaks. However, often donated pharmaceuticals are inappropriate and unsuitable. This convergence of inappropriate pharmaceuticals is a severe operational challenge and results in environmental hazards. This study explores the pharmaceutical supply chains (PSCs) during a disease outbreak to relieve the negative impact of the material convergence problem (MCP).

Design/methodology/approach

This study adopts a situation-actors-process learning-action-performance (SAP-LAP) linkage framework to understand the PSC dynamics. The problem-solving component of the SAP-LAP analysis provides the strategies catering to MCP. The findings from the SAP-LAP helped to develop the causal loop diagram (CLD). This study conducts several experiments on the proposed strategies by integrating CLD into a stock and flow diagram. Later, a disease outbreak case study accessed the pharmaceutical donations effect on PSC performance.

Findings

The study synthesises and evaluates propositions and strategies to incorporate circular economy (CE) principles in PSC. This study proposed two strategies; one to sort and supply and the other to sort, supply and resell. The reuse policy improves humanitarian organisations' finances in the simulation study. This study verified the operational improvement of PSC by reducing the transport and storage burden due to MCP.

Originality/value

This study comprehensively approaches the issue of drug donation and uniquely produced several propositions for incorporating a CE perspective in PSC. The study also proposed a unique simulation approach to model the donation arrivals in response to a disease outbreak using susceptible, exposed, infectious and recovered modelling.

Primary prevention of prescription opioid diversion: a systematic review of medication disposal interventions

Background: In the U.S., 50-75% of nonmedical users of prescription opioids obtain their pills through diversion by friends or relatives. Increasing disposal of unused opioid prescriptions is a fundamental primary prevention strategy in combatting the opioid epidemic.Objectives: To identify interventions for disposal of unused opioid pills and assess the evidence of their effectiveness on disposal-related outcomes.Methods: A search of four electronic databases was conducted (October 2019). We included all empirical studies, systematic literature reviews, and meta-analyses about study medication disposal interventions in the U.S. Studies of disposal interventions that did not include opioids were excluded. We abstracted data for the selected articles to describe the study design, and outcomes. Further, we assessed the quality of each study using the NIH Study Quality Assessment Tools.Results: We identified 25 articles that met our inclusion criteria. None of the 13 studies on drug take-back events or the two studies on donation boxes could draw conclusions about their effectiveness. Although studies on educational interventions found positive effects on knowledge acquisition, they did not find differences in disposal rates. Two randomized controlled trials on drug disposal bags found higher opioid disposal rates in their intervention arms compared to the control arms (57.1% vs 28.6% and 33.3%, p = .01; and 85.7% vs 64.9%, p = .03).Conclusions: Peer-reviewed publications on opioid disposal interventions are limited and either do not address effectiveness or have conflicting findings. Future research should address these limitations and further evaluate implementation and cost-effectiveness.

Disposal Practices of Unused and Leftover Medicines in the Households of Dhaka Metropolis

Background: This fact-finding study aimed to attain an overall idea and knowledge about medicine disposal practices in Dhaka Metropolitan households. Methods: This mixed study (both quantitative and qualitative) was orchestrated to inspect the household leftover medicine disposal pattern's governing status. A cross-sectional survey was conducted following a structured questionnaire and key informant interview with a household person and in-depth interviews with the top pharmaceutical and government officials. Results: Findings disclose that, for most of the key informants, the terms "drug disposal" and "drug pollution" were unknown; more precisely, 67% and 74% of key informants even did not hear these two terms. Almost all (87%) households faced undesired incidents due to the insecure storage of medicines. People disposed of excess and expired medication in regular dustbins (47%), threw out of the window (19%), flushed within commode (4%), burnt in fire (2%), and reused (4%). A good percentage of people (21%) returned unexpired drugs to the pharmacy and bought other medicines on a need basis. A total of 72% wanted a medicine take-back program, and 100% agreed on mass education on this issue. Officials of pharmaceuticals conferred mixed opinion: top-ranked pharmaceuticals will adopt leftover medicine disposal practices; middle and low-ranked pharmaceutical companies are reluctant, merely denied mentioning the less important issue. Conclusions: The absence of mass awareness and standard laws and policies may explain these existing aberrant practices.

Pharmaceutical pollution sources and solutions: Survey of human and veterinary medication purchasing, use, and disposal

Human and veterinary pharmaceuticals offer many benefits, but they also pose risks to both the environment and public health. Life-cycle stewardship of medications offers multiple strategies for minimizing the risks posed by pharmaceuticals, and further insight is required for developing best practices for pharmaceutical management. The goal of this study was to clarify points of intervention for minimizing environmental and public health risks associated with pharmaceuticals. Specifically, our objectives were to provide insight on purchasing, use, and disposal behaviors associated with human and veterinary medications. This study used a state-wide representative sample of Vermont adults (n = 421) to survey both human and veterinary pharmaceuticals as potential sources of the unintended consequences of prescribed and over-the-counter (OTC) medications. The majority (93%) of respondents had purchased some form of medication within the past twelve months, including OTC (85%), prescription (74%), and veterinary (41%) drugs. Leftover drugs of any kind were reported by 59% of respondents. While 56% of people were aware of drug take-back programs, the majority reported never being told what to do with leftover medications by their physician (78%), pharmacist (76%), or veterinarian (53%). Among all respondents, take-back programs were the most common disposal method (22%), followed by trash (19%), and flushing (9%), while 26% of respondents reported keeping unused drugs. Awareness of pharmaceutical pollution in the environment and having received information about proper disposal were both significantly associated with participation in take-back programs. These findings indicate that a large volume of drugs are going unused annually, and that only a portion of leftover medications are returned to take-back programs where they can be appropriately disposed. Our results warrant further investigation of clinical interventions that support lower dose prescribing and dispensing practices in order to reduce the unintended environmental and public health consequences of pharmaceuticals within the consumer sphere. In addition, our findings suggest that directed efforts to raise awareness of proper disposal may be more effective than broad awareness campaigns, and we recommend research on the efficacy of providing disposal instructions on drug packaging.

Development and validation of medication storage and disposal questionnaire

Objectives

Inappropriate medication storage and disposal is a global problem and has a negative impact on public health, economy and the environment. One of the main causes of this problem is the lack of knowledge among the population about medication storage and disposal. This study aimed to develop a tool to measure knowledge and practice about medication storage and disposal and measure it among the Jordanian population.

Methods

This web-based cross-sectional study developed a tool to evaluate medication storage and disposal knowledge attitude and practice. Exploratory factor analysis, analysis of variance and t-test were conducted to analyze the data.

Key findings

1132 responses were collected. The exploratory factor analysis suggested a three-factor model, the three models are knowledge-need, patient-related, and medication-related factors. Knowledge-need factor evaluates the participants’ perceptions of the need for awareness and regulations regarding medication storage and disposal. The patient-related factor evaluates medication discontinuation behaviours. Medication-related factor evaluates the handling of damaged or expired medication practices. The highest mean of all three factors was for the knowledge-need factor (mean = 4.13), while the lowest was for the patient-related factor (mean = 3.22). The education level was negatively associated with patient-related factor indicating good behaviours. The means of the three factors were significantly associated with the respondents reporting that they know the correct medication storage and disposal behaviours, and the respondents believing that there are consequences of keeping medication at home.

Conclusion

The questionnaire was a valid and reliable tool to assess the knowledge and practice of medication storage and disposal. This study’s findings suggest that the lack of knowledge is the main reason behind the inappropriate medication storage and disposal practice. There is a need for awareness-improvement, which should involve healthcare awareness campaigns and governmental regulations.

Evaluating patient knowledge and use of medication disposal in a Chinatown community pharmacy

BACKGROUND

Drug take-back programs (TBPs) provide the opportunity to safely dispose of unused or expired medications (UEMs), potentially reducing the risk of environmental harm and morbidity. Data on patient perceptions and participation are limited, especially in underserved Asian populations.

OBJECTIVE

This study aimed to evaluate medication disposal perceptions and behaviors through a free mail-in medication disposal program among patients in a Chinatown community pharmacy.

METHODS

An institutional review board-approved Web-based survey was developed in English and Mandarin. Student pharmacists tabled at a Chinatown community pharmacy in Boston, Massachusetts. The patients were educated about safe medication disposal practices and invited to take the anonymous survey assessing medication disposal needs, practices, and beliefs accessed in person by using a quick response code. On survey completion, the patients were offered a disposal envelope. Envelope tracking numbers were used to evaluate medication disposal over a 9-month follow-up period.

RESULTS

Sixty-two patients of Asian descent completed the survey, and 42 (67.7%) accepted an envelope. Forty-seven patients (75.8%) reported having access to UEMs. More than half indicated that TBPs were important to alleviate the risk of medication and environmental consequences despite low previous use (6.5%). Most patients felt more aware of TBPs (72.6%), an increased sense of the importance of TBPs (74.2%), and intent to participate in TBPs (69.4%), including using the envelope (75.8%). Three (4.8%) patients disposed of medications using the study-provided envelope during the 9-month follow-up.

CONCLUSION

Patient education about TBPs and their importance may be effective in increasing TBP awareness in a population with low TBP use. Free disposal envelopes did not seem to be highly used within 9 months of receipt despite interest and access to UEMs. Future research should continue offering programs at no charge, evaluating barriers to free TBP use, and implementing follow-up procedures to increase envelope use.

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.

Evaluation of a Revised Home Medication Experience Questionnaire (HOME-Qv2)

The Home Medication Experience Questionnaire (HOME-Qv2) was developed to identify patient medication experience issues for pharmacist intervention. The study objectives were to (1) evaluate patient responses to the HOME-Qv2 medication experience questionnaire and (2) describe recommendations made by pharmacists in response to the identified medication experience issues and adoption of recommendations. The study sample was comprised of older adults, 55 years and above, who have one or more chronic illnesses for which they routinely take 4+ prescription medications. The HOME-Qv2 was administered to patients and a pharmacist made recommendations based on the responses. At 3 months, the research team followed up with participants via telephone, during which the HOME-Qv2 was again administered and participants shared their adoption of recommendations. Twenty-four patients completed the questionnaire, and twenty-one were available for follow-up. At 3 months, there was a significant decrease in patient self-reported HOME-Qv2 medication experience issues. There were 31 interventions/recommendations provided by the pharmacists, and 64.5% reported adopted. The HOME-Qv2 appears to facilitate patient disclosure of medication experience issues and informed targeted pharmacist recommendations.

Communication of Recommendations for the Disposal of Unused Prescription Opioid Medications by Stakeholders in the News Media

OBJECTIVE

The opioid epidemic is a national public health emergency that requires a comprehensive approach to reduce opioid-related deaths. Proper and timely disposal of unused prescription opioids is one method to deter improper use of these medications and prevent overdose. The objective of this study was to understand how recommendations for disposing of unused prescription opioids, including both take-back programs and toilet disposal, are communicated to the public.

METHODS

Two hundred sixty-three US newspaper articles published between January 1, 2014, and June 30, 2017, containing information on opioids and take-back programs were found using LexisNexis. Using content analysis, articles were coded for the presentation of and recommendation for opioid disposal practices, beliefs about environmental harm from toilet disposal, and additional strategies to reduce opioid supply. The entity responsible for the statement was also captured.

RESULTS

Take-back programs were presented as a recommended disposal strategy for unused prescription opioids in 88.6% of coded articles. Toilet disposal was presented as a recommended disposal strategy for unused prescription opioids in 3.4% of articles and as harmful to the environment in 16.0% of articles. Individuals from health care, government, and law enforcement were primarily involved in discussing opioid disposal practices.

CONCLUSIONS

Although toilet disposal is recommended by the US Food and Drug Administration (FDA) for disposal of unused prescription opioids when a take-back program is not readily available, it was infrequently presented or recommended in news media articles. These results highlight the importance of improving communication of FDA guidelines for opioid disposal in the media, particularly by health care providers, government employees, and law enforcement officials.

What's in Your Body of Water? A Pilot Study Using Metaphoric Framing to Reduce the Psychological Distance in Pharmaceutical Pollution Risk Communication

Aquatic pharmaceutical pollution poses ecotoxicological risks to the environment and human health. Consumer pharmaceutical use and disposal behaviors represent a significant source of pharmaceutical compounds in surface waters, and communication strategies are needed to promote pro-environmental behaviors to reduce pharmaceutical pollution. Designing effective risk communication campaigns requires an understanding of public perceptions of aquatic pharmaceutical pollution. The purpose of this mixed-methods pilot study was to test the efficacy of using theories from cognitive linguistics and psychology (conceptual metaphor theory and construal level theory of psychological distance, respectively) in using metaphors in pharmaceutical pollution risk communication. Our methods included a randomized cross-over design in which a convenience sample of university students (n = 20) viewed visual representations of pharmaceutical pollution risks (metaphor based and non-metaphor). We used cognitive interviewing methods to assess metaphor use on participants understanding of pharmaceutical pollution risk, concern about this risk, and willingness to act. Results indicate that participants preferred the metaphorically-framed visual, and that the use of metaphor significantly reduced participants' perceived social and geographic distance of pharmaceutical pollution risk, suggesting a relationship between metaphoric framing and psychological distance warranting additional research. Theoretical and practical implications of metaphor use in risk communications are discussed.

Household Pharmaceutical Waste Disposal in Selangor, Malaysia-Policy, Public Perception, and Current Practices

Although pharmaceuticals treat illnesses and prevent diseases in humans and animals, ironically, they are now among the emerging pollutants in the environment. As individuals continue to consume medicines, households can become a primary source of pharmaceutical pollutants. This paper explains relevant Malaysian law and policy on the issue. Using a questionnaire survey, it also assesses public perception concerning the environmental impact of pharmaceutical waste and the current methods of disposal that are practiced in Selangor. The survey used a convenience sampling and the data collected were analysed using statistical descriptive analysis. Most of the participants were aware that pharmaceutical waste can have an adverse impact on the environment and public health. Half of the participants disposed of their pharmaceutical waste in trash bins. About 2.9% of the respondents poured their household pharmaceutical waste (HPW) directly down the drain, while 8.8% poured them down the sink in the kitchen or toilet. The study also discovered that while 73.8% of the respondents felt that HPW should be separated from other household solid waste, only 25.2% returned their medicinal waste through the medicine return-back programme. The majority of the respondents (82.5%) agreed that information concerning the proper disposal of HPW is insufficient. The study concludes that while the respondents were aware of the adverse impact of HPW, their practices to ensure proper disposal is discouraging. There is a need for effective unwanted medicines return-back programme as a more prudent disposal method of HPW to avoid any risk to the environment or human health.

U.S. News Media Coverage of Pharmaceutical Pollution in the Aquatic Environment: A Content Analysis of the Problems and Solutions Presented by Actors

Pharmaceutical pollution in the aquatic environment is an issue of concern that has attracted attention by the news media. Understanding the factors that contribute to media framing of pharmaceutical pollution may lead to a better understanding of the management and governance of this issue, including why these pollutants are generally unregulated at this time. This study conducted a content analysis of 405 newspaper articles (81 had substantive information on the topic) from 2007 to 2014, using the search terms "water" and "pharmaceuticals" in the Chicago Tribune, Denver Post, Los Angeles Times, New York Daily News, New York Times, USA Today, Wall Street Journal, and Washington Post. We sought to analyze the factors that contributed to the news media presentation of pharmaceutical pollution in the United States, including the presentation of the risks/safety and solutions by various actors. We found that the primary issues in the news media were uncertainty regarding public health and harm to the environment. The primary solutions recommended within the news media were implementing additional water treatment technologies, taking unused pharmaceuticals to predetermined sites for disposal (take-back programs), and trash disposal of unused pharmaceuticals. Water utilities and scientists presented improved water treatment technology, government actors presented take-back programs, and pharmaceutical representatives, while sparsely involved in the news media, presented trash disposal as their primary solutions. To advance the understanding of the management of pharmaceutical pollution, this article offers further insight into the debate and potential solutions within the news media presentation of this complex scientific topic.