Handling of unused prescription drugs--knowledge, behaviour and attitude among Swedish people

Emerging contaminants: A One Health perspective

Environmental pollution is escalating due to rapid global development that often prioritizes human needs over planetary health. Despite global efforts to mitigate legacy pollutants, the continuous introduction of new substances remains a major threat to both people and the planet. In response, global initiatives are focusing on risk assessment and regulation of emerging contaminants, as demonstrated by the ongoing efforts to establish the UN's Intergovernmental Science-Policy Panel on Chemicals, Waste, and Pollution Prevention. This review identifies the sources and impacts of emerging contaminants on planetary health, emphasizing the importance of adopting a One Health approach. Strategies for monitoring and addressing these pollutants are discussed, underscoring the need for robust and socially equitable environmental policies at both regional and international levels. Urgent actions are needed to transition toward sustainable pollution management practices to safeguard our planet for future generations.

Patients' knowledge, attitude, and practices toward unused medications in Qatar: A cross-sectional survey

Background

Global evidence has linked unused medications and their inappropriate disposal to adverse health, economic, environmental, and ethical impacts. However, such evidence is scarce in Qatar. This study explored patients' knowledge and attitude toward unused medications and their practices toward medication supply and disposal (KAP) in Qatar.Materials and methods.

Study design

A cross-sectional survey using a pretested questionnaire was performed between February 2020 and October 2020. Descriptive statistics, Man Whitney U, and Kruskal-Wallis Rank-Sum tests were applied. The Chi square test assessed the association between socio-demographic characteristics and KAP scores. Characteristics that were found significantly associated with KAP (i.e., p-values <0.05) were further included as predictor variables in the multiple linear regression model.

Results

All items pertaining to patients' knowledge were found to be good (mean score > 3), except for "awareness of unwanted medication return policy" (mean score < 3), i.e., the lowest level of patient agreement (31 %) (median (M) = 3, Interquartile Range (IQR) = 3). Their attitude was generally good (mean score > 3). Conversely, their practice toward medication supply was poor (mean score < 3). Possible future use was the most reported reason (79 %) for keeping medications at home, and home trash was the most widely disposing place of unused ones (76 %). Knowledge was significantly higher among non-laborers and other occupations than among patients with no work (p < 0.001) and (p = 0.005), respectively. The attitude was significantly lower among patients with healthcare providers (HCPs) in their household than among those without (p = 0.001). Practices were also significantly lower among those aged 40-49 years and those with HCPs in their household than those aged 18-29 years (p = 0.012) and those without HCPs, (p < 0.001), respectively.

Conclusions

Overall, patients' knowledge and attitude toward unused medications seem good, while their practices toward medication supply and disposal are bad. To mitigate the health, economic, and environmental impacts of unused medications, interventions including rationalizing drug supply, use, disposal, prescribing, manufacturing, and promotion are recommended.

Home drug utilization, storage practice and associated factors among people living in Bahir Dar city, Ethiopia

Background

Medicines are maintained at home for several reasons. However, irrational household storage of medicines is a universal public health problem, causing significant harm to health and the healthcare system.

Objective

This study aimed to assess home drug use and storage practices among the residents of Bahir Dar. Town, Ethiopia.

Method

A cross-sectional household study was conducted in three sub-cities of the town of Bahir Dar from July to October 2022. Multistage stratified sampling was used to select the households included in the study. Data on the prevalence of home drug storage, storage place, and self-medication practice, among others, were collected using a semi-structured questionnaire and analyzed using Statistical Package for Social Science version 20.

Results

More than half (57.9%) of the respondents stored medicines at home, mostly in drawers (35%). In this study, the widespread use of self-medication (44.6%) and drug-sharing practices (25%) were observed. Most of the leftover medicines (67.3%) were disposed of in the trash. Education status (AOR=3.8, 95% CI: 1.6-9.1), occupation (AOR=2.9, 95% CI: 1.2-7.2), income (AOR=1.73, 95% CI: 1.01-3.0), and the presence of chronic disease (AOR=3.2, 95% CI: 1.7-5.9) showed a significant association with home drug storage.

Conclusion

Many study participants stored medications at home and bought them from pharmacies without consulting physicians. Disposing of medications into waste and practice of medication sharing were found to be high in the current study, suggesting that there is a lack of home drug utilization and storage practices by the general public.

Assessment of general population knowledge, attitude, and practice on safe unused and expired drugs disposal: a cross-sectional study

Background

The appropriate disposal of medication is a well-recognized issue that has convened growing recognition in several contexts. Insufficient awareness relating to appropriate methods for the disposal of unneeded medicine may result in notable consequences. The current research was conducted among the public in Iraq with the aim of examining their knowledge, attitude, and practices regarding the proper disposal of unused and expired medicines.

Methods

The present study used an observational cross-sectional design that was community-based. The data were obtained from using an online questionnaire. The study sample included people of diverse genders, regardless of their race or occupational status. The study mandated that all participants meet two criteria: firstly, they had to be a minimum of 18 years old, and secondly, they needed to have permanent residency status in Iraq.

Results

The research population consisted of 591 participants from general population. The majority of participants were men (64.8%) with average age of 33.5±9.1 years. The majority of participants (˃50%) answered four out of eight knowledge questions correctly. There were significant (P-value ˂0.05) differences in four knowledge items about disposing of unused/expired medications according to the educational level. Elder participants had significantly higher knowledge about the disposing of unused/expired medications compared to younger ones. More than 84% correctly agreed that improper disposal of unused and expired medication has adverse effects on environment. Although the majority of the participants had positive attitude toward the safe disposal of unused/expired medications, their actual practice was improper for these medications. Approximately 70% of the participants have disposed unused/expired medications into their home trash can.

Conclusion

Despite increasing awareness from the general populace about the possible harm and substantial hazards linked to expired medicines, there is an absence of understanding concerning the proper techniques for disposing of and managing these prescriptions.

Medical Household Waste as a Potential Environmental Hazard: An Ecological and Epidemiological Approach

Nowadays, the contamination caused by emerging pollutants is a global concern due to the lack of scientific evidence to demonstrate the risk or toxicity to humans due to the presence of pharmaceutical residues in the environment. This study aimed to identify and describe the disposal practices of unused and unwanted medications, as well as to analyze and identify the most frequent drugs determined on water bodies adjacent to the biggest urban population in Mexico. A two-phase study with an epidemiological and an ecological assessment was performed. The epidemiological phase was carried out with a descriptive cross-sectional study among citizens from Mexico City and the metropolitan area using an electronic survey applied to 719 subjects aimed to assess practices in which pharmaceutical products are disposed. The ecological phase included a review of scientific reports. The results show that nearly 83.5% of those surveyed use inappropriate practices for disposal medicines, the main ones are through the municipal dump or directly in the drain. The ecological approach was carried out by a systematic literature review of original reports published between 2013 to 2023; information about the class of drugs, active substance, environmental compartments, location, and concentration was extracted and presented. Fifty-one different types of pharmaceutical residues were detected in wastewater in Mexico City in the last decade. The results of this study can contribute to the application of public policies for waste management authorities to mitigate the socio-environmental risks due to the inappropriate disposal of medicines.

Public knowledge of antibiotics, self-medication, and household disposal practices in Jordan

BACKGROUND

This study aimed to assess public understanding of antibiotics, self-medication, and drug disposal practices.

METHODS

A cross-sectional self-administered online survey was undertaken in Jordan.

RESULTS

The study was completed by 1,105 participants. When asked about their knowledge of antibiotics, rational antibiotic use, and disposal practices, 16% percent believed they should discontinue antibiotics once they felt better, and 12% agreed to take the same antibiotics prescribed to others for the same illness. Self-medication with antibiotics was practiced by 44% of the participants. Prior experience, healthcare costs, and pharmacy location were all major determinants of self-medication. Only 6.4% of unneeded antibiotics were returned to the pharmacy, 60% were kept at home, and 26.6% were disposed of at home. Almost half of those who kept the antibiotics said they would use them again, and one-third said they would give them to friends and family. Respondents who had used antibiotics within the previous 6 months (p = 0.052) and relied on medication leaflets (p = 0.031) and physician recommendations (p = 0.001) were less likely to self-medicate with antibiotics.

CONCLUSIONS

The study highlighted areas of inappropriate use of antibiotics, self-medication and the improper antibiotic disposal that can inform antimicrobial stewardship.

Prevalence of leftover medicines, disposal practices, and associated factors in Arba Minch Town, Southern Ethiopia

Objective

The increased prevalence of leftover medicines in the community is currently a global concern due to the detrimental effects on the environment and health. However, several developing countries have failed to give sufficient consideration to the issue. The primary purpose of this study was to describe the prevalence of leftover medicines, disposal practices, and the factors affecting those in households in Arba Minch Town, Southern Ethiopia.

Methods

A community-based, descriptive cross-sectional study was conducted among households in Bere Edigetber and Nech Sar of Arba Minch town, from June 25 to August 27, 2022. Data were gathered through face-to-face interviews with revalidated structured questionnaires. A multistage sampling technique was utilized to select each household.

Results

Three hundred forty-eight households agreed to participate in a study, resulting in a 94.8% response rate. Of the study participant, 172 (49.4%) of the households had leftover medicines, with antibiotics being the most common (64% of 172). Subsidy of symptoms and saving for later use were two frequently cited reasons for the presence of leftover medicines in the house. Throwing leftover medicines in household garbage was the preferred method of disposal (>60%). Only 0.1% of respondents considered returning leftover medicines to healthcare facilities or professionals. A binary regression analysis identified four predictors for having leftover medicines. Medicines obtained without prescription were the strongest predictor (odds ratio = 3.7; p < 0.001), followed by higher family monthly income (odds ratio = 2.5; p = 0.005), those waived paying for medicine (odds ratio = 0.294; p = 0.049), and those used medications for acute diseases (p = 0.048; odds ratio = 0.450). Respondents who had prior information on safe medicine disposal were 2.3 (p = 0.04) more likely to dispose of possessed leftover medicines rather than keep them for future use.

Conclusions

This study revealed a high prevalence of leftover medicines and their improper disposal in Arba Minch town. The preferred methods of leftover medicine disposal in this study deviate from conventional standards. Significant factor variables that predict having leftover medicines are attributed to purchasing medicine without a prescription, higher family monthly income, those waived paying for medicine, and those who used medications for acute diseases. Prior knowledge of proper disposal practices predicated the decision to dispose of on-hand leftover medicines or keep them for future use. These findings would be critical in developing strategies to reduce leftover medicines and promote proper disposal practices.

End-of-life management strategies of pharmaceuticals in Portuguese households

The end of life of pharmaceutical products through environmentally unsafe routes is a growing concern in our society. However, the studies reported so far, apart from being limited in number, do not reflect the current management practices for the end-of-life management of pharmaceuticals. Published work lacks an in-depth analysis in focusing on the pharmaceutical waste in households. The present work focused on (1) performing a state-of-the art overview to compare worldwide studies and the results and (2) implementing a comprehensive survey in Portugal (n = 454 respondents). The results showed that the delivery to pharmacies was used by the majority of the respondents (72%), indicating a good awareness of pharmaceutical waste management issues, when compared to the reviewed studies. Statistically significant variables for the destination of end-of-use pharmaceuticals include gender, age and distance from the residence to the pharmacy (p < 0.05). Most participants believe that educating the population on existing structures of medication and packaging management is of the utmost importance to improve the national managing system. This is the first study conducted in Portugal; it includes statistical analysis of the data and reflects on the practices that should be adopted to reduce incorrect pharmaceutical waste disposal. These findings call upon the strategies to strengthen the pharmaceutical waste management programme.

Expired medications and disposal practices in Arab households

OBJECTIVES

Over the past few decades, the accumulation of expired and unused medications in households has become a concern. Most people are unaware of how to properly dispose of unused and/or expired medicines. Our objective was to inspect the extent of expired medications within Arab households in United Arab Emirates (UAE), to determine which therapeutic groups yield greater amounts of unused medications, and evaluate drugs' disposal practices.

METHODS

This descriptive study was written in accordance with the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) checklist for cross-sectional studies. It was conducted among Arab households in UAE (n = 503) using an online questionnaire between November 2020 and January 2021. Questions were related to participants' socio-demographics, the prevalence of expired medications in households and their disposal.

KEY FINDINGS

Around 58% of the respondents had expired medications in their houses and 74% had drugs that were never used. The most common medicines left unused were analgesics (34%) followed by cosmetics (27%) and antibiotics (26%). More than 42% of expired medications were in solid dosage forms, 28% were semisolid and 24% were liquid dosage forms. The predominant disposal method among the surveyed participants was throwing medications into the garbage (86%).

CONCLUSIONS

Large quantities of expired medications in Arab households exist with a high prevalence of analgesics, antibiotics and cosmetics. Arab households are unaware of the proper drug disposal procedures. Therefore, community pharmacists are recommended to offer training on proper medication disposal practices and to encourage the public to return medications to pharmacies.

Knowledge, attitude and practice of community pharmacists towards household pharmaceutical waste disposal

Objective

To assess the knowledge, attitude and practice of community pharmacists (CP) towards household pharmaceutical waste disposal.

Methods

All pharmacists attending the Malaysian Community Pharmacy Guild event held in-person were invited to self-administer a web-based survey.

Key findings

The response rate was 61% (168/276). Overall, community pharmacists have mixed knowledge (mean ± SD: 5.89 ± 1.38) and positive attitude (mean ± SD: 9.58 ± 0.81) towards household pharmaceutical waste disposal. However, few community pharmacists (18/168, 10.7%) have promotional materials encouraging safe medication disposal in their pharmacies.

Conclusions

Community pharmacists do not proactively promote safe household pharmaceutical waste disposal to mitigate pharmaceutical pollutants entering the environment although they have satisfactory knowledge and attitude.

Pharmacy and Nursing Students' Knowledge and Practices Concerning the Disposal of Unused and Expired Medicines in Kosovo

This descriptive cross-sectional study aimed to assess the knowledge and practices of pharmacy and nursing students at a medical college in Kosovo concerning unused and expired medications. A self-administered questionnaire was distributed to 500 randomly selected students of pharmacy (200 questionnaires) and nursing students (300 questionnaires). Overall, 336 returned the filled forms and the response rate was 67.2. SPSS version 26.0 was utilized for statistical analysis. The results showed that 89.2% of pharmacy students and 82.2% of nursing students check the expiration date of medications before purchasing them and a considerable number of students stated that they possess unused medicines at home (78.4% of pharmacy and 74% of nursing students). Regarding disposal practice, over 50% of both nursing and pharmacy students dispose of unused and expired medications in the trash. A small proportion of students returned unused or expired medicines to the pharmacy (11.4% of pharmacy students and 10.7% of nursing students return unused medications, whereas 14.4% of pharmacy respondents and 10.1% of nursing respondents reported returning expired medicines). There was a statistically significant difference in the ways pharmacy and nursing students purchase pharmaceuticals and in their opinions regarding institutions in charge of disposing of unused and expired medicines (p = 0.000). Students are aware of the detrimental effects improper disposal of unused and expired medicines has on the environment and public health, but lack information regarding the return of unused and expired medicines to the pharmacy. To change the existing practice the most appropriate method would be to add additional lectures on safe disposal practices into existing modules. It is recommended for involved stakeholders in Kosovo to organize training, seminars, and workshops for health professionals especially pharmacists and nurses, since they pass the information to patients/consumers as well as the government to make amendments to current legislation to ameliorate the returning procedures for patients/consumers in pharmacies.

Assessment of knowledge, attitude, and practice of disposing and storing unused and expired medicines among the communities of Kathmandu, Nepal

Background

Unused medicines can be stored by many people at their places of residence and houses for later use. This study evaluated knowledge, and attitudes regarding unused and expired medicines and explored medicine storage and disposal practices among selected households in the Kathmandu valley, Nepal.

Method

A cross-sectional study with a two-stage cluster survey design was done using a semi-structured questionnaire from April to October 2021. The sample size (total number of households) after adjusting for design effect and non-response rate was 210 and the study population was the household heads. Simple random sampling was done to select clusters during the first stage and systematic random sampling to select households during the second stage. Descriptive statistics and t-test/one-way ANOVA were used to compare the respondents’ average knowledge scores. Practice variables were presented using frequency distribution.

Results

Around half the respondents were from the Kathmandu district, nearly 20% were from Bhaktapur and 30% were from Lalitpur. Nearly two-thirds were male and about 25% had a bachelor’s degree. Nearly 90% of respondents agreed that storage of excess medicines at home may promote self-medication. Similarly, 97.6% of respondents agreed there is a lack of adequate information on the safe disposal of unused medicines. The majority [125 (59.5%)] of participants always checked the expiry date of medicines. The safe methods of medicine disposal were not known by 137 (65.2%) participants. Throwing in a dustbin was the preferred method of expired medicine disposal.

Conclusion

The level of knowledge and practice of disposing of unused and expired medicines requires improvement. Educational interventions may help improve awareness further. Creating a chart summarizing disposal procedures of common medicines is important. Similar studies in other regions are required.

Removal of Paracetamol from Aqueous Solutions by Photocatalytic Ozonation over TiO2-MexOy Thin Films

Analgesics and nonsteroidal anti-inflammatory drugs (NSAIDs) such as paracetamol, diclofenac, and ibuprofen are frequently encountered in surface and ground water, thereby posing a significant risk to aquatic ecosystems. Our study reports the catalytic performances of nanosystems TiO₂-Me_xO_y (Me = Ce, Sn) prepared by the sol-gel method and deposited onto glass slides by a dip-coating approach in the removal of paracetamol from aqueous solutions by catalytic ozonation. The effect of catalyst type and operation parameters on oxidation efficiency was assessed. In addition to improving this process, the present work simplifies it by avoiding the difficult step of catalyst separation. It was found that the thin films were capable of removing all pollutants from target compounds to the oxidation products.

Knowledge and practices concerning the storage and disposal of home medications among people in the eastern region of Saudi Arabia: A cross-sectional study

Background

Medications are widely used and stored in people’s homes throughout the year. Inappropriate storage of home medications is a worldwide problem and may affect the effectiveness and stability of medications, which impacts the activity and capability of these medications to treat diseases. This study aimed to assess the awareness of the public in the eastern region of Saudi Arabia concerning the appropriate storage of used medications and the proper disposal of unwanted medications.

Method

A cross-sectional survey was conducted in the eastern region of Saudi Arabia between February and June 2018. The study questionnaire tool was constructed based on several previous studies regarding medication storage, recycling, and the correct and safe disposal of expired, unwanted, or unused medication.

Results

A total of 820 responses was collected. The results showed that 91.0% of the respondents keep their medications in the original container, and only 4.5% of them write the expiry date on the new containers. While 47.1% of the respondents read the storage instructions written in the medication leaflet, only 16.2% of the respondents ask the pharmacist about the storage instructions. A majority of the respondents (84.4%) check the expiry date of medications before use, and 70.1% of them periodically check the expiry date of stored medications. Age, gender, and education level were important factors that affected medication storage practices.

Conclusion

This work underpinned the lack of awareness among the public regarding the appropriate way to store home medications and the proper way to dispose of unwanted and expired medications.

Attitudes and Considerations towards Pharmaceuticals-Related Environmental Issues among Finnish Population

A number of policy recommendations identify the general public as a key participant in environmentally sustainable pharmaceutical policies. However, research into pharmaceuticals-related environmental issues from the population perspective is scarce. We studied the awareness among Finnish adults (n = 2030) of pharmaceutical residues in Finnish waterways, their perceived environmental sources, views on pharmaceuticals-related environmental issues, and their association with background characteristics. Of the respondents, 89.5% were aware of the presence of pharmaceuticals in Finnish waterways. Wastewaters from the pharmaceutical industry were most frequently, and pharmaceuticals excreted by humans least frequently, considered a major environmental source of pharmaceuticals. The vast majority of the respondents were worried about the environmental and health impact of pharmaceutical residues and emphasized issues such as the importance of environmentally sustainable actions by pharmaceutical companies and the recyclability of the pharmaceutical packaging materials. Age, education, use of prescription medicines, and environmental attitude were associated with awareness of pharmaceutical residues, while gender, age, education level, and environmental attitude were associated most frequently with pharmaceuticals-related environmental considerations. These results indicate a need for improved communication about the environmental effects of pharmaceuticals and the significance of different pharmaceutical emission sources in order to promote a more environmentally friendly, effective pharmaceutical policy.

Medication take-back programs in Qatar: Parental perceptions

Purpose:

To identify parental perception of a take-back program for medications.

Materials and Methods:

A cross-sectional study using a questionnaire was conducted at Hamad Medical Corporation, the only tertiary pediatric hospital in the State of Qatar at the time of the study. Qatar is a rapidly developing country with limited national data on the awareness of medication misuse among adults living with children at home and on the safety practices regarding medication disposal.

Results:

305 questionnaires were completed (response rate = 90%). More than 80% of parents were in between 20 and 39 years of age, 70% of them were females, and 80% were college graduates. Approximately 90% of participants have immediate relatives who were taking medications for chronic diseases. Almost 60% of parents stated that they keep unused medications at home, whereas 10% were not aware of the fate of the left over medications. Approximately 95% of the parents dispose the expired medications. In terms of the mode of disposing the medications, 66% of caregivers dispose the medication bottle or package in the trash can, whereas 14% remove the medications from the bottles or packages and throw them in the trash, and 15% put them through the drain. When asked if participants read disposal measures in the medication pamphlet, only 10% answered “always,” whereas 26% answered “sometimes.” Participants were asked if they have heard of any medications take-back programs, 75% answered no, whereas 14% were not sure. However, almost 60% of them will use the take-back program if available and 18% were not sure.

Conclusion:

Parents residing in the State of Qatar have deficiencies in knowledge about medication disposal. Parent's attitudes and perceptions are considered indispensable targets for community health intervention. Our next step is to share our data with the ministry of health to spread awareness about the proper disposal of medicines and take-back programs in Qatar.

Disposal practice and factors associated with unused medicines in Malaysia: a cross-sectional study

Background

The improper disposal of unused medicines is a worldwide concern because of its impact on the environment, economy, and health. This study aims to describe the disposal practice of unused medicine and identify factors associated with unused medicines in Malaysia.

Methods

This was a cross-sectional, face to face interview-based survey using a structured questionnaire. We used a convenience sampling method to recruit participants from Kuala Lumpur and Selangor in Malaysia.

Results

We interviewed 1184 participants, and the response rate was 96%. Out of the total respondents, 995 (84%) reported having unused medicines. About a quarter of respondents kept unused medicines in the cabinet, and another quarter disposed of them into the trash or toilet. Only half of the respondent who used medicines for chronic illnesses had unused medicines compared to about 90% of respondents who used medicines for acute illnesses. The main reason for having unused medicines among those who used medicines for chronic illness was non-adherence (69%, p <  0.05). Only 27% of these respondents returned unused medicines under the “Medicine Return Programme (MRP)”. The other group who used medicines for acute illnesses had unused medicines because their health conditions improved. Thus, most of the unused medicines will eventually end up in household waste. A multivariate logistic regression analysis identified respondents who used medicines for acute illnesses as the strongest predictor of having unused medicines (Odds Ratio (OR) = 29.8; p <  0.001), followed by those who pay for their medicines (OR = 6.0; p < 0.001) and those who were willing to participate the Medicine Return Programme (OR = 2.5; p = 0.009).

Conclusion

The prevalence of unused medicines and their improper disposal were high in Malaysia. Unused medicines are associated with people who use medicines for acute illnesses, pay for their medication, and are willing to participate in an MRP. Rationale prescription and optimal dispensing practice, together with a broader MRP facilities coverage, could reduce unused medicine possession.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-11676-x.

Recycling of Expired Ceftamil Drug as Additive in the Copper and Nickel Electrodeposition from Acid Baths

Due to the large quantity of expired and unused drugs worldwide, pharmaceutical disposal has become a serious problem that requires increased attention. In the present paper, the study on recycling ceftazidime (CZ) as an additive in copper and nickel electrodeposition from acid baths is highlighted. CZ is the active substance from expired commercial drug Ceftamil^®. Its electrochemical behavior was studied by cyclic voltammetry. As well, kinetic parameters for copper and nickel electrodeposition were determined using Tafel plots method at different temperatures and CZ concentrations in these acid baths. The activation energy was calculated from Arrhenius plots. Electrochemical impedance spectroscopy was used to investigate the charge transfer resistance and coverage degree in the electrolyte solutions at several potential values. Gibbs free energy values, calculated from Langmuir adsorption isotherms, revealed the chemical nature of CZ–electrode surface interactions. The favorable effect of the organic molecules added in copper and nickel electroplating baths was emphasized by optical microscope images. The morphology of the obtained deposits without and with 10⁻⁴ mol L⁻¹ CZ was compared. The experimental results revealed that expired Ceftamil^® is suitable as additive in copper and nickel electroplating processes from acid baths.

Diagnosing Down-the-Drain Disposal of Unused Pharmaceuticals at a River Catchment Level: Unrecognized Sources of Environmental Contamination That Require Nontechnological Solutions

Down-the-drain disposal of pharmaceuticals remains an overlooked and unrecognized source of environmental contamination that requires nontechnological "at-source" solutions. Monitoring of 31 pharmaceuticals over 7 days in five wastewater treatment plants (WWTPs) serving five cities in South-West UK revealed down-the-drain codisposal of six pharmaceuticals to three WWTPs (carbamazepine and propranolol in city A, sildenafil in city B, and diltiazem, capecitabine, and sertraline in city D), with a one-off record codisposal of estimated 253 pills = 40 g of carbamazepine and estimated 96 pills = 4 g of propranolol in city A accounting for their 10- and 3-fold respective increases in wastewater daily loads. Direct disposal of pharmaceuticals was found to affect the efficiency of wastewater treatment with much higher pharmaceutical removal (decrease in daily load) during "down-the-drain disposal" days. This is due to lack of conjugated glucuronide metabolites that are cleaved during "consumption-only" days, with the release of a parent pharmaceutical counterbalancing its removal. Higher removal of pharmaceuticals during down-the-drain disposal days reduced pharmaceutical loads reaching receiving environment, albeit with significant levels remaining. The estimated daily loads in receiving water downstream from a discharge point accounted for 13.8 ± 3.4 and 2.1 ± 0.2 g day^-1 of carbamazepine and propranolol, respectively, during consumption-only days and peaked at 20.9 g day^-1 (carbamazepine) and 4.6 g day^-1 (propranolol) during down-the-drain disposal days. Actions are needed to reduce down-the-drain disposal of pharmaceuticals. Our recent work indicated that down-the-drain disposal of pharmaceuticals doubled since the last study in 2005, which may be due to the lack of information and messaging that informs people to dispose of unused medicines at pharmacies. Media campaigns that inform the public of how to safely dispose of medicines are key to improving rates of return and reducing pharmaceutical waste in the environment. The environment is a key motivator for returning unused medicines to a pharmacy and so messaging should highlight environmental risks associated with improper disposal.

Household Drug Management Practices of Residents in a Second-Tier City in China: Opportunities for Reducing Drug Waste and Environmental Pollution

The total amount of drug waste is expanding significantly as populations age and societies become wealthier. Drug waste is becoming a problem for health and the environment. Thus, how to reduce and effectively dispose of drug waste is increasingly becoming an issue for society. This study focuses on household drug management, which involves five sub-practices: selection, purchasing, using, storing, and disposing of drugs. A questionnaire survey was conducted in a second-tier Chinese city that reveals both problems and opportunities in these five sub-practices. The results show that consumers are aware of significant issues with regard to the safe and effective use of drugs as well as with regard to proper ways of disposing of and recycling drugs. Moreover, our analysis reveals promising opportunities for addressing these issues by developing novel services based on the idea of connecting the five involved sub-practices of household drug management. Connecting and adjusting practices in this manner can be seen as an important factor in reducing drug waste and pharmaceutical pollutants.

Poor and Unsatisfactory Disposal of Expired and Unused Pharmaceuticals: A Global Issue

Pharmaceuticals are beneficial to humankind and emerged as crucial arms to treat/manage multiple disease pathogenesis in the present era. In analogous, these medicines/ medical devices should be used cautiously as they possess a potential threat to induce multiple undesired effects that may be related to human health or the environment. Daunting effects may arise due to the improper disposal of unused/expired medicines. Hence, to minimize such harm, there should be adequate knowledge and practice among the population regarding the safe disposal of unused/expired medicines or related pharmaceutical devices. The lack of approved information regarding safe disposal of such substances may invite serious concerns like environmental pollution, which may induce immediate health hazards to the present population and upcoming future generations. There are numerous ways to dispose of, or manage the unused and expired pharmaceutical substances. Sharing the medicines among siblings, friends, and family members are never free from serious health risks. Storing the unused and expired medicines in the home increases the risk of intentional or accidental ingestion of such substances and may create a health emergency. Disposing medicines like household and municipal waste may lead to environmental pollution and harm to humans and animals. The present review finds the multiple unsafe ways of disposal of unutilized medications/tools. Furthermore, it also summarizes the disposal pattern of unutilized medications among the few developed and undeveloped nations.

Community Pharmacists' Practice, Awareness, and Beliefs about Drug Disposal in Saudi Arabia

The awareness among Saudi people regarding the good and safe practice of drug disposal is fairly low. Community pharmacists’ potential toward drugs disposal directions and practice are not emphasized enough. Therefore, a cross sectional study was conducted in Riyadh, Saudi Arabia, to evaluate the practice, awareness and beliefs of community pharmacists about disposal of unused drugs. Out of 360 subjects who participated in the study, more than 70% returned the unused drugs to the pharmaceutical distributors. Around 80% of the participants confirmed the risk of environmental damage due to the inappropriate disposal of drugs, and 87.5% of them held themselves responsible for preventing such risk. Approximately 85% of surveyed pharmacists believed community pharmacies to be an appropriate location for the collection of unused drugs. There was no significant association between the community pharmacists’ age group and years of practice as community pharmacists with either the awareness of unused medication disposal on environmental hazards, or the beliefs about the appropriate location for collecting unused drugs (p > 0.05). The awareness and proactive accountable responsibility, along with community pharmacists’ belief of appointing pharmacies to collect unused drugs, strongly support the institution of drug take-back programs.

Medicine storage, wastage, and associated determinants among urban households: a systematic review and meta-analysis of household surveys

Background

Irrational household storage of medicines is a world-wide problem, which triggers medicine wastage as well as its associated harms. This study aimed to include all available evidences from literature to perform a focused examination of the prevalence and factors associated with medicine storage and wastage among urban households. This systematic review and meta-analysis mapped the existing literature on the burden, outcomes, and affective socio-economic factors of medicine storage among urban households. In addition, this study estimated pooled effect sizes for storage and wastage rates.

Methods

Household surveys evaluating modality, size, costs, and affective factors of medicines storage at home were searched in PubMed, EMBASE, OVID, SCOPUS, ProQuest, and Google scholar databases in 2019. Random effect meta-analysis and subgroup analysis were used to pool effect sizes for medicine storage and wastage prevalence among different geographical regions.

Results

From the 2604 initial records, 20 studies were selected for systematic review and 16 articles were selected for meta-analysis. An overall pooled-prevalence of medicine storage and real wastage rate was 77 and 15%, respectively. In this regard, some significant differences were observed between geographical regions. Southwest Asia region had the highest storage and wastage rates. The most common classes of medicines found in households belonged to the Infective agents for systemic (17.4%) and the Nervous system (16.4%). Moreover, income, education, age, the presence of chronic illness, female gender, and insurance coverage were found to be associated with higher home storage. The most commonly used method of disposal was throwing them in the garbage.

Conclusions

Factors beyond medical needs were also found to be associated with medicine storage, which urges effective strategies in the supply and demand side of the medicine consumption chain. The first necessary step to mitigate home storage is establishing an adequate legislation and strict enforcement of regulations on dispensing, prescription, and marketing of medicines. Patient’s pressure on excessive prescription, irrational storage, and use of medicines deserve efficient community-centered programs, in order to increase awareness on these issues. So, hazardous consequences of inappropriate disposal should be mitigated by different take back programs, particularly in low and middle income countries.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-11100-4.

Development, translation, and validation of a bilingual questionnaire on unused medications in homes

Background

Unused medications in homes pose significant health, economic, and environmental risks. Patients are the medications end users and their knowledge, attitude, and practices (KAP) play an important role towards medication use, unuse and wastage. Thus, a valid instrument to reliably measure patients’ KAP towards unused medications in homes may help manage the associated risks.

Objective

To develop, translate, and validate a questionnaire for the assessment patients’ KAP towards unused medications in Qatar homes (i.e., QUM-Qatar).

Setting

This cross-sectional validation study was conducted among randomly selected outpatients visiting various public and private pharmacies in Qatar between September 2019 and February 2020.

Method

Nine experts in the field of pharmacy practice with Qatar contextual background established the content validity of the instrument. The validity was quantified using content validity index (CVI). Furthermore, construct validity was performed using principal component analysis (PCA), whereas internal consistency reliability of items was determined using Cronbach’s alpha. Statistical analyses were performed using STATA 15 statistical software.

Main outcome measure

The psychometric properties of the QUM-Qatar assessment instrument.

Results

An English/Arabic questionnaire was developed and validated. Content validity in the form of scale-level-CVI (S-CVI)/Average and S-CVI/UA was 0.88 and 0.84, respectively, suggesting adequate relevant content of the questionnaire. Variation explained by the multivariate model was 85.0% for knowledge, 94.8% for attitude, and 89.8% for practice. Cronbach’s alpha coefficients were 0.68, 0.82, and 0.84, for knowledge, attitude, and practice domains, respectively. From the psychometric results obtained, the questionnaire's validity and reliability were attained.

Conclusion

The QUM-Qatar instrument has acceptable psychometric properties and has the potential for future use in research and practice to assess KAP towards unused medications in Qatar and elsewhere. It may consequently help in improving medication use and mitigating the negative health, economic, and environmental impacts of unused medications.

Impacts on practice.•

There is now a valid and reliable English/Arabic language questionnaire to assess patients’ KAP towards unused medications.

•

Policymakers can utilize this questionnaire to develop evidence-based policies and strategies for managing unused medications and their disposal.

•

To improve medication use review, rational use of medicines, and adherence, it is necessary to consider patient-reported outcomes that may eventually reflect on saving health, economic resources, and environment.

Lack of Awareness of the Impact of Improperly Disposed Of Medications and Associated Factors: A Cross-Sectional Survey in Indonesian Households

Introduction: Disposal of unused medications through environmentally unsafe routes is common in Indonesia. The lack of awareness of the impact of improperly disposed of medications is a significant contributing factor. The objectives of this study were to identify factors associated with lack of awareness of the impact of improperly disposed of unused medications and to assess the associations of awareness with medication disposal practices among the general population in Indonesia.

Patients and methods: An observational cross-sectional survey was conducted using nonprobability sampling in Bandung, Indonesia, from November 2017 to January 2018 among respondents who were older than 18 years, had used any medication in the past, were literate, and had signed an informed consent document. Disposal practices and awareness regarding the impact of improperly disposed of unused medications were collected using an online- and a paper-based pre-validated questionnaire. The paper-based questionnaires were distributed to respondents in public places such as city center, markets, and religious places. Binary logistic regression was performed to assess associations of sociodemographic and other related factors with a lack of awareness. Odds ratios (ORs) with 95% confidence intervals (CIs) are reported.

Results: Of 497 participating respondents, 433 and 64 respondents filled an online- or a paper-based questionnaire, respectively. Most respondents were female, aged between 18 and 30 years, and students/university students. Of 497 respondents, more than half (53.1%) were not aware that improper medication disposal could harm the environment and population health. Most respondents (79.5%) had never received information about proper medication disposal practices. The education level, the number of stored medications at home, and previous education about medication disposal practices were significantly associated with awareness of proper practices. In the multivariate analysis, only those with previous education about medication disposal practices were less likely to report a lack of awareness (OR: 0.043; 95% CI: 0.02–0.09). Respondents with a lack of awareness tended to dispose of their unused medications in the garbage or shared them with friends or relatives.

Conclusion: There is a clear need to increase awareness of the importance of proper medication disposal practices, in particular among the student population of Bandung city, Indonesia. Healthcare providers can play an important role by educating this specific population on the proper disposal of unused medications.

Guidance on Implementing an Oral Chemotherapy Drug Repository Program in a Medically Integrated Pharmacy Setting

Oncology drug repository programs allow patients to donate oral chemotherapy that can be redispensed to patients in need and could ultimately reduce drug waste. Medically integrated pharmacies can serve as a platform for drug repository programs because of the integration of healthcare providers and pharmacists at one location, facilitating an effective transition from donation to redispensing. Before implementing a program, pharmacies should consider state laws regarding who can donate medications, the type of setting (including open or closed systems), as well as how to assess the quality of the medication donated, expiration dates, storing and maintenance of a separate inventory, written policies and procedures, and a priority list for dispensing medications to patients. In this article, we provide the initial steps to assist states and oncology pharmacists interested in developing a drug repository program.

Knowledge and Practice on Ecopharmacovigilance and Medicine Storage Amongst Medical and Dental Students in Lalitpur, Nepal

Background

Medicines may remain unused and often get expired. Unused medicines can promote self-medication. Unsafe and improper medicine disposal can cause significant environmental harm. Medical and dental students as future prescribers should be aware of the safe disposal of medicines, ecopharmacovigilance and self-medication. The present study examines knowledge and practice about unused and expired medicines and medicine disposal among undergraduate medical and dental students in Nepal.

Methods

The study was conducted during September 2020 using an online survey form. First to final year undergraduate students provided their consent and signed an integrity pledge electronically. Age, gender, program of study, year of study, whether staying with family or not, method of financing education, and whether they had used any allopathic medicines during the past 6 months were noted. The total knowledge score among different subgroups was compared. The frequency of responses regarding practice items and the free-text comments were also listed. Statistical analysis was performed using Mann–Whitney test and Kruskal–Wallis test.

Results

Altogether 441 of the 668 students (66%) participated. The majority were below 23 years and female. Over 65% had used allopathic medicines during the last 6 months. The median knowledge score was 8 (maximum 10) and was significantly higher among older respondents, females and students in later years of study. Most kept unused medicines at home/hostel till expiry which were disposed of in the household garbage. Over 40% had educated their family members about safe medicine disposal. Knowledge scores were significantly different among subgroups according to respondents’ age, gender and year of study.

Conclusion

Respondents were aware of expiry of medicines and knew methods to safely dispose expired medicines. However, they practiced self-medication, stored medications at home and did not practice the safe disposal of medications. Understanding why respondents did not dispose medicines properly is important.

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Disposal practices of expired and unused medications among households in Mwanza, Tanzania

BACKGROUND

The community practice towards disposal of expired and unused medications in spite of its adverse impact have been widely neglected in many developing countries. The available guidelines in Tanzania focus on the disposal of expired medications and cosmetics in hospitals and community pharmacies only.

AIM

The aim of this study was to assess the disposal practice of expired and unused medications at household level in Mwanza city, north-western Tanzania.

METHODOLOGY

The household based cross-sectional study was conducted among 359 randomly selected household members. Semi-structured questionnaires were used for interview during data collection and while STATA® version 13 was used for analysis.

RESULTS

Out 359 households visited, 252 (70.19%) had medications kept in their houses at the time of data collection. Among them, 10 (4.0%) households had kept medications at their houses because they were still continuing with treatment while 242 (96.0%) kept unused medications which were supposed to be discarded. The main reason for keeping unused or expired medications at home was uncompleted course of treatment (199 (82.20%) after feeling that they had recovered from illness. The main reason for discarding medications were recovering from illness (141(48.7%) and expiry (136 (46.9%). The major discarding practices for medications were disposing into domestic trashes (219 (75.5%) and pit latrines (45 (15.5%). Majority of respondents (273 (76%) were aware that improper disposal of expired medications are detrimental to human health and environment in general.

CONCLUSION

Improper disposal of unused and expired medications at household level was a common practice in the study area. Tailor-made interventions by the Food and Drugs Authority (FDA) and other national as well as local stake holders are urgently needed to address the situation.

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.

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.

Intentions to "Reuse" Medication in the Future Modelled and Measured Using the Theory of Planned Behavior

BACKGROUND

A range of pro-environmental behaviors are recognized, promoted, and investigated, but urgent action is also needed to tackle the direct and indirect environmental impact of medication waste. One solution is to reissue medicines, returned unused to pharmacies (i.e., reuse medicines). Yet, if medicines reuse is to be formally introduced in the UK, it is imperative also to understand people's willingness to take part in such a scheme and importantly, the underpinning drivers. This study aimed to develop, validate, and evaluate a Theory of Planned Behavior model aimed at predicting medicines reuse behavioral intentions.

METHODS

The behavior of interest, medicines reuse, was defined according to its Target, Action, Context, and Time. Then themes from an existing qualitative study were used in order to draft, validate and pilot a Theory of Planned Behavior-based questionnaire before its completion by a representative sample (n = 1003) of participants from across the UK.

RESULTS

The majority expressed pro-medicines reuse intentions. The three direct measures accounted for 73.4% of the variance in relation to people's intention to reuse medicines in the future, which was statistically significant at p < 0.001. People's specific beliefs about medicines reuse and how they evaluate other people's expectations of them had a substantial impact on their intentions to reuse medication in the future, mediated in an intricate way via attitudes, subjective norms and perceived behavioral control (PBC).

CONCLUSIONS

This study shows how people could embrace medicines reuse via practical measures that illustrate the safety and quality assurance of reissued medicines, educational interventions that bolster beliefs about the pro-environmental benefits, and norm-based interventions encouraging doctors and pharmacists to endorse the practice. The findings add to the emerging work on medicines reuse and, significantly, provide a theoretical framework to guide policymakers and other organizations looking to decrease the impact of medication waste through medicines reuse schemes.

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.

Current Disposal Practices of Unused and Expired Medicines Among General Public in Delhi and National Capital Region, India

BACKGROUND

Stocking unused or expired medicines or donating these to others can lead to accidental or inappropriate ingestion, increasing the risk of adverse drug reaction(s) and even lead to antibiotic resistance. Further improper disposal of expired or unused medicines is associated with environmental pollution, health hazards and damage to ecosystem. Ecopharmacovigilance is an important area in this context.

OBJECTIVE

To explore the awareness and disposal practices of unused/expired in the general public.

MATERIALS AND METHODS

The current study is an observational, cross-sectional, questionnaire-based study conducted in 956 medicine consumers in New Delhi and National Capital Region, India. The knowledge, attitude, and practice of consumers regarding the disposal of unused medicines were evaluated.

RESULTS

The majority (89.9%) of consumers opined that expiry of medicine(s) meant for completion of shelf life, production of toxic chemical and loss of or decreasing of beneficial effects of medicines. Majority (87%) of the consumers stored medicines at home. Almost all (92.6%) of the consumers threw away the expired medicines after storing for few days. Consumers discarded the expired medicines mainly in household trash (73%). The majority (93%) of consumers were in favour of a government program to collect unused or expired medicines from their home.

CONCLUSION

The knowledge and practices of consumers towards disposal of unused and expired medicines needs to be improved. Health care professionals, government and policy makers should offer training to educate and guide the general public on safe and proper disposal practices of expired or unused medicines.

Knowledge, Attitude, and Practice of Unused and Expired Medication Disposal among Patients Visiting Ayder Comprehensive Specialized Hospital

Background

Accumulation of unused and expired medicines at home is a source of environmental hazards and public health problems due to lack of awareness on appropriate medicine disposal methods. Therefore, the study was conducted to assess the knowledge, attitude, and practice of unused and expired medicine disposal among patients visiting Ayder Comprehensive Specialized Hospital.

Methods

A descriptive cross-sectional study was conducted among 384 patients who visited Ayder Comprehensive Specialized Hospital outpatient pharmacy from April to June 2019. Convenience sampling was used to recruit the participants, and data was collected by a face-to-face interview using a structured questionnaire. The data were entered and analyzed by using SPSS version 21.0. Descriptive statistics on sample characteristics was computed, and results were presented in the form percentage using table and statements.

Results

Out of the 384 respondents included in the study, 205 (53.4%) of them were males. More than half (199 (51.8%)) of the respondents did not correctly knew about medicine waste, and 233 (60.7%) of them did not have any prior information regarding medicine waste disposal instruction. But 351 (91.4%) of the participants correctly responded that inappropriate unused and expired medicine disposal can cause environmental harm. Above half (218 (56.8%)) of the respondents “agreed” about the potential risks related to having unused/expired medicines at home, and 206 (53.6%) of them “strongly agreed” that children are more vulnerable. One hundred fifty-nine respondents had unused/expired medicines in their homes. The most commonly used disposal practice for unused medicines were throwing them in a household trash as reported by 297 (77.3%) followed by flushing unused medications in toilet/sink 152 (39.6%). Throwing them away in household garbage and flushing them in toilet/sink were also the most commonly preferred disposal practice for expired medicines.

Conclusion

The majority of the study participants dispose unused and expired medicine in household garbage and toilet/sink. This is against the recommendations of both national and international policies and guidelines on safe and appropriate pharmaceutical waste disposal.

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.

The grey water footprint of human and veterinary pharmaceuticals

Water pollution by pharmaceuticals is widespread, causing both environmental and human health risks. We assess pharmaceutical water pollution from human and veterinary pharmaceuticals at three geographical levels: global, national (considering Germany and the Netherlands) and catchment level (with a case study for the Vecht catchment shared by Germany and the Netherlands). The grey water footprint (GWF), a measure of water pollution in volumetric terms, is estimated from pharmaceutical loads entering the aquatic environment, considering different pollutant sources and pathways. We study different substances depending on data availability, which varies across geographical levels. Results show a global per capita GWF of 1900 m³ yr^-1 resulting from human consumption of ciprofloxacin. The largest GWFs in both Germany and the Netherlands were found for ethinylestradiol for human and amoxicillin for veterinary use. The estimated per capita GWF from human use of ethinylestradiol is 2300 m³ yr^-1 for Germany and 11,300 m³ yr^-1 for the Netherlands. The per capita GWFs of German and Dutch consumers of animal products are 12,900 and 10,600 m³ yr^-1, respectively. For the Vecht catchment, we estimate the water pollution level per sub-catchment by comparing the GWF to available runoff, which enables us to identify geographic hotspots. In the basin as a whole, GWFs from human and veterinary pharmaceuticals both exceed available runoff. At all levels, pharmaceutical water pollution substantially adds to earlier water footprint studies that excluded this type of pollution, which demonstrates the importance to include pharmaceutics in water footprint studies.

Assessment of Knowledge, Attitude, and Disposal Practice of Unused and Expired Pharmaceuticals in Community of Adigrat City, Northern Ethiopia

Background

Medicines have become part of our day-to-day life. Due to different reasons, patients may not use all the medications dispensed to them. The storage of drugs at home promotes self-medication, which results in variety of adverse consequences. Global growth in health-seeking awareness and behavior among people has resulted in increment of medicine consumption over years. However, Ethiopians have little awareness about proper disposal of unused and expired pharmaceuticals. Besides, large quantities remain unused or expired since not all medications given to the consumers are consumed. Hence, this study could serve as an indicator for the country policy makers concerning pharmaceutical waste management.

Objective

To assess knowledge, attitude, and disposal practice of unused and expired pharmaceuticals in the community of Adigrat city, Tigray, Ethiopia, 2019. Methodology. A cross-sectional study was conducted among 359 respondents from the residents of Adigrat city. Semistructured questionnaires, which focused on knowledge, attitudes, and disposal practices for unused and expired medications, were used to collect data from respondents. Epi-data 3.0 suite and the statistical package for social sciences (SPSS) version 20 were used in data entry and analysis.

Results

All of the 359 returned questionnaires were valid for data entry and analysis. Of the 359 respondents, 57.7% were men and the majority (93%) were Orthodox Christians. Almost half of the respondents (50.14%) have good knowledge concerning the disposal of unused and expired pharmaceuticals. Most (82.2%) of the respondents have a positive attitude towards the disposal of unused and expired pharmaceuticals. Around fifty-two (52.4) of the respondents had unused medicines stored at home, with analgesics being the most common (41.5%). Around three-quarters (75.2%) and 63% of the respondents discarded unused and expired medicines in the garbage bins, respectively.

Conclusion

Although the majority of the respondents had a positive attitude towards the disposal of unused and expired medications, almost half of the sample population were unaware of proper disposal practices. Furthermore, less were inclined to practice proper disposal of unused and expired medications in the city. Therefore, we recommend further studies that focus on how the disposal attitude of the population can influence their knowledge and practice of the disposal of unused and expired medications.

Consumer willingness to pay for a pharmaceutical disposal program in Serbia: A double hurdle modeling approach

Proper collection and disposal of pharmaceutical waste from households can reduce the negative influence of medicines on the environment. The aim of this paper is to examine the current methods of disposal of unused medicines from households, as well as the willingness of Serbian residents to participate and bear the costs of an organized collection program. Moreover, this research aims to define factors contributing to an individual's willingness to participate and pay for a medicine collection program. The survey included randomly selected patients older than 18 years visiting private pharmacies in the four largest Serbian cities. The questionnaire included information regarding the presence of unwanted medicines within the household, general medicine disposal practices, the likelihood to participate in a medicine take-back program, willingness to pay for a medicine disposal program (per prescription and per visit), importance to the environment, and demographic variables from participants. Approximately 80% of surveyed respondents are very or somewhat likely to participate, however less than half of the respondents are willing to pay for the collection of their unused medicines. The factors that influenced willingness to participate are environmental awareness and income, while the factors affecting willingness to pay, are previously received advice about proper disposal, education level, number of unwanted medicines in the household and gender. The majority of Serbian people dispose unused medicines improperly, mostly into household garbage. Well-organized and easily accessible collection programs are essential in order to enable the general public to return unused medicines for proper disposal.

Expired Medication: Societal, Regulatory and Ethical Aspects of a Wasted Opportunity

A massive volume of expired medications amasses annually around the world because of pharmaceutical overprescription, combined with overproduction. The accumulation of pharmaceutical waste imposes ecological, economic and social/ethical burdens. Managing this presumed “waste” has developed into a global challenge due to the absence of specific regulations, unreasonable behavior of the patients, and an improper understanding of the concept of “expired medications” in general. This paper summaries, first, the recent literature reporting practices related to the disposal of unused medications. In this context, 48 papers from 34 countries with a total of 33,832 participants point towards a significant lack of public awareness regarding the appropriate disposal of such biologically potent chemicals. These findings are corroborated by a local survey on the disposal practices of unused medicines among pharmacy students at Saarland University. The regulatory aspects surrounding this topic, often based on the official guidelines for the disposal of expired medications and local waste management strategies, are then discussed in light of these findings. Finally, a closer inspection of the epistemic values of expired medications and different strategies for managing expired medications have been reviewed.

Investigation and Analysis of Medication Disposal in Hospitals and Community Pharmacies in Taiwan

Taiwan offers affordable access to health care through the National Health Insurance (NHI) Program, but this increases the risk of waste of medications and pollution caused by improper disposal. This research aimed to: (1) understand methods of disposal of unused medications, and public awareness of related issues, (2) understand the sources and types of unused medications and reasons for their disposal, and (3) propose improvements to current disposal practices. Data on practices and perspectives on the disposal of medications were collected from members of the public using a questionnaire, and subjected to chi-square analysis of demographic variables. The survey found that many respondents disposed of medications inappropriately, but most believed the government should establish a return system. The majority of discarded medications came from hospitals, and were most frequently discarded because patients had forgotten to take them. Based on these findings, the study proposes that receiving stations be established across Taiwan for the safe and environmentally friendly disposal of unused medications, along with a system of monthly checks and compensation for pharmacists’ costs. The study also suggests that pharmacists strengthen medication guidance, spend more time on medication counseling, better understand the reasons for medication waste, and offer health education and advice to physicians and the public.

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.

Pharmaceutical Household Waste Practices: Preliminary Findings from a Case Study in Poland

Pharmaceutical consumption continues to grow constantly. Unused/expired pharmaceuticals are disposed of to the municipal sewage system or waste disposal. Consequently, many countries have implemented a system of collecting pharmaceutical waste, with pharmacies playing an important role. It is important to educate consumers on rational consumption and the appropriate disposal of unused/expired pharmaceuticals and to identify the level of public awareness. Two studies were conducted in Poland to estimate the problem of collection and disposal of expired/unused pharmaceuticals. The purpose of the Survey I was to identify the scale of pharmaceutical consumption and the way pharmaceuticals are disposed of by various social groups. The Survey II was aimed to identify patients' attitudes regarding expired/unused pharmaceuticals at home. Of the respondents who participated in in Survey I, almost 74% indicated that analgesics were among the over-the-counter drugs they purchased. Group of pharmaceuticals 65% of the respondents purchased were medicines for treating flu symptoms. Almost 68% of the respondents said they usually disposed of expired pharmaceuticals in their household waste or by flushing them down the toilet. In Survey II more than 35% reported that they disposed of pharmaceuticals in the same ways. Of all respondents, ~30% returned their expired pharmaceuticals to pharmacies. Most respondents (over 65%) who participated Survey I indicated that they were aware that pharmaceutical waste can be returned to pharmacies. It should be noted that local governments are currently not obliged by law to work with or compensate pharmacies in the collection and proper disposal of unused pharmaceuticals.

Investigation of medicines consumption and disposal in Brazil: A study case in a developing country

The incorrect disposal of medicines can be harmful to the environment. Here, we aim to understand the consumption and disposal of medicines in Brazil using online forms. 64% of the respondents have the habit to self-medicate. 66% of respondents dispose the disused or expired medicines in the garbage. 71.9% of respondents never receive any information about correct disposal of medicines. 95.2% of respondents believe that residues of medicines can be harmful to the environment. Environmental education can provide information to the population and help to mitigate pharmaceuticals pollution.

Assessment of disposal practices of expired and unused medications among community pharmacies in Anambra State southeast Nigeria: a mixed study design

Background

Expired or unused medicines are potentially toxic substances that should be managed effectively to avoid accumulation of potentially toxic pharmaceuticals in the environment. In Nigeria, there is currently limited literature on the methods and protocols used by community pharmacists in the disposal of expired drugs. This study assessed disposal practices of expired and unused medications by pharmacists in Anambra State and compared them to the National Agency for Food and Drug Administration and Control (NAFDAC) guideline on disposal of expired drugs.

Methods

A questionnaire survey and key informant interview (KII) was used for the study. The pre-tested revised and adapted questionnaires were sent to all the 103 community pharmacies in Pharmacists Council of Nigeria (PCN) 2015 record of registered pharmacies in Anambra State. The participants were asked questions about how they disposed of expired and unused medications. The respondents that used NAFDAC or drug wholesalers were asked questions on how the third party destroys their expired drugs. In addition to the use of a questionnaire, KII was conducted to assess relevant professionals and stakeholders in this area.

Results

The study recorded 77 successfully returned questionnaires out of the 103 distributed and a response rate of 74.8%. The various disposal methods were: through NAFDAC 28.0 (31.8%), drug distributors 21.0 (23.9%), rubbish bins 8.0 (9.1%); this was mainly for solid dosage forms. However, 6.0(7.1%) reported that they used the sink to dispose of their liquid dosage forms and 24.0 (29.6%) noted they do not stock Class B controlled drugs. A lesser proportion of respondents 18.0 (23.4%) complied fully with the national guideline on disposal of expired drugs, while 17.0 (22.1%) complied partially and 42.0 (54.5%) did not comply. Some of the respondents 17.0 (22.1%) reported that NAFDAC uses incineration or other forms of heat to dispose of expired drugs, but 19.0 (24.7%) reported they do not know how NAFDAC dispose of their expired drugs. Majority of the respondents 55.0 (71.4%) suggested the state-run disposal system.

Conclusion

Poor compliance with the national guideline for medication disposal increases the potential risk of contamination of our environment and increases the possibility of ingesting toxic pharmaceutical wastes by humans and animals. This underscores the need for improvement on expired drugs management protocols to prevent contaminations and the attendant health hazards.

Development and Validation of the Return and Disposal of Unused Medications Questionnaire (ReDiUM) in Malaysia

The aim of our study was to develop and validate the return and disposal of unused medications (ReDiUM), as there are currently no validated tools available (worldwide) to assess this. The ReDiUM was developed by an expert panel. It was then administered to community-dwelling adults, who could understand English, at baseline and 2 weeks later. A total of 338/354 participants agreed to participate (response rate = 95.4%). Flesch reading ease was 60. The overall Cronbach's α was 0.703 (range = 0.609-0.762). At test-retest, κ values ranged from 0.244 to 0.523. Median total knowledge score was 60% (interquartile range = 40% to 70%). The majority of participants (94.4%) knew that improper drug disposal has harmful effects on the environment. However, their knowledge was low (11.2%) regarding the disposal of pressurized metered-dose inhalers in the garbage. The ReDiUM was found to be a valid and reliable instrument to assess the knowledge, attitude, and practice on the ReDiUM in Malaysia.

Assessment of knowledge, attitude and practice towards disposal of unused and expired pharmaceuticals among community in Harar city, Eastern Ethiopia

Background

Pharmaceuticals are produced and consumed in increasing volume every year. Unfortunately, not all medications that go in to the hand of the consumers get consumed; large quantities remain unused or expire. The accumulation of medication at household and unsafe disposal of unwanted medicines could lead to inappropriate medicine sharing, accidental childhood poisonings and diversion of medicines to illicit use.

Methods

A descriptive cross-sectional study was conducted among 695 residents in kebele(ward) 16 of Jinela woreda(district), Harar city from February 27–April 27. A multi-stage sampling technique was used to select individual households. Face-to-face interview using structured questionnaires were conducted to collect data from each study subject. The cleaned data was entered in to epidata analyzed using SPSS version 20 software. Descriptive statistics on sample characteristics was computed including frequencies and percentage and presented using tables and figures.

Results

Most participants displayed correct understanding toward medication waste (72.9%) and its effect on environmental if disposed improperly (86%). A large portion of the respondents did not know about drug-take-back system 464 (66.9%). In order to minimize the entry of pharmaceuticals into environment, 68.6% of the participants suggested the need for proper guidance to the consumer. Majority of the respondents believed risk related to the presence of unwanted drug in home, potential harm to children, lack of adequate information on safe disposal practice and need for take-back program. Approximately 66% of the respondents had unused medicine stored at home and the common types of medicines kept in households were analgesics (62.7%) and antibiotics (24%). Preferred ways of disposal of both unused and expired medicine was throwing away in household garbage (53.2%) and two third of them disposed the pharmaceuticals in its original package and dosage form.

Conclusion

In present study, there was high practice of keeping medication at home and most disposal approach indicated by the participants was not recommended methods. Awareness about proper disposal of unused and expired medicines among the public should be created. Guidelines on safe disposal are required and an organized method of collecting unused and expired pharmaceuticals needs to be introduced.

'You don't throw these things out:' an exploration of medicines retention and disposal practices in Australian homes

BACKGROUND

Consumers most commonly discard unwanted medicines in household rubbish or drains, however, there are global concerns over the extent, environmental impact and health risks. When consumers procure or store medicines for future use, this can impact negatively on quality use of medicines and consumer safety. We sought greater insight into the extent of these practices by exploring the volume and types of medicines in Australian homes, and self-reported practices related to medicine accumulation, use and disposal. This qualitative study formed part of a larger project that included a general population survey on household medicine disposal practices.

METHODS

Semi-structured telephone interviews were undertaken with a subset of respondents (n = 166) from the survey. Participants were eligible if they were experienced medicine users, i.e. used five or more prescribed, over the counter, and/or complementary and alternative medicines. Participants were asked to collect and name all medicines in their household; further detail was obtained about medicines used only when required or no longer used, such as expiry dates and quantity remaining. The quantitative data on the number and type of medicines stored at home were analysed descriptively. All interviews were transcribed verbatim and thematically analysed.

RESULTS

A total of 2301 medicines were identified as 1424 medicines not in everyday use (unused, unwanted, expired or when required) in 166 households, and 877 regularly used medicines by 119 participants. Medicines were often stored in multiple locations, particularly kitchens. Although accidental ingestion in children and pets and decreased efficacy were recognised health risks, this did not always translate to appropriate storage, usage or disposal practices. Individual risk-benefit assessments were applied to decisions to retain, use or dispose of medicines, including expired medicines.

CONCLUSIONS

Inappropriate medicine storage, use, and/or disposal practices raises public health concerns, particularly as there is a free returned medicines scheme available, and that this particular participant group were considered experienced medicine users. Healthcare professionals must act to address consumer misconceptions around the quality use of medicines, including medicine retention, storage and disposal. Future research is warranted to explore consumer practices in this context and confirm these findings in a younger, or healthier population.