Practice and opinion towards disposal of unused medication in Kuwait

Advanced oxidation and biological integrated processes for pharmaceutical wastewater treatment: A review

The stress of pharmaceutical and personal care products (PPCPs) discharging to water bodies and the environment due to increased industrialization has reduced the availability of clean water. This poses a potential health hazard to animals and human life because water contamination is a great issue to the climate, plants, humans, and aquatic habitats. Pharmaceutical compounds are quantified in concentrations ranging from ng/Lto μg/L in aquatic environments worldwide. According to (Alsubih et al., 2022), the concentrations of carbamazepine, sulfamethoxazole, Lutvastatin, ciprofloxacin, and lorazepam were 616-906 ng/L, 16,532-21635 ng/L, 694-2068 ng/L, 734-1178 ng/L, and 2742-3775 ng/L respectively. Protecting and preserving our environment must be well-driven by all sectors to sustain development. Various methods have been utilized to eliminate the emerging pollutants, such as adsorption and biological and advanced oxidation processes. These methods have their benefits and drawbacks in the removal of pharmaceuticals. Successful wastewater treatment can save the water bodies; integrating green initiatives into the main purposes of actor firms, combined with continually periodic awareness of the current and potential implications of environmental/water pollution, will play a major role in water conservation. This article reviews key publications on the adsorption, biological, and advanced oxidation processes used to remove pharmaceutical products from the aquatic environment. It also sheds light on the pharmaceutical adsorption capability of adsorption, biological and advanced oxidation methods, and their efficacy in pharmaceutical concentration removal. A research gap has been identified for researchers to explore in order to eliminate the problem associated with pharmaceutical wastes. Therefore, future study should focus on combining advanced oxidation and adsorption processes for an excellent way to eliminate pharmaceutical products, even at low concentrations. Biological processes should focus on ideal circumstances and microbial processes that enable the simultaneous removal of pharmaceutical compounds and the effects of diverse environments on removal efficiency.

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.

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.

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.

Patients' knowledge and awareness of safe handling of oral anticancer agents at Sultan Qaboos University Hospital in Oman

BACKGROUND

Safe handling of oral anticancer agents is of great concern. There is a lack of clear, national guidelines on how patients can safely handle and dispose of unwanted medications. We aimed to evaluate the safe handling, storage, and disposal of oral anticancer drugs among cancer patients and caregivers at home.

METHOD

This cross-sectional survey of adult cancer patients (or their adult caregivers) used a closed-ended questionnaire from May 2019 to March 2020.

RESULTS

A total of 257 patients (50 ± 15 years; range: 18-93 years) were enrolled; however, only 91% (233/257) reported self-administering oral anticancer medications. Caregivers were more likely to administer oral anticancer agents for patients ≥60 years than those <40 years old (63% vs. 8%; P = 0.001). Most patients (52%; 133/257) did not wash their hands after administering the drug; 74% (164/222) of the respondents reported that their medications were kept in a bedroom cabinet, while 18% (40/222) stored their medications in a refrigerator, and 5% (12/222) in a kitchen cabinet. A total of 55% (68/124) of patients returned their excess oral chemotherapy medications to the hospitals; however, 36% (45/124) disposed of their unused oral chemotherapy drugs in a household garbage container.

CONCLUSION

While two-thirds of patients stored their oral anticancer medications properly, more than half used inappropriate handling procedures. Disposal practices were inconsistent and did not adhere to the reported international guidelines.

Assessment of knowledge, attitude, and practice regarding the disposal of expired and unused medications among the Lebanese population

BACKGROUND

Medication waste is a public health problem affecting developed and developing countries. In Lebanon, a developing country in the Middle East, efforts are being deployed in hospitals but not in the community.

OBJECTIVE

This study aimed to validate a questionnaire to explore the knowledge, attitude, and practice (KAP) towards the disposal of unused and expired medicines among the Lebanese population and then identify the factors associated with these variables comparatively between the general population and healthcare professionals.

METHODS

A cross-sectional study was conducted among the general Lebanese population in May-June 2022 using a standardized questionnaire. The validity and reliability of the KAP scales were assessed, then a thorough statistical analysis was done to explore the factors associated with these scales.

RESULTS

The KAP scales generated by this study were valid and reliable. Using these scales, 24.5%, 22.6%, and 21% of participants demonstrated proper knowledge, attitude, and practice, respectively. Higher knowledge scores were significantly associated with female gender (Beta = 0.97), a high monthly income (Beta = 1.68), a secondary (Beta = 6.11) or university (Beta = 6.80) education level, and postgraduate education (Beta = 7.13). However, older age (Beta = - 0.06) and a low monthly income (Beta = - 3.06) were significantly associated with lower knowledge scores. A higher knowledge score (Beta = 0.06) was significantly associated with a more positive attitude regarding unused or expired medication disposal. Being a healthcare professional (Beta = 0.72) was significantly associated with a higher practice score, while being a female (Beta = - 0.32) and living in a rural area (Beta = - 0.37) were significantly associated with lower practice scores.

CONCLUSION

This study validated KAP scales regarding medication waste in Lebanon and showed low KAP scores in the majority of respondents. Factors associated with higher KAP scores in various aspects of medication disposal, including gender, age, education level, and profession (healthcare professionals), suggest the need to consider those when implementing targeted corrective measures. Although further studies are required to confirm our findings, this study could be the ground for a medication waste management national strategy in Lebanon.

Over-prescription of short-acting β2-agonists and asthma management in the Gulf region: a multicountry observational study

Background

The overuse of short-acting β₂-agonists (SABA) is associated with poor asthma control. However, data on SABA use in the Gulf region are limited. Herein, we describe SABA prescription practices and clinical outcomes in patients with asthma from the Gulf cohort of the SABA use IN Asthma (SABINA) III study.

Methods

In this cross-sectional study conducted at 16 sites across Kuwait, Oman, and the United Arab Emirates, eligible patients (aged ≥ 12 years) with asthma were classified based on investigator-defined disease severity guided by the 2017 Global Initiative for Asthma report and by practice type, i.e., respiratory specialist or primary care physician. Data on demographics, disease characteristics, and prescribed asthma treatments, including SABA, in the 12 months prior to a single, prospective, study visit were transcribed onto electronic case report forms (eCRFs). All analyses were descriptive in nature. Continuous variables were summarized by the number of non-missing values, given as mean (standard deviation [SD]) and median (range). Categorical variables were summarized by frequency counts and percentages.

Results

This study analyzed data from 301 patients with asthma, 54.5% of whom were treated by respiratory specialists. Most patients were female (61.8%), with a mean age of 43.9 years, and 84.4% were classified with moderate-to-severe disease, with a mean (SD) asthma duration of 14.8 (10.8) years. Asthma was partly controlled or uncontrolled in 51.2% of patients, with 41.9% experiencing ≥ 1 severe exacerbation in the 12 months preceding their study visit. Overall, 58.5% of patients were prescribed ≥ 3 SABA canisters, 19.3% were prescribed ≥ 10 canisters, and 13.3% purchased SABA over-the-counter (OTC) in the 12 months before the study visit. Most patients who purchased OTC SABA (92.5%) also received SABA prescriptions. Inhaled corticosteroid/long-acting β₂-agonist combinations and oral corticosteroid bursts were prescribed to 87.7% and 22.6% of patients, respectively.

Conclusions

SABA over-prescription was highly prevalent in the Gulf region, compounded by purchases of nonprescription SABA and suboptimal asthma-related outcomes. Increased awareness among policymakers and healthcare practitioners is needed to ensure implementation of current, evidence-based, treatment recommendations to optimize asthma management in this region.

Trial registration

NCT03857178 (ClinicalTrials.gov).

Supplementary Information

The online version contains supplementary material available at 10.1186/s40733-022-00085-5.

Disposal practices of unused and expired pharmaceuticals among the general public in Quetta city, Pakistan

Objective

Although community practices towards disposal of expired and unused medications vary globally, the phenomenon is neglected specifically in developing countries. We, therefore, aimed to assess the disposal practices of unused and expired pharmaceuticals among the general public in Quetta city, Pakistan.

Methods

A questionnaire-based, cross-sectional survey was conducted among 830 respondents in Quetta city, Pakistan. A pre-validated, structured questionnaire was used for data collection. Data were coded and analyzed by Statistical Package for Social Science (SPSS) version 26. Both descriptive and inferential statistics were sued and p<0.05 was taken as significant.

Results

Almost 87% of the respondents had unused medicines at their homes and reusing the medications was the purpose of medicine storage (50%). Medicines were mostly kept in refrigerators (36.0%) followed by bedrooms (28.8%). Fifty percent of the respondents never checked the expiry date before using the medications. The procedure to dispose of nearly expired or expired medicines was unknown to 88% of the respondents and for those reasons, medicines were disposed either in household trash or flushed in the toilet or sink. Interestingly, medicines were kept at home even after being expired by 27% of the respondents. Income was associated with reason of storing medicines (p = 0.004; φc = 0.402) while educational status had significant associations with storage of medications (p = 0.002; φc = 0.399), reading about storage instructions (p = 0.008; φc = 0.452) and checking expiry date before purchasing and using the medicines (p = 0.007; φc = 0.114 and p = 0.001; φc = 0.100) respectively.

Conclusion

Improper storage and disposal of unused and expired medications is a common practice among study respondents and raised serious concerns. Findings of the current study call upon immediate development and implementation of the strategies to promote awareness and strengthen the pharmaceutical waste management program at the societal level.

Occurrence of Pharmaceutical Residues and Antibiotic-Resistant Bacteria in Water and Sediments from Major Reservoirs (Owabi and Barekese Dams) in Ghana

The presence of pharmaceuticals in the environment is undesirable since their biological activity may impair ecosystem health of reservoirs that receive inflows from other water sources. This work determined the concentrations of analgesics and antibiotics, and the occurrence of antimicrobial resistance among microbes in water and sediment samples from Owabi and Barekese reservoirs—two main sources of pipe-borne water in the Kumasi metropolis in Ghana. The study also assessed the knowledge, attitude, and practice of inhabitants near these reservoirs regarding the disposal of unused and expired medicines. Out of nine targeted pharmaceuticals, four were detected in at least one sample. Five analytes (caffeine, ciprofloxacin, doxycycline, ibuprofen, and metronidazole) were below detection limit for all samples. The levels of pharmaceuticals were low, as expected, ranging from 0.06 to 36.51 μg/L in the water samples and 3.34–4.80 μg/kg in sediments. The highest detected concentration of any pharmaceutical in water was for diclofenac (107.87 μg/L), followed by metronidazole (22.23 μg/L), amoxicillin (1.86 μg/L), chloramphenicol (0.85 μg/L), and paracetamol (0.16 μg/L). Chloramphenicol recorded the highest concentration (10.22 μg/kg) in the sediments. Five bacteria isolates (Enterobacter, Clostridium, Pseudomonas, Acinetobacter, and Klebsiella) from the samples were resistant to all the antibiotics tested. Isolates of Corynebacterium and Listeria showed susceptibility to only doxycycline. Isolates of Bacillus were susceptible to only two antibiotics (erythromycin and doxycycline). All the 100 respondents interviewed admitted that they dispose of medications once they do not need them. Of those who disposed of unwanted medicines, 79% did so inappropriately. Disposal in household trash (67%) was the most common method used. Majority of respondents felt the need for a facility or program to collect unused medicines (77%), hence their willingness to pay to reduce pollution by pharmaceuticals in the environment. It is quite clear from the ecotoxicological risk assessment that a single pharmaceutical at very low level as those in this study and other works is likely to pose many ecological risks upon long-term exposure and therefore cannot be ignored.

The perception and disposal practices of unused and expired medicines by households in an urban municipality, southwest Nigeria: A comparative cross-sectional study

Unused, damaged, and expired medicines (UEMs) pose disposal challenges globally, despite their importance. The environmental disposal of UEMs portends public health consequences, hence, this study in high-density (HDS) and low-density (LDS) urban households in Southwest Nigeria. The comparative, cross-sectional study utilised multi-stage samplingto enrol 404 females, experienced in use and medicines safekeeping. The response rate was 93%. Data were analysed by IBM-SPSS, version 20. Continuous and categorical variableswere presentedin tables as mean(±SD), proportions (%), respectively while χ² and logistic regression statistics determined differences between LDS and HDS (P_α > 0.05). 53.4% and 71.2% of respondents respectively had good knowledge and positive attitudes to safe disposal of UEMs. At least 31.5% of households don't stock medicines while antimalarial (57.3%), analgesics (52.7%) and antibiotics (49.7%) predominate in households and significantly different between LDS and HDS. 72.9% and 67.8%; 47.9% and 55.6% respondents in LDS and HDS, respectively, disposed of solid and liquid UEMs in storage bins, though 34.9% (LDS) and 16.7% (HDS) disposed of liquid UEMs in toilet/sink. There were significant differences in medicines abundance and disposal practices between LDS and HDS for solid and liquid medicines. 37.1% of respondents perceived consequences for the poor UEMs disposal, including accidental ingestion (76.6% vs 26.7%), land pollution (69.6% vs 36.7%), water pollution (72.4% vs 32.8%) and toxicity (58.3% vs 32.8%), respectively in LDS and HDS. Respondents' good knowledge and positive attitudes contrasted with poor UEMs disposal practices, which compromise public health. Legislation, compliance monitoring and enforcement are germane for incentive-driven UEMs recovery.

Increasing Awareness of Proper Disposal of Unused and Expired Medication Using a Knowledge-Based Disposal Management System

Medicines are used daily in Saudi Arabian homes. However, when these medicines are no longer needed, most people dispose of them incorrectly, forgetting the harmful impact of improper disposal. Inadequate awareness and knowledge are major reasons for improper disposal. In this study, we create a broad inclusive knowledge base that includes many types of medications available in Saudi homes and provides guidance on how to dispose of them as a means of raising awareness on correct disposal methods and preventing harmful impacts on both the environment and society. The study primarily aims to understand societal behaviour regarding the disposal of unused and expired medications and develop a prototype of a knowledge-based system that helps raise awareness of correct disposal methods for unused and expired medications. The data in the knowledge base are presented in tables that are easy to understand and comprehend, and the recommendations are also easy to apply and practice in everyday life. The results from the survey show that 66.8% of the 310 participants had unneeded medications in their homes, and only 14.9% knew how to dispose of unusable medications, while only 6.5% knew how to dispose of expired medications. Overall, the research studied Saudi society's behaviour regarding unused and expired medications, and we created a prototype of a knowledge-based system designed to increase awareness of proper disposal and management of unused and expired medications.

Knowledge, Attitude, and Practices of Unused Medications Disposal among Patients Visiting Public Health Centers in Gondar Town, Ethiopia: A Cross-Sectional Study

Background

The improvement of healthcare systems has brought the subsequent increase in people access to medications. The consumers are not able to use all the dispensed medications because of various reasons. The improper disposal of these unused medicines has led to environmental contamination to an alarming extent. Therefore, the study was conducted to assess the knowledge, attitude, and practice of unused medications disposal among patients visiting public health centers in Gondar town, Ethiopia.

Methods

A descriptive cross-sectional study was conducted among 404 patients visiting public health centers in Gondar town, Ethiopia, from August to September 2021, by using standardized and a locally translated semistructured questionnaire. The data were entered and analyzed by using the SPSS version of 21.0. The variable of interest was described in the form of statements and tables.

Result

Out of 404 respondents included in the study, 221 (54.7%) of them were female. More than half (226 (55.9%)) of the respondents had unused medicine at home. The common methods of disposal practice were throwing into a household garbage (150 (31.4%)), followed by flushed into toilet/sinks (88 (21.8%)). More than half (286 (70.8%)) of the respondents knew about medication waste and 239 (59.2%) of them checked their medication expiry date. More than half (215 (53.5%)) of the participants strongly agreed that unused medicine can cause potential risk at home and 279 (69.1%) of study participants strongly agreed that children are more vulnerable to the potential risk of unused medicine at home.

Conclusion

There was a high practice of keeping medication at home, and most disposal approach indicated by the participants was not recommended methods. Awareness about the proper disposal of unused 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.

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.

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.

Emerging contaminants in the water bodies of the Middle East and North Africa (MENA): A critical review

Many emerging contaminants (ECs) are not currently removed by conventional water treatment methods and consequently, often reach the aquatic environment. In the absence of proper management strategies, ECs can accumulate in water bodies, which poses potential environmental and health risks. This paper critically reviews, for the first time, the reported occurrence and treatment of ECs in the Middle Eastern and North Africa (MENA) region. The paper also provides recommendations to properly manage EC risks. In the MENA region, pharmaceuticals and personal care products (PPCPs) have been detected in surface water, seawater, groundwater, and wastewater treatment plants. A focus on surface water in the published literature suggests that studies are skewed towards worldwide trends, whereas studies on ECs in seawater are of great importance in the study region. The types of PPCPs detected in the MENA region vary, but anti-inflammatories and antibiotics dominate. In comparison, microplastics have mainly been studied in surface waters and seawater with much less focus on drinking water. The majority of microplastics in the region are secondary types resulting from the degradation of larger plastic debris; polyethylene (PE) and polypropylene (PP) fibers are the most frequently detected polymers, which are indicative of local anthropogenic sources. Research progress on ECs varies between countries, having received more attention in Iran and Tunisia. Most MENA countries have now begun monitoring water bodies for ECs; however, studies are still lacking in some countries including Sudan, Djibouti, Syria, Ethiopia, and Bahrain. Based on this review, critical knowledge gaps and research needs are identified. Countries in the MENA region require further research on a broader range of EC types. Overall, water pollution due to the use and release of ECs can be tackled by improving public awareness, public campaigns, government intervention, and advanced monitoring and treatment methods.

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.

Towards Medicines Reuse: A Narrative Review of the Different Therapeutic Classes and Dosage Forms of Medication Waste in Different Countries

BACKGROUND

Medicines reuse, the idea of re-dispensing returned medicines to others following quality control, is yet to be implemented in the UK. This practice is potentially a sustainable way of dealing with returned medicines, which are otherwise classed as medication waste and destroyed. To inch towards medicines reuse, it is important to know more about the different therapeutic classes and dosage forms that make up medication waste. For example, it is helpful to know if medicines being returned are mostly solid-dosage forms and thus have the potential to be reused or are from therapeutic classes that would make medicines reuse cost-effective. Little is known about the therapeutic classes and the dosage forms of wasted medicines. This study aimed to narratively review and report findings from the international literature on the different therapeutic classes and the dosage forms of medicines that are returned by patients to community pharmacies, hospitals, general practitioners' clinics, or collected through waste campaigns. Studies based on surveys without physically returning medicines were also included where relevant.

METHODS

A comprehensive electronic search of databases, including PubMed and Google Scholar, was carried out over one month in 2017 and updated by 5 November 2020, using a combination of carefully created keywords.

RESULTS

Forty-five studies published in English between 2002 and 2020, comprising data from 26 countries were included and reviewed. Oral solid dosage forms (mostly tablets) were the commonly reported dosage form of all wasted medicines in 14 studies out of the 22 studies (64%) that described the dosage form, with percentages ranging from 40.6% to 95.6% of all wasted medicines. Although there was variability among the levels of medication waste reported in different countries, findings from the UK and Ethiopia were relatively consistent; in these, medicines for the cardiovascular system and anti-infective medicines, respectively, were the most common therapeutic classes for medication waste.

CONCLUSION

This narrative review provides insights about the different therapeutic classes and dosage forms of medication waste either returned by patients, collected through waste campaigns, or indicated in survey responses. The findings could help policy makers understand the potential implications of treating most unused medicines as medication waste and whether therefore pursuing a medicines reuse scheme could be environmentally or financially logical. The quality and the safety of these returned medicines using criteria related to the storage conditions (such as heat and humidity), physical shape (such as being sealed, unopened, unused, and in blister packaging), and tampering are other important considerations for a medicines reuse scheme.

Leftover drug disposal: Customer behavior, pharmacist recommendations, and obstacles to drug take-back box implementation

Production and use of pharmaceuticals in the United States is high and continues to grow. This, combined with poor wastewater removal rates for drugs in excreted waste, and improper pharmaceutical disposal leads to the presence of pharmaceuticals in fresh- and marine waters and wildlife. In the United States, safe drug take-back boxes, or dropboxes, were established in pharmacies after federal legislation passed in 2014, allowing for year-round safe collection of leftover pharmaceuticals. The overarching objective of this work was to identify opportunities for improving access to proper pharmaceutical disposal. We assessed consumer behavior regarding drug disposal choices and knowledge of dropboxes at pharmacies, investigated pharmacist attitudes toward and recommendations about leftover drug disposal, and compared responses at locations with and without dropboxes. We also explored obstacles to dropbox adoption and usage. We found that customer awareness of dropboxes as well as knowledge about risks of improper disposal are low, however awareness was greater at pharmacies with dropboxes. Additionally, pharmacists at dropbox locations were more consistent in their messaging to customers, more likely to recommend proper disposal methods, and more supportive of drug take-back programs. Through a focus group, we learned that further consumer education would overwhelm the capacity of the existing dropboxes. Based on our findings, we recommend solutions to improper disposal focus on legislation mandating dropboxes at pharmacies and pressure on the pharmaceutical industry to fund proper disposal of unused pharmaceuticals.

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.

"Knowledge and practices of HIV infected patients regarding medicine disposal among patients attending public ARV clinics in KwaZulu Natal, South Africa"

Background

Recent analysis of drinking water in South Africa found the presence of ARVs, other pharmaceutical and personal care products. The environmental and human health risk that this presents is daunting. The increased use of ARVs with poor disposal practices could be the reason for these substances being present in drinking water. Therefore, this study aimed to determine the knowledge and practices of HIV infected patients, regarding medicine disposal.

Method

A descriptive, cross sectional, quantitative study that utilised a structured, self-administered, questionnaire was undertaken at 3 different public ARV clinics in the eThekwini Metro of KwaZulu Natal, SA. The variables included questions on demographics, knowledge and practices of medicine disposal of ARV and other medications. Data was captured using excel spreadsheets and analysed using SPSS version 25. Chi square tests were used to compare factors between correct and incorrect knowledge and practice groups.

Results

Four hundred and eighty four participants agreed to participate in this study, of which the majority (71.1%) were females. Over 87% of the participants knew that improper disposal of medicines were harmful to the environment with only 28.3% knowing that there were laws governing the way medicines should be disposed. Majority of participants that had unused and expired ARVs at home disposed of these medicines. The most common route of medicine disposal for ARVs was by throwing these medicines into the bin (56.4%). Only 24.2% of participants were informed by healthcare professionals about the proper method of medicine disposal. Participants who had secondary and tertiary level of education (p = 0.043) and the ability to speak English (p = 0.001) had appropriate knowledge on medicine disposal.

Conclusion

This study identified that poor medicine disposal practices and lack of adequate information about the proper methods of medicine disposal were evident among the participant population. There is a need for patient education and healthcare professional intervention to ensure patients are aware of standard proper medicine disposal practices.

Disposal Practices of Unused Medications Among Patients in Public Health Centers of Dessie Town, Northeast Ethiopia: A Cross-sectional Study

BACKGROUND

Disposal of pharmaceutical waste among patients is a global challenge especially in developing countries like Ethiopia. Improper medication disposal can lead to health problems and environmental contaminations. Therefore, the present study aimed to assess disposal practices of unused medications among patients in public health centers of Dessie town, Northeast Ethiopia.

METHODS

A descriptive cross-sectional study was conducted among 263 patients in four public health centers of Dessie town, Ethiopia from March to June, 2019. Face-to-face interviews using structured questionnaires were used to collect data from each study subject.

RESULTS

The majority of the respondents, 224 (85.17%) had unused medications at their home during the study period. The most commonly reported disposal method in the present study was flushing down into a toilet 66 (25.09%). None of the respondents practiced returning unused medications to Pharmacy. Moreover, 85 (32.31%) of the respondents reported never disposing their medications and believed that it is acceptable to store medications at home for future use.

CONCLUSION

In the present study, there was a high practice of keeping medications at home and most of the disposal practices were not recommended methods. In addition, most of the respondents did not get advice from pharmacists and other health care professionals on how to dispose off unused medications. Hence, there is a need for proper education and guidance of patients regarding disposal practices of unused medications.

Disposal Practices of Unused Medications Among Patients in Public Health Centers of Dessie Town, Northeast Ethiopia: A Cross Sectional Survey

Background

Disposal of pharmaceutical waste among patients is a global challenge, especially in developing countries like Ethiopia. Improper medication disposal can lead to health problems and environmental contamination. Therefore, the present study was aimed to assess disposal practices of unused medications among patients in public health centers of Dessie town, Northeast Ethiopia.

Methods

A descriptive cross-sectional survey was conducted among 263 patients in four public health centers of Dessie town, Ethiopia from March to June 2019. Face-to-face interviews using structured questionnaires were used to collect data from each study subject.

Results

The majority of the respondents, 224 (85.17%), had unused medications at their home during the study period. The most commonly reported disposal method in the present study was flushing down into a toilet, 66 (25.09%). None of the respondents practiced returning unused medications to the pharmacy. Moreover, 85 (32.31%) of the respondents reported never disposing of their medications and believed that it is acceptable to store medications at home for future use.

Conclusion

In the present study, there was a high practice of keeping medications at home and most of the disposal practices were not recommended methods. In addition, most of the respondents did not receive advice from pharmacists and other health-care professionals on how to dispose of unused medications. Hence, there is a need for proper education and guidance of patients about disposal practices of unused medications.

Prevalence and Predictors of Storage of Unused Medicines among Households in Northwestern Ethiopia

Background

Unused medicines are those that are expired, discontinued, deteriorated, and/or not intended for any future use. The aim of this study was to assess the prevalence of unused medicines and predicting factors in households of Awi zone, Amhara regional state, Northwestern Ethiopia.

Methods

A community-based cross-sectional study was conducted. A survey of unused medicines was conducted through interviews with representatives of households. The collected data were entered with Epi Data version 3.1 and exported to SPSS version 21 for analysis. Predictors of storage of unused medicines were assessed through binary and multivariable logistic regression methods. A confidence interval of 95% and a P-value of <0.05 were considered to declare statistical significance.

Results

Of the total of 507 households surveyed, 70 (13.8%) were found to have unused medicines. These constituted twenty-eight types of unused medicines. Anti-infective medicines were the most commonly unused medicines, 58.9%. People who pay for medicines by themselves, those who lacked knowledge about medicines, and those who did not receive enough counseling about medicines they took were found to be 2.6, 4.8, and 3 times more likely to have unused medicines, respectively.

Conclusion

A significant amount of unused medicines was present in the community. Strategies aimed at educating the public regarding the safe disposal of unused medicines and an organized method of collection and disposal of unused medicines in the community need to be introduced.

Estoque e descarte de medicamentos no domicílio: uma revisão sistemática

Resumo Este estudo teve como objetivo analisar a evidência científica nacional e internacional existente sobre o motivo do estoque e a forma de descarte dos medicamentos no domicílio. Realizou-se uma revisão sistemática da literatura de 2001 a 2016 nas bases de dados PubMed, Lilacs e Elsevier’s Scopus Database, utilizando os seguintes unitermos: "Disposal of medicines in household", "Disposal of expired drugs", "Residential expired drugs", "Management of expired medications in household". Foram selecionados 33 estudos originais após aplicação dos critérios de inclusão e exclusão. Os estudos analisados demonstraram que os principais motivos de estoque no domicílio foram: automedicação; guarda para uso futuro e sobras de tratamentos anteriores. E quanto ao descarte dos medicamentos, prevalecem práticas inadequadas, como descarte no lixo comum e na rede de esgoto. Alguns países têm adotado programas de orientação sobre o armazenamento e o descarte correto, no entanto, foi apenas encontrado um estudo que descreve um programa nacional gratuito, para orientar essas práticas. A partir das evidências cientificas verificou-se a importância do incentivo para a elaboração e a implementação de políticas públicas voltadas para o uso e descarte adequado de medicamentos no domicílio.

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.

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.

Pharmacists' Knowledge Regarding Drug Disposal in Karbala

Background: Consumers and caregivers should remove expired, or unwanted, medications to minimize the chance for misuse or accidentally using those medicines. This study investigated pharmacists' knowledge regarding drug disposal in Karbala, Iraq. Methods: This study was a cross-sectional survey among pharmacists in Karbala. It was performed from December 2018 until January 2019. A standardized, 12-item, self-administered questionnaire was designed, developed and validated to assess pharmacists' knowledge when generating pharmaceutical waste in pharmacies. Results: One hundred twenty-nine participants enrolled in the study. The mean age of participants was 33 ± 9.3 years-more than two-thirds (65.9%)-agreed that the return of medications to the source would be appropriate drug disposal. A good proportion of participants agreed with disposing of drugs in the trash. Further, 63.6% believe that education is the main barrier opposing the implementation of a medicine-take-back program in Iraq. Conclusion: Pharmacists had relatively poor knowledge regarding drug disposal methods. Health care providers (not only pharmacists) need educational courses and workshops to improve their knowledge regarding medication disposal in Iraq.

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.

A Survey of Knowledge, Attitude, and Practice of Consumers at a Tertiary Care Hospital Regarding the Disposal of Unused Medicines

Objectives:

To evaluate the knowledge, attitude and practice of consumers in India about disposal of unused medicines.

Materials and Methods:

A questionnaire comprising 11 questions evaluating the Knowledge (2), Attitude (3) and Practice (6) of unused medicines was prepared and pre validated before administering to 200 consumers of medicines attending the outpatient department of Civil Hospital Ahmedabad, a tertiary care teaching hospital in Western India. Requisite permissions from Institutional Ethics Committee and informed consent were obtained prior to recruiting them for the study. Responses were recorded, in Microsoft Excel^® spreadsheet and evaluated for percentage response.

Results:

Majority of the respondents (136, 68%) stored unused medicines at home. Analgesics (26.5%) were the most common unused medicine stored. Safe disposal of medicine was considered necessary by majority respondents (160, 80%) for different reasons like prevention of illegal/unintended use (84, 42%), prevention of environmental pollution (32, 16%) or possible ADR caused by old drugs (54, 27%). Only 78 (39%) respondents were aware of appropriate methods of disposal. Disposal in household trash (61, 30.5%) was the most common method used. Majority of respondents felt the need for a facility or programme to collect unused medicines (152, 76%) and an increased awareness among consumers regarding hazards and methods of disposal of unused medicines (154, 77%).

Conclusion:

Majority of consumers are aware about the need for safe disposal of unused medicines. But the right attitude for and practice of safe disposal of medicines is lacking. A need for increased awareness regarding safe disposal of medicines is acknowledged by majority of consumers.

Disposal of Unused Drugs: Knowledge and Behavior Among People Around the World

The purpose of this systematic review was to determine the practice of medication disposal around the world and get insight into possible association between environmental awareness and people's behavior regarding this issue. A literature search (2005-2015) was performed to identify reports with quantitative data on disposal practices published in peer-reviewed literature. The most common method for disposal of unused medications in households is disposal in the garbage (Kuwait, United Kingdom, Lithuania, Qatar, Serbia, Ghana, Bangladesh, Malta and Saudi Arabia). The practice of flushing drugs into the sewage system still takes place in New Zealand, USA and Bangladesh. Only in Sweden and Germany, practice of returning drugs to pharmacy was practiced to a larger extent. The environmental impact of improper medication disposal is expected in countries with poorly functioning waste management schemes (Middle Eastern, Asian and African countries). Lack of the adequate information and clear instructions on proper manners of drug disposal was reported in many surveyed countries (USA, New Zealand, Bangladesh, Malta and Ireland). Clear and definite connection between knowledge about environmental detrimental effects of improper drug disposal and the preference towards disposal methods could not be established. Many respondents were generally concerned with issues of inadequate medicines discarding but the behavior regarding disposal of unused drugs often did not equate the awareness (Serbia, USA, Kuwait, Malta and UK). The current data emphasizes the global issue of improper medicine disposal, prevalent in environmentally-aware people.

Evaluation of a Novel Approach for Reducing Emissions of Pharmaceuticals to the Environment

Increased interest over the levels of pharmaceuticals detected in the environment has led to the need for new approaches to manage their emissions. Inappropriate disposal of unused and waste medicines and release from manufacturing plants are believed to be important pathways for pharmaceuticals entering the environment. In situ treatment technologies, which can be used on-site in pharmacies, hospitals, clinics, and at manufacturing plants, might provide a solution. In this study we explored the use of Pyropure, a microscale combined pyrolysis and gasification in situ treatment system for destroying pharmaceutical wastes. This involved selecting 17 pharmaceuticals, including 14 of the most thermally stable compounds currently in use and three of high environmental concern to determine the technology's success in waste destruction. Treatment simulation studies were done on three different waste types and liquid, solid, and gaseous emissions from the process were analyzed for parent pharmaceutical and known active transformation products. Gaseous emissions were also analyzed for NOx, particulates, dioxins, furans, and metals. Results suggest that Pyropure is an effective treatment process for pharmaceutical wastes: over 99 % of each study pharmaceutical was destroyed by the system without known active transformation products being formed during the treatment process. Emissions of the other gaseous air pollutants were within acceptable levels. Future uptake of the system, or similar in situ treatment approaches, by clinics, pharmacists, and manufacturers could help to reduce the levels of pharmaceuticals in the environment and reduce the economic and environmental costs of current waste management practices.

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

The release of pharmaceuticals and personal care products (PPCPs) into the environment has been held up as a potential threat to ecosystem and human health. Using a custom-designed survey of residents living in Xiamen, China, this paper examines individuals' disposal practices, awareness of the environmental impact of PPCPs, and willingness to pay for measures aimed at reducing the likelihood of PPCPs being released into the environment. The vast majority of respondents report that they dispose of PPCPs through the thrash. The results of a contingent valuation experiment suggest a substantial willingness to pay (WTP) for policy measures aimed at reducing PPCP pollution. Income as well as subjective perceptions relating to overall financial health, expenditure on PPCPs, and overall concern with environmental issues emerged as significant predictors of respondents' WTP. Our results should be of interest to policymakers looking for ways to mitigate the introduction of PPCPs in the environment. Integr Environ Assess Manag 2016;12:793-800. © 2015 SETAC.

Investigating the disposal of expired and unused medication in Riyadh, Saudi Arabia: a cross-sectional study

Background Improper disposal of medication has several possible consequences such as childhood poisoning, environmental pollution, a negative impact on wildlife, and antibiotic resistance. The number of studies conducted to characterize pharmaceutical disposal practices is limited, particularly in the Middle East. Objective The aim of this cross-sectional study was to examine the behaviour of individuals with respect to the disposal of expired and unused medications. Furthermore, we aimed to identify the best methods of education regarding appropriate, safe disposal of medication. Setting The study was carried out in King Khalid University Hospital (KKUH), and King Saud University (KSU), during a 3-month period from February 2015 to April 2015. Method Twelve hundred patients were randomly selected from KKUH and KSU. Participants were invited to complete paper-based questionnaire with self enumeration. Pilot testing was conducted and involved 50 randomly selected participants. Main outcome measures The proportion of expired medications present in the home and their therapeutic groups, disposal methods of expired and unused medications, and preferred educational methods regarding safe and proper disposing of medications. Results A substantial proportion (79.15 %) of respondents disposed of unwanted medication via household waste, while a small proportion (1.70 %) returned unwanted medication to a pharmacy. Although currently practised disposal methods are undoubtedly unsuitable, 70.20 % of respondents considered finding appropriate, safe methods via which to dispose of unwanted medication their responsibility, and 78.6 % expressed an interest in receiving information concerning the correct disposal of unwanted medication. Conclusion We have demonstrated that a low percentage of respondents have ever received information regarding correct medication disposal. Moreover, the results have shown that over half of the respondents store antibiotics in their households. Additionally, respondents weren't aware of the consequences of keeping expired medication at home. It is quite clear that the awareness of proper and safe drug disposal among the Saudi population is quite low making it a priority of concerned authorities to implement educational programs.

[Patients' knowledge and practices about unconsumed drugs disposal. An Approach to Ecopharmacovigilance]

Objective To describe knowledge, attitudes and practices about remaining drugs (RD) and expired drugs (ED) disposal. Method Descriptive study in 392 patients at a hospital in Bogotá, Colombia. Results Participants were 17 to 86 years old. 66.1% of them had RD, 31.4 % were nervous system drugs (according to Anatomical Therapeutic Chemical classification of WHO). 25.8 % of people dispose of RD in common waste (CW) and 64.0 % dispose of ED in CW. 17.4 % think RD, and 62.5 % think ED should be thrown away like CW. 4.9% of people think RD, and 6.6 % think ED should be thrown away in specialized places. 92.4 % people don't know about DRP nor 86.7 % about "Puntos Azules"; 94.6 % would like more information. 79.1 % think that throwing away drugs can affect health and, 88.8 %, the environment. Conclusions Most participants dispose of drugs inappropriately. They think that it is wrong and this can damage the environment and health. There is an interest in being informed. This reveals an area of possible work in awareness, information and education from pharmacovigilance about this subject for the benefit of the population.

Patient participation in a clinic-based community pharmacy medication take-back program

OBJECTIVES

To describe patient interest and involvement in participating in a clinic-based community pharmacy drug take-back program to dispose of unused, unwanted, or expired (UUE) medications and to identify patients' reasons for participating in the program.

METHODS

A convenience sample of patients at the University of Oklahoma Family Medicine Pharmacy was recruited to complete a needs assessment survey regarding interest in drug take-back programs and current practices for handling UUE medications. Participants who purchased a postage-paid drug disposal envelope were asked to complete a program survey identifying sources of UUE medications, experience with drug take-back programs, and reasons for participation. These participants were later contacted for a follow-up telephone survey regarding their experience with the program and medications sent back.

RESULTS

62 needs assessment surveys were collected. 61% of patients reported interest in a drug take-back program. 57% reported having no UUE medications at home. Commonly reported UUE handling practices included disposal in the garbage (53.2%) or sewer (29.0%) and home storage (17.7%). 15 disposal envelopes were sold to 10 participants whose most common reasons for participation included concern about the safety of household members, accidental or intentional ingestion, and environmental impact. For 4 patients who returned a median of 9.5 prescriptions, the most common class of returned drugs was antibiotics (19.0%).

CONCLUSION

Interest in drug take-back programs exists, but awareness and availability of continuous programs is limited. Programs may be more successful if offered at no cost to patients. Future studies are needed on the types of medications sent back and specific reasons for accumulation.

A systematic review of the literature on 'medication wastage': an exploration of causative factors and effect of interventions

INTRODUCTION

Reducing any wastage, including that of medications, is a paramount objective in promoting appropriate utilisation of finite resources. The objective was to systematically review the published literature, the possible causative factors associated with medication wastage and the effectiveness of any interventions to reduce wastage.

METHOD

A systematic review of studies published in English was identified from the following databases: Cumulative Index to Nursing and Allied Health Literature, Embase, Medline, PubMed, Science Citation Index and The Cochrane Library. Data extraction and critical appraisal was undertaken independently by two researchers.

RESULTS AND DISCUSSION

Title, abstract and full paper screening reduced the 14,157 studies to 42. A general definition of medication wastage was reported in one paper only. 'Medication changed', 'patient death', 'resolution of patient's condition' and 'expired medications' were most commonly cited reasons for wastage. Only two studies were identified reporting wastage as a research outcome measure following intervention.

CONCLUSION

The systematic review has identified a limited literature on medication wastage with a lack of consistency of terms. There is a paucity of robust research focusing on the impact of healthcare interventions on outcomes around medication wastage.

Medicines in Pharmacy Students' Residence and Self-medication Practices

This study was aimed at identifying the types of medicines in pharmacy students’ residence and to determine if a relationship exists between keeping medicines in students’ accommodation and self-medication practices. A cross-sectional survey of a random sample of 240 undergraduate pharmacy students of the University of Jos, Jos, Nigeria, was carried out. Participating students were given a self-administered questionnaire, and only 188 students returned their filled questionnaire. The data collected were entered and analyzed using SPSS 16, and the χ²-test was used to determine associations between the variables. The results revealed that 66.0% of respondents had medicines in their room. A total of 318 medicines items (2.56 items per student's room) of which 37.1% were leftover medicines were present in respondents’ rooms. Analgesics (34.3%) and antibiotics (25.2%) were the common classes of medicines present in respondents’ rooms. Respondents reported getting these medicines on prescription (25.8%) and self-medication (56.5%) or both (17.7%). Self-medication practice was common among respondents (53.2%); however, no significant relationship (P>0.05) existed between having medicine in students’ room and self-medication practices. Common reasons given by respondents for having medicines in their rooms were that they were leftover medicines and that they were keeping them for emergency use or for use in an event of a similar illness. Most respondents (72.2%) reported disposing of their unused medicines in a trash can/dust bin. This study demonstrated that the prevalence of medicine storage in students’ room and self-medication practice is high. Analgesics and antibiotics were the most common types of medicines present in students’ residence.

Disposal of unwanted medications: throw, bury, burn or just ignore?

OBJECTIVES

The aim of this article is to highlight the relevance of proper disposal of unwanted medications.

KEY FINDINGS

Proper disposal of unwanted medications is a global issue. The consequences of improper disposal are a major concern, as it has negative consequences on both human health and the environment. Pharmacists are in a key position to ensure proper disposal and reduce the generation of unwanted medications.

CONCLUSION

There is urgent need for awareness on a global scale, among the public and healthcare professionals, of the importance of proper disposal of unwanted medications. Research is required to assess pharmacists' attitudes and methods used for disposal from pharmacies.

Practice, awareness and opinion of pharmacists toward disposal of unwanted medications in Kuwait

BACKGROUND

The disposal of unwanted medications has been a concern in many countries, as pharmaceutical waste enters the ecosystem, ultimately having an effect on human health and environment. Earlier studies in Kuwait found that the method of disposal by the public was by disposing in the garbage or by flushing down the drain. In accordance with patient preference and environment safety, it would be appropriate to use local government pharmacies as collection points for proper disposal.

OBJECTIVE

To determine the practice of pharmacists, working in government healthcare sectors, with regard to disposal of returned unwanted medications by the public. This study also aims to assess pharmacists' awareness toward the impact of improper disposal on the environment and to investigate whether pharmacists agree to have their pharmacies as collection points for future take-back programs.

METHOD

A random sample of 144 pharmacists from the six main governmental hospitals and 12 specialized polyclinics in Kuwait, completed a self-administered questionnaire about their practice of disposal, awareness and opinion on using pharmacies as collection points for proper disposal of UMs. Data were analyzed using descriptive statistics.

RESULTS

A total of 144 pharmacists completed the survey. Throwing UMs in the trash was the main method of disposal by majority of the respondents (73%). Only 23 pharmacists disposed UMs according to the guidelines of Ministry of Health, Kuwait (MOH). However, about 82% are aware that improper disposal causes damage to the environment and 97% agree that it is their responsibility to protect the environment. About 86-88% of the pharmacists agree to have government hospital pharmacies and polyclinics as collection points for future take-back programs.

CONCLUSION

Even though the current practice of disposal by majority of pharmacists is inappropriate, they are aware of the damage and acknowledge their responsibilities toward environment protection. Concerned authorities should monitor and implement proper disposal guidelines in all pharmacies. Majority of pharmacists support the idea of having the government pharmacies as collection points for safe disposal of UMs in Kuwait.

Disposal practices for unused medications around the world

Pharmaceuticals have been detected throughout the environment where at least in some cases, they have been shown to have a detrimental effect. Many result from improper patient disposal of unused pharmaceuticals via environmentally-unfriendly routes, such as the sink, toilet or rubbish bin. This review surveys the current peer-reviewed literature on attitudes and practices to medicine disposal methods as reported by patients and the various medication disposal and destruction systems around the world. A literature search was carried out using the keywords 'medicines disposal', 'unused medicines', 'medicines wastage', and 'medication disposal' in the PubMed TM, ISI Web of Knowledge TM, Google Scholar TM, Medline TM, Scopus TM and International Pharmaceuticals Abstracts TM up to the end of May 2010. Twelve peer-reviewed articles with specified sample sizes were selected. The most popular methods for medication disposal were in the garbage, toilet or sink. Liquid medications were more likely to be rinsed down the sink, as opposed to solid tablets and capsules which were more likely deposited in the rubbish bin. Much confusion exists about the 'proper' way of medication disposal as many countries do not have standard medication disposal protocols. Furthermore, some pharmacies around the world refused to accept unused medications or discouraged the practice. Patients with knowledge about the impact of pharmaceuticals in the environment were more likely to return medications for proper disposal and destruction. It is concluded that it is of paramount importance that a formalized protocol for patient disposal and destruction of pharmaceuticals be implemented around the world.

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

Unused prescription drugs can pose a security risk particularly for children or addicts; and they can pose an environmental risk if they are not disposed of properly through correct destruction. The general recommendation in Sweden is to return the unused medicines to a pharmacy. The Swedish Association of the Pharmaceutical Industry AB (LIF) has together with the Swedish retail chain Apoteket AB conducted surveys in 2001, 2004 and 2007 to investigate the level of knowledge in the general public on this issue. The result from the survey in 2007 shows, inter alia: 85% knew that correct disposal was to return unused medicines to a pharmacy and 43% had in fact returned their medicines to a pharmacy during the last 12 months. Of those who saved their medicines, 55% implied they would in the future return it to a pharmacy. 50% answered that they returned the unused medicines for environmental reasons and 42% answered that they worry about the environmental impact of medicines. Comparing the results from the earlier surveys it can be concluded that an increasing number of the Swedish population does return unused medicines to a pharmacy for correct disposal. Environmental concerns are getting more important than security concerns as a reason for returning unused medicines to a pharmacy and a growing fraction is worried about the environmental impact of pharmaceuticals.

The presence of pharmaceuticals in the environment due to human use--present knowledge and future challenges

Intensive research on pharmaceuticals in the environment started about 15 years ago. Since then a vast amount of literature has been published. The input and presence of active pharmaceutical ingredients (APIs) and their fate in the environment were and is still of high interest. As it has been extensively demonstrated that the active compounds are present in the environment some of the research interest has moved from analysis of the compounds, which is still undertaken, to effect studies in the lab and in field trials. It has been found that environmental concentrations can cause effects in wildlife if proper tools are applied for effect assessment. The question of mixture toxicity has gained more and more attention. It has been learned that classical tests may underestimate effects and risks. Work has been done in the field of risk assessment and risk management. As for risk management strategies to eliminate pharmaceuticals from wastewater or from the effluent of sewage treatment plants have been proposed and investigated. A tremendous amount of literature can now be found describing technical management measures such as oxidative or photolytic effluent treatment, filtering techniques, and application of charcoal. It has been learned however, that each of these approaches has its specific shortcomings. Therefore, additional approaches such as including people handling and using the compounds, and focusing on the properties of the compounds ("green pharmacy") came into focus. Accordingly, this review gives an overview of the present state of knowledge presenting typical results and lines of discussion. This review makes no claim to give a complete overview including the full detailed body of knowledge of pharmaceuticals in the environment. Rather, it addresses important and typical topics to stimulate discussion.

Types and quantities of leftover drugs entering the environment via disposal to sewage--revealed by coroner records

Pharmaceuticals designed for humans and animals often remain unused for a variety of reasons, ranging from expiration to a patient's non-compliance. These leftover, accumulated drugs represent sub-optimal delivery of health care and the potential for environmentally unsound disposal, which can pose exposure risks for humans and wildlife. A major unknown with respect to drugs as pollutants is what fractions of drug residues occurring in the ambient environment result from discarding leftover drugs. To gauge the significance of leftover drugs as potential pollutants, data are needed on the types, quantities, and frequencies with which drugs accumulate. Absence of this data has prevented assessments of the significance of drug accumulation and disposal as a contributing source of drug residues in the environment. One particular source of drug accumulation is those drugs that become "orphaned" by the death of a consumer. A new approach to acquiring the data needed to assess the magnitude and extent of drug disposal as a source of environmental pollution is presented by using the inventories of drugs maintained by coroner offices. The data from one metropolitan coroner's office demonstrates proof of concept. Coroner data on leftover drugs are useful for measuring the types and amounts of drugs accumulated by consumers. This inventory also provides an accurate measure of the individual active ingredients actually disposed into sewage by coroners. The types of questions these data can address are presented, and the possible uses of these data for deriving estimates of source contributions from the population at large are discussed. The approach is proposed for nationwide implementation (and automation) to better understand the significance of consumer disposal of medications.

Disposal of unwanted medicines from households in Kuwait

OBJECTIVE

To test the effectiveness of a simple educational intervention to encourage households to return unwanted medicines via a municipal collection program and to investigate the most common sources and types of unwanted medicines in the home.

SETTING

Households in Kuwait City, Kuwait.

METHOD

A convenience sample of 200 households in Kuwait received an educational letter and special plastic bags in which to place unwanted medicines to be collected by the municipality. They also completed a short self-administered questionnaire on medicine disposal habits. A second convenience sample of an additional 14 households in Kuwait received the same educational letter together with a face-to-face interview and assistance in collecting unwanted medicines. Returned medicines were categorized and their source and expiry dates noted.

MAIN OUTCOME MEASURE

Quantity and types of medicines returned.

RESULTS

No medicines were collected from the 200 households participating in the municipal collection scheme in spite of 45% of respondents agreeing that this was an appropriate method of disposal. 97% of the respondents said they currently disposed of their medication in the garbage. The second intervention yielded 123 medicines from 14 homes, a third of which were for the respiratory system (38% of these were cough and cold preparations). The majority of returned medications were for acute conditions, almost all were from government health centers and 52% were expired.

CONCLUSION

Simple collection of unwanted medicines by municipal authorities is unlikely to be effective. A multifaceted approach is more effective but resource intensive. Using local pharmacies as collection points in a reverse distribution system may be more cost-effective.