Pharmacists' Knowledge Regarding Drug Disposal in Karbala

A critical review of innovative strategies for the sustainable management of solid waste generated in the health institutions of Zimbabwe

Innovative frameworks and strategies for solid waste management have been brought forward by researchers to solve the phenomenon of accumulating waste in the environment globally. The sustainability of medical waste management then pivots on the ability of waste management in a way that proves harmless to humans, animals, plants and the environment at large. This review looks into the strategies for the sustainable management of solid waste generated in the health institutions of Zimbabwe. Waste management includes waste generation, waste segregation, waste storage, waste collection and transportation, waste treatment and disposal and waste reuse and recycling. Exhaustive literature review was conducted as the methodology for this review soliciting information on the solid medical waste management status worldwide. In Zimbabwe, hazardous medical solid waste segregation, storage, transportation and disposal is a responsibility of the medical institutions generating the waste. These include trip and fall hazards, infectious hazards, cuts and lacerations, drugs addictions and radioactive hazards. The environment also faces contamination to the land, underground water bodies through leaching, surface water bodies, damage to flora, poisoning of fauna and contamination of the atmosphere by methane and carbon monoxide. Findings of the study show that innovations for medical solid waste management include frameworks such as the Ladder of Lansink and the three 'R's. Innovative technologies include rotary kiln incinerators, automated segregation and engineered landfills. Therefore, the framework addresses issues impeding the adoption of these innovative strategies in Zimbabwe.

A systematic review of the knowledge, attitude and practice of healthcare professionals and healthcare professional students towards household pharmaceutical waste disposal

Background

Active pharmaceutical residues introduced into the environment through irresponsible household disposal of unused and expired medication can damage nature and health. Through medication take-back programmes, these risks can be mitigated. However, healthcare professionals' neglect of their responsibility to ensure proper disposal practices has perpetuated subpar norms among the public.

Objectives

The objectives of this systematic review were to assess the knowledge, attitude, and practice of household pharmaceutical waste disposal among healthcare professionals and healthcare professional students as well as to compare their respective levels of knowledge, attitude and practice.

Methods

A systematic search of published articles from 2014 to 2023 in three online journal databases (Pubmed, Scopus, and Web of Science) yielded an initial pool of 10,381 records, which was narrowed down by title and abstract screening to 46 relevant publications for full-text examination and the final inclusion of 21 papers for data extraction and synthesis.

Results

The findings revealed deficiencies in academic curricula and medication disposal training, leading to inadequate knowledge and perceptions among healthcare professionals. Many healthcare professionals consider public education about safe medication disposal practices to be outside their job descriptions, leading to infrequent communication of medication disposal methods to their consumers and service users. Additionally, inadequate and inaccessible infrastructure further hinders proper medication disposal practices despite awareness of the consequences.

Conclusions

This study provides insights for policymakers and educators to address these and enhance healthcare professionals' participation in improving safe medication disposal practices. Efforts to strengthen training programmes, incorporate comprehensive education on medication disposal into curricula, and improve infrastructure for safe medication disposal are essential to effectively address the issue of household pharmaceutical waste disposal.

UAE pharmacists' perceptions of the causes of unwanted or unused medications, their practices, and barriers to promoting safe medication disposal by the public

BACKGROUND

The improper disposal of unwanted or unused medications is a pressing issue that can lead to drug misuse and environmental contamination. Pharmacists play a crucial role in promoting safe drug disposal by the public. This study explores pharmacists' perceptions of the causes of unwanted and unused medications, their practices, and the barriers to promoting safe medication disposal among the public in the United Arab Emirates.

METHODS

This cross-sectional study included pharmacists working in the UAE's community and hospital settings with direct patient contact. A convenience sampling approach was used, where pharmacists who were available during the data collection period were invited to participate. Printed copies or a survey link to the questionnaire were provided to pharmacists to complete independently during in-person visits. Participants were categorised into three levels: extensive, adequate, or minimal involvement, based on their engagement in activities such as reviewing patients' medications, educating them on proper storage and disposal, and participating in drug take-back programmes. Chi-square test was used to assesses the association between categorical variables and pharmacists practice levels. The data was analysed using the Statistical Package for the Social Sciences (SPSS) software version 29.

RESULTS

A total of 370 pharmacists participated in this survey, most of whom were between 18 and 34 years old (69.2%). The top three perceived causes of unwanted or unused medications include changes in prescriptions due to patients' poor clinical outcomes (83.8%), inappropriate storage conditions (79.7%), and expiration of medications (78.6%). Moreover, factors such as pharmacist age, type of pharmacy, country of education, pharmacy location, employment status, and years of experience were significantly associated with pharmacists' level of involvement in promoting safe medication disposal practices. The most cited barriers were a lack of public awareness about the risks of improper medication disposal (88.9%), lack of time due to workload (82.4%), and lack of training and education (78.1%). Most pharmacists believed in collaborating with public health agencies to promote medication disposal awareness (97.6%) and developing national guidelines (97.6%).

CONCLUSION

This study's findings have significant implications for public health, highlighting the necessity of essential groundwork for developing targeted interventions and policies to enhance public awareness and identify specific areas where pharmacists can actively encourage safe medication disposal practices in the UAE.

Assessing the knowledge, attitudes and practices of healthcare staff and students regarding disposal of unwantead medications: a systematic review

OBJECTIVES

We sought to review studies that examine healthcare professionals' and students' knowledge, attitudes and practices (KAP) regarding medication disposal. We also explore recommendations and barriers related to appropriate medication disposal.

DESIGN

A systematic review was conducted that adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses.

DATA SOURCES

MEDLINE, Embase, CINAHL, Web of Science, PsycINFO and Google Scholar were searched up to 23 February 2024.

STUDY ELIGIBILITY CRITERIA AND SETTING

Qualitative, quantitative and mixed-method primary research studies. There was no limitation on the publication date, geographical locations or the study settings.

PARTICIPANTS

Pharmacists, doctors, nurses and students from these respective professional groups in any country.

PRIMARY OUTCOME MEASURES

The levels of healthcare staff and students' KAPs about disposal of unwanted medications.

DATE EXTRACTION AND SYNTHESIS

Data extraction was conducted by four of the researchers independently. The study details were categorised into three main domains, that is, KAP using the KAP model. Other relevant information was also extracted, and synthesised in overall themes, such as challenges and recommendations.

RESULTS

Thirty-seven studies from 18 countries (Asia n=21, the USA n=7, Africa n=5, EU n=2, South America n=2) were included. 86.5% (n=32) investigated participants' knowledge of medication disposal. Although there was a good level of awareness about the environmental impacts, there were significant gaps in knowledge regarding correct disposal methods, available services, guidelines and training. Thirty studies explored participants' attitudes towards medication disposal. There was a generally positive attitude towards the need for environmentally safe disposal practices. Thirty-five studies evaluated participants' practices in relation to medication disposal. Although there was generally a positive attitude and some understanding of appropriate disposal methods, the majority of the participants did not follow the practice guidelines, especially outside healthcare settings.

DISCUSSIONS AND CONCLUSIONS

Although healthcare staff and students have fair knowledge and positive attitudes towards medicine disposal, their actual practices are lacking. One significant challenge identified is the limited awareness about proper disposal methods coupled with a lack of established services or guidelines. Even in cases where take-back programmes are available, they often face issues with accessibility. To tackle these challenges, it is suggested that governmental bodies should establish and enforce clear policies on medication disposal while also expanding educational initiatives to increase understanding among professionals and students. Furthermore, improving access to take-back programmes is crucial for ensuring safe medication disposal and minimising potential environmental and health hazards.

PROSPERO REGISTRATION NUMBER

CRD42024503162.

Pharmacists perspectives on challenges and facilitators in initiating medications take-back program in Indonesia: A qualitative study

Objective

The establishment of a medication take-back program is an important intervention to prevent the improper disposal of expired or unused household medications. However, such a program has not been established in Indonesia. A significant step in establishing the program is to gain a better understanding of pharmacists' perspectives on the associated challenges and facilitators. Therefore, this study aimed to explore pharmacists' perspectives on the associated challenges and facilitators in initiating medications take-back program in Indonesia.

Methods

This qualitative study was conducted through Key Informant Interviews with a purposive sample of nine pharmacists working in community health centers (CHC) in Bandung City, Indonesia. The discussions were transcribed, coded, and analyzed using Atlas.ti9 software.

Results

Pharmacists' perspectives on initiating medications take-back program were categorized into two main themes, including challenges and facilitators. The identified challenges comprised a lack of personnel, financial constraints, geographical constraints, lack of facilities, and inadequate knowledge. Meanwhile, the facilitators included the good responsibility of pharmacists, incentives, and convenient locations.

Conclusion

The identified challenges and facilitators should be considered when initiating medication take-back programs in Indonesia.

Guidance provided by pharmacists to customers regarding to destination of unused household medications: disposal of household medications

BACKGROUND

Discarding pharmaceuticals in the garbage or into the sewage system are still the most common methods in many countries. This study aims to investigate the guidance provided by pharmacists to customers on the disposal of unused and expired household medications in São Paulo State, Brazil.

METHOD

The study population consisted of 630 pharmacists from the State of São Paulo, who work in community pharmacies. They answered an online questionnaire with questions composed in three blocks: demographic, work, and academic information on the pharmacist; guidance about the disposal of household medications; and knowledge regarding the reverse logistics of these medications. An invitation to participate in the questionnaire was made via WhatsApp, individually and collectively. Inferential statistics were performed using the chi-square test and were considered significant when p < 0.05%.

RESULTS

Among the participating pharmacists, the majority were women under 60 years old,56 (8.89%) stated that they never orient the customer regarding the disposal of unused and expired household medications, while 574 (91,12%) indicated that they almost provide guidance. The frequency with which they provided guidance was influenced by the number of years since graduation (p = 0.0047), the time they had worked in pharmacies and drugstores (p = 0.0007), and whether or not they had a graduate degree (p = 0.0181). Regarding the disposal of medications, among the 643 responses provided by the pharmacists,516 (80.25%) indicated that they oriented customers to return them to a pharmacy.

CONCLUSION

A small number of pharmacists always orient customers on the proper disposal that should be followed for unused and expired household medications, prioritizing their return to a pharmacy. In general, these pharmacists have longer periods of work experience and higher academic qualifications. Thus, it is important to increase knowledge through professional training and further education programs.

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.

Assessment of practices and awareness regarding the disposal of unwanted pharmaceutical products among community pharmacies: a cross-sectional study in Palestine

BACKGROUND

The improper disposal of pharmaceutical preparations substantially threatens human health and environmental safety. Pharmacists are responsible for properly disposing of unwanted medications and educating patients about how to do so themselves. This study aimed to assess community pharmacists' knowledge, determine their views on how to dispose of unwanted pharmaceuticals, and assess the extent to which they realize that it is their responsibility to guide patients toward the safe disposal of expired medications.

METHODS

A descriptive cross-sectional study was conducted between December 2021 and April 2022 among 400 practicing pharmacists who were chosen to participate by random cluster sampling. Community pharmacists' practices, awareness, and beliefs about disposing of unused drugs were evaluated. The Statistical Package for Social Sciences (IBM-SPSS) version 21 was used for data entry and analysis.

RESULTS

Of 400 pharmacists, 348 stated that they did not participate in courses on the safe disposal of unwanted medications. Disposal of drugs in the garbage, an unsafe method, was very frequently recommended by pharmacists to patients, especially regarding inhalers, antibiotics, hormonal drugs, and solid and semisolid drugs. However, many pharmacists advised patients to return their hormonal, category B, and category C drugs to the pharmacy. A total of 61.3% of pharmacists agreed and 26% strongly agreed that unsafe disposal of drugs negatively affects the environment. A total of 54.3% of the participants agreed that improper disposal of antibiotics might be a reason for increased antimicrobial resistance, and 54.5% of them agreed that improper disposal of hormonal drugs might contribute to the development of certain cancers. A total of 80.3% of the participants perceived that most unwanted drugs in pharmacies were those returned from patients. A total of 97.3% of the participants supported establishing a drug disposal system, with 77.5% choosing to have the district health board responsible for funding this system. A total of 48.5% of the participants indicated that a lack of education and awareness on the issue of getting rid of unused drugs constitutes a challenge to the safe disposal of medicines, and 66% of them said that a lack of law enforcement constitutes another challenge. A total of 95.5% of the participants agreed or strongly agreed that good training for health sector workers and organizing workshops to develop knowledge on this subject would improve practices. A total of 93.3% supported distributing educational brochures, and 92.8% supported placing special containers in every pharmacy to collect unwanted drugs.

CONCLUSIONS

Most pharmacists in our study returned drugs to manufacturing companies and stores, and few followed the correct methods of incineration and return of drugs to the Ministry of Health. Current data emphasize the issue of improper disposal of medicine in Palestine and the need for improved education among healthcare workers.

An assessment of the current practice of community pharmacists for the disposal of medication waste in the United Arab Emirates: A deep analysis at a glance

Objective

The study aimed to identify the current practice carried out by community pharmacists to dispose of expired medications in their workplace and assess any practical steps utilized to reduce medication waste.

Method

A cross-sectional study was conducted among community pharmacists in the United Arab Emirates (UAE). The participants were asked about their routine practice in disposing of different expired medications and the current actions taken to reduce the number of disposed medicines.

Results

The study included (n = 418) community pharmacists. More than a third of expired liquid, solid, and semi-solid dosage forms were collected by licensed contractors. In addition, more than a third of the pharmacists disposed of different dosage forms via unauthorized methods (general garbage, sink and toilet). Most expired drugs were skin and hair products, antibiotics and analgesics. The majority of pharmacists (68.4 %, n = 286) agreed that expired pharmaceutical and non-pharmaceutical products, other than those disposed of via contractor, should be done through a specialized centre. This opinion was found to be strongly associated with years of practice as community pharmacists (P < 0.05).

Conclusion

Part of the existing disposal practices for expired pharmaceutical products in the UAE is carried out by contractors licensed by health authorities. However, concern remains regarding some pharmaceutical and non-pharmaceutical products that have not been disposed of correctly. Additionally, there is a need for a specialized center for medication disposal (p < 0.05). A stock limitation is the best practice for managing medication quantities in stock (p < 0.05).

Bio-removal of emerging pollutants by advanced bioremediation techniques

This review highlights the relevance of bioremediation techniques for the removal of emerging pollutants (EPs). The EPs are chemical or biological pollutants that are not currently monitored or regulated by environmental authorities, but which can enter the environment and cause harmful effects to the environment and human health. In recent times, an ample range of EPs have been found in water bodies, where they can unbalance ecosystems and cause negative effects on non-target species. In addition, some EPs have shown high rates of bioaccumulation in aquatic species, thus affecting the safety and quality of seafood. The negative impacts of emerging pollutants, their wide distribution in the environment, their bioaccumulation rates, and their resistance to wastewater treatment plants processes have led to research on sustainable remediation. Remediation techniques have been recently directed to advanced biological remediation technologies. Such technologies have exhibited numerous advantages like in-situ remediation, low costs, eco-friendliness, high public acceptance, and so on. Thus, the present review has compiled the most recent studies on bioremediation techniques for water decontamination from emerging pollutants to extend the current knowledge on sustainable remediation technologies. Biological emerging contaminants, agrochemicals, endocrine-disrupting chemicals, and pharmaceutical and personal care products were considered for this review study, and their removal by bioremediation techniques involving plants, bacteria, microalgae, and fungi. Finally, further research opportunities are presented based on current challenges from an economic, biological, and operation perspective.

Nanohybrid catalysts with porous structures for environmental remediation through photocatalytic degradation of emerging pollutants

Water supplies have been seriously challenged by new emerging pollutants, which are difficult to remove by traditional wastewater treatment. Thus, new technologies such as catalytic advanced oxidation processes have merged as suitable solutions; however, the drawbacks of typical catalysts limit their application. To overcome this issue, new materials with enhanced textural properties have been developed, showing that their porosity and chemical nature influence their potential as a catalyst. Herein, the recent progress in highly porous catalysts and their suitable deployment to effectively nano-remediate the polluted environmental matrices are reviewed in detail. First, following a brief introduction, several environmental pollutants of emerging concerns from different sectors, including pharmaceutical residues, endocrine-disrupting chemicals (EDCs), pesticides, and hazardous dyes are also introduced with relevant examples. To effectively tackle the sustainable remediation of emerging pollutants, this work also focuses on the multifunctional features of nanohybrid porous materials that act as catalysts constructs to degrade emerging pollutants. The influence of surface reactive centers, stability, bandgap energies, light absorption capacities, and pollutants adsorption capacities are also discussed. Successful examples of the employment of nanohybrid porous catalysts for the degradation of pharmaceutical pollutants, EDCs, pesticides, and hazardous dyes are summarized. Finally, some challenges faced by nanohybrid porous materials to achieve their potential application as advanced catalysts for environmental remediation have been identified and presented herein.

Disposal of leftover and expired medicines by community pharmacies and their clients in Ghana

Improper and unsafe disposal of expired and unwanted medicines could cause harm to both people and the environment and therefore it is of public health importance. The objective of the study was to determine the methods employed by community pharmacist and their clients in the disposal of unwanted and expired medicines. Furthermore, the role of the pharmacists in the assessment of clients left over medicines was also explored. A cross sectional study design was employed with a sample of 120 pharmacy staff and 200 clients. Semi structured questionnaires were developed and administered to the two groups. Ethical approval was obtained. Data collected were analyzed using the Statistical Package for Social Sciences (SPSS v.24). Two hundred and eighty medicines were assessed from 131 respondents (65.5%) who brought their unused or left-over medicines to the pharmacy. These included analgesics 102(36.4%), antibiotics 50 (17.9%) and antacids 22 (7.9%). Disposal of expired and left-over medicines cited by respondents were the general-purpose bin 58(77.0%) and down the sink 11(14.3%). The majority 99(82.9%) of community pharmacies also disposed of solid dosage forms through the general-purpose bin. In addition, 90(75%) community pharmacies disposed of liquid waste in general purpose bin. Lack of enforcement of legislation was cited by community pharmacy staff as a barrier to the proper disposal of pharmaceutical waste. The predominant method of disposal of expired/unwanted medicines by community pharmacies and their clients was via the general-purpose bin. Implementation of interventions such as take back programmes that will enhance proper disposal of expired and left over medicines should be initiated.

Decontamination of emerging pharmaceutical pollutants using carbon-dots as robust materials

Environmental pollution is a critical issue that requires proper measures to maintain environmental health in a sustainable and effective manner. The growing persistence of several active pharmaceutical residues, such as antibiotics like tetracycline, and anti-inflammatory drugs like diclofenac in water matrices is considered an issue of global concern. Numerous sewage/drain waste lines from the domestic and pharmaceutical sector contain an array of toxic compounds, so-called "emerging pollutants" and possess adverse effects on entire living ecosystem and damage its biodiversity. Therefore, effective solution and preventive measures are urgently required to sustainably mitigate and/or remediate pharmaceutically active emerging pollutants from environmental matrices. In this context, herein, the entry pathways of the pharmaceutical waste into the environment are presented, through the entire lifecycle of a pharmaceutical product. There is no detailed review available on carbon-dots (CDs) as robust materials with multifunctional features that support sustainable mitigation of emerging pollutants from water matrices. Thus, CDs-based photocatalysts are emerging as an efficient alternative for decontamination by pharmaceutical pollutants. The addition of CDs on photocatalytic systems has an important role in their performance, mainly because of their up-conversion property, transfer photoinduced electron capacities, and efficient separation of electrons and holes. In this review, we analyze the strategies followed by different researchers to optimize the photodegradation of various pharmaceutical pollutants. In this manner, the effect of different parameters such as pH, the dosage of photocatalyst, amount of carbon dots, and initial pollutant concentration, among others are discussed. Finally, current challenges are presented from a pollution prevention perspective and from CDs-based photocatalytic remediation perspective, with the aim to suggest possible research directions.

Can We Create a Circular Pharmaceutical Supply Chain (CPSC) to Reduce Medicines Waste?

BACKGROUND

The increase in pharmaceutical waste medicines is a global phenomenon and financial burden. The Circular Economy, as a philosophy within the pharmaceutical supply chain, aims to promote waste reduction, maximise medicines value, and enable sustainability within this supply chain (increasing circularity). Circularity strategies for pharmaceuticals are not currently implemented in many countries, due to quality and safety barriers. The aim of this study was to determine whether the application of circular economy principles can minimise pharmaceutical waste and support sustainability in the pharmaceutical supply chain; Methods: a detailed narrative literature review was conducted in order to examine pharmaceutical waste creation, management, disposal, and the application of circular economy principles; Results: the literature scrutinised revealed that pharmaceutical waste is created by multiple routes, each of which need to be addressed by pharmacists and healthcare bodies through the Circular Economy 9R principles. These principles act as a binding mechanism for disparate waste management initiatives. Medicines, or elements of a pharmaceutical product, can be better managed to reduce waste, cost, and reduce negative environmental impacts through unsafe disposal.

CONCLUSIONS

the study findings outline a Circular Pharmaceutical Supply Chain and suggests that it should be considered and tested as a sustainable supply chain proposition.

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.