Analysis of medicines returned to pharmacies for disposal and estimation of the cost due to medicine wasting

Amount, type and storage of medicines in households - A survey for medicine users

With increasing medicine use, more medicines are being stored at home, yet the understanding of household medicines remains limited. This study aimed to assess the amount, type and storage practices of medicines in households. It also explored the reasons for unnecessary or expired medicines, as well as the factors associated with the presence of expired medicines in a household. The online survey was conducted among loyal customers of University Pharmacy in June 2023 (n = 5004). The data were analysed for frequencies and percentages, and binary logistic regression was used to examine the association between background factors and expired medicines in households. On average, one household had 13.9 active, 2.8 unnecessary and 2.2 expired medicine packs. Medicines were typically stored in the kitchen (67.0%) and in cabinets (58.7%), and 40% were to be stored safely. The main reasons for unnecessary or expired medicines were improved health (39.2%), medication changes (31.9%) and oversized packs (28.0%). Households returning medicines biennially (odds ratio (OR): 2.85; 95% confidence interval (CI): 2.13-3.82) and those with many active medicines (OR: 2.14; 95% CI: 1.79-2.54) had expired medicines more often. The study showed that households had many medicines, highlighting the need for better storage and optimized packaging to improve safety, reduce waste and enhance rational pharmacotherapy.

Content and cost of waste pharmaceuticals collected by pharmacies for disposal

BACKGROUND

The research aims to the costs and contents of waste pharmaceuticals collected through pharmacies for disposal. This study adds significant value to the country's economy in terms of cost and number of medicines.

METHODS

The study was conducted with waste pharmaceuticals collected from 29 pharmacies in Erbaa district of Tokat province in Turkey. In the study, the total of waste pharmaceuticals, ATC classification and cost data of these medicines were obtained from the Eczanem automation program. Microsoft Office Excel and IBM SPSS programs were used in the analysis of the data.

RESULTS

In the study, 1178 waste pharmaceuticals were evaluated. It was determined that approximately 88% of the waste pharmaceuticals were never used and 30% of them had not expired. Finally, it was determined that the total monthly cost of the collected waste pharmaceuticals was 4,908.88 USD. When this amount is calculated nationwide, the annual estimated cost of waste pharmaceuticals is 58,281,272.36 USD.

CONCLUSION

As a result of the research, it was revealed that waste pharmaceuticals constitute a serious national burden and waste in terms of both number and cost. Therefore, it is important to investigate the causes of waste pharmaceuticals in detail and take measures against them.

Evaluation of antibiotics returned for safe disposal during and after a community pharmacy antibiotic amnesty campaign

Background

Community pharmacies in England offer convenient and safe disposal of unwanted medicines, including antimicrobials, and better uptake of this service could limit environmental antimicrobial resistance. However, there is limited information on the extent and nature of antibiotic returns to community pharmacies. The impact of an antibiotic amnesty campaign promoting antibiotic disposal through community pharmacies was evaluated with the intention of collecting detailed information on the antibiotics returned.

Methods

An antibiotic amnesty campaign was delivered by community pharmacies in the Midlands (England) with an audit of returned antibiotics conducted in 19 community pharmacies in Leicestershire. Detailed information on antibiotics returned for disposal was gathered during the month-long amnesty campaign and again 3 months later in the same pharmacies.

Results

Antibiotics accounted for 3.12%-3.35% of all returned medicines. The amnesty campaign led to a significant increase in defined daily doses of returned antibiotics compared to the post-amnesty period (P = 0.0165), but there was no difference in the overall number of returned medicines. Penicillins were the most commonly returned antibiotics in both periods (29.3% and 42.5% of packs, respectively), while solid oral dose formulations predominated. A total of 36.6% of antibiotics returned during the amnesty period were expired, increasing to 53.4% in the post-amnesty period. Amnesty conversations had a significant impact on the number of antibiotic returns but campaign posters did not.

Conclusions

Antibiotic conversations can increase the amount of antibiotics returned to community pharmacies for safe disposal, and passive campaign materials had limited impact. More research is needed to identify the most effective interventions to increase returns.

Unused medicine take-back programmes: a systematic review

Background

Improper disposal of unused medicine can impact the environment causing significant healthcare and financial burdens. While the medicine take-back programme is an effective management strategy, its effectiveness differs across countries. This study aimed to systematically review the take-back programmes in various countries and to identify areas needing improvement for programme enhancement.

Methods

We conducted searches in Medline, EMBASE, CINAHL, Web of Science, Scopus, and Google Scholar, from database inception to June 2023.

Results

The review included 27 studies spanning 15 countries' medicine take-back programmes. While some programmes, mostly observed in the USA, were conducted at the local level with non-health-associated facilities, others were done at the national level within healthcare facilities. The cost of collected medicines ranged from US$7,416 to US$1,118,020, primarily involving medicines related to the nervous system, cardiovascular system, alimentary tract, and metabolism. Legislations pertaining to these programmes were available in the USA, most European countries, and Mexico, but unavailable in Spain, Austria, Australia, and New Zealand. However, despite this, the government or the industry in these countries managed the programmes.

Conclusion

Well-structured take-back programmes featuring easily accessible collection points, regular collection schedules, clear programme ownership, with legislation defining financial responsibilities, showed positive outcomes.

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

Introduction

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

Methods

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

Results

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

Conclusions

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

Emicizumab prophylaxis for people with hemophilia A: Waste estimation and the Brazilian perspective

Costs of hemophilia A treatment are increasing. Waste of clotting products should be avoided. To estimate the first-year waste of emicizumab prophylaxis for people with hemophilia A and inhibitors (PwHAi) who failed immune tolerance induction (ITI), in Brazil. We evaluated the manufacturer and the Brazilian Ministry of Health (MoH) protocol-recommended regimens in a budget impact model. The loading dose consisted of 3.0 mg/kg/Q1W for 4 weeks, for both recommendations. The manufacturer maintenance regimens comprised 1.5 mg/kg/Q1W, 3.0 mg/kg/Q2W, and 6.0 mg/kg/Q4W. The MoH protocol maintenance regimen encompassed a hybrid Q1W/Q2W administration, depending on the body weight. The Q4W regimen was not recommended by the MoH protocol. Analyses were performed to estimate waste given its expense based on the World Health Organization body weight range (percentiles [P] 15, 50, and 85). The first-year emicizumab waste was estimated individually and for the disclosed PwHAi who failed ITI (n = 114). The highest emicizumab waste was estimated for the lowest body weights and the Q1W regimen. The Q4W regimen resulted in the lowest emicizumab waste, followed by the MoH protocol regimen. The total reconstituted costs estimated for the PwHAi who failed ITI according to the hybrid MoH protocol ranged from US$32,858,777 (P15) to US$47,186,858 (P85), with emicizumab waste ranging from 7.9 % (US$2,594,515) to 3.7 % (US$1,738,750), respectively. Lost resources due to current protocols for emicizumab prophylaxis for PwHAi who failed ITI in Brazil are considerable. Waste was more pronounced due to lower body weight and shorter administration intervals.

Logistics performance: critical factors in the implementation of end-of-life management practices in the pharmaceutical care process

The management of healthcare waste and end-of-life medication coming from different sources are primary challenges faced by public health leaders. Several factors may be considered critical and inhibitive to reverse logistics within the context of waste management processes. If those factors are not addressed, they may become obstacles to reverse logistics implementation. The purpose of this study is to evaluate the effect that critical factors play in the adoption of end-of-life management practices for medication and its influence on logistics performance. Literature provided some critical factors: management factor, collaboration factor, information technology factor, infrastructure factor, politics factor, financial and economic factor, end-of-life management practices, and logistics performance factor. A sample of 67 professionals from the public pharmaceutical care process answered a structured questionnaire. The collected data was analyzed using partial least square-structural equation modeling. The theoretical structural test confirmed eleven out of the fifteen hypotheses considered. The results have indicated that end-of-life management practices exert a direct influence on logistics performance. The analysis confirmed a direct effect of the information technology factor on end-of-life management practices, but not a moderation effect. Findings have contributed to the literature by providing deeper insights into the relationship between end-of-life management practices for medicines and logistics performance. Moreover, it supports health managers' decision-making in the pharmaceutical care process improvement and engagement with solid waste management policies.