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

A cross-sectional study on perceptions towards safe disposal of unused/expired medicines and its associated factors among the public in Saudi Arabia-a threat to the environment and health

Background

The unsafe disposal of pharmaceutical waste poses significant health hazards and causes environmental pollution on a global scale. The lack of specifically authorized guidelines in Saudi Arabia for the disposal of unused medicines available at home creates an undue economic burden and potentially threatens the environment and healthcare.

Aim

The current study aimed to determine the presence, disposal practices, and perceptions of unused or expired household medicines. Furthermore, it identifies the association between demographic characteristics and the presence, disposal practices, and perceptions of the safe disposal of unused/expired medicines. The study also intended to obtain opinions on methods to control the hazardous effects of waste medicines and promote awareness among the public about the safe disposal of unused/expired medicines.

Methods

This study is a web-based, cross-sectional questionnaire-based survey conducted in Saudi Arabia. The authors of the current study developed a questionnaire based on relevant literature. The study questionnaire comprises various domains such as demographic characteristics, presence and disposal of unused/expired medicines, perception of safe disposal of unused/expired medicines, and recommended improvement plan for safe disposal of used/expired medicines. Estimating internal consistency, expert review, and retranslation methods ensured reliability, face validity, and language validation. The results are expressed as frequency and percentages for categorical data. In addition, a chi-square test was also performed to find the association between the independent variables and the survey responses.

Results

Among the total population, 643 reported having unused/expired medicines at home, with antibiotics being the most common (79.4%). Symptom improvement is associated with accumulating unused medicines at home (71.7%). Age group, educational level, and occupational status were the predictors of the prevalence of waste medicines available at home (p < 0.05). The method selection for disposing of unused medicines was influenced by gender, age group, marital status, and educational level (p < 0.05), and the preferred method was putting them in the garbage (86.1%). Educational level is the most prominent factor associated with the perception of disposal of unused/expired medicines (p < 0.001).

Conclusion

Our study reveals a positive perception of the safe disposal of used or expired medicines, but practice requires improvement. The initiatives to improve the safe disposal practice should be tailored based on gender, educational level, and occupational status. Patient education during medicine dispensing could be an appropriate intervention and can be done by the pharmacist. Introducing medicine waste collection programs or safe medicine disposal guidelines for the public in Saudi Arabia could effectively prevent potential environmental and health hazards.

Environmental and Health Consequences of Pharmaceutical Disposal Methods: A Scoping Review

The global rise in pharmaceutical production and consumption has led to an increase in pharmaceutical waste, posing significant risks to both public health and the environment. Improper disposal methods contribute to environmental degradation, including disruptions to aquatic ecosystems and the spread of antimicrobial resistance. Despite these growing concerns, a comprehensive review of pharmaceutical waste management and disposal practices is still lacking. To address this gap, a scoping review was conducted, analyzing 4269 records from three databases (Medline OVID, Web of Science, and Embase) and grey literature, with 67 studies ultimately included. The initial records were identified through a comprehensive search across the aforementioned databases using a structured strategy based on three core concepts: medication waste, disposal methods, and environmental or human health impacts. This was followed by a two-stage screening process guided by the PCC framework and predefined inclusion criteria. The review aims to assess disposal practices and their impacts, identify research gaps, and guide future research toward effective strategies for managing pharmaceutical waste while protecting ecological balance and public health. The publications timeline shows increasing interest in the topic, particularly with a surge in studies during 2022 and 2023. The findings reveal a significant regulatory gap, especially in the Global South, where limited infrastructure and public awareness lead to reliance on household waste disposal. In contrast, medication take-back programs are more common in the Global North. This disparity underscores the urgent need for policy development. Addressing pharmaceutical waste effectively requires coordinated efforts from the pharmaceutical industry, healthcare providers, regulatory bodies, and local communities. Key strategies should include regulatory action, public education, technological innovation, and addressing issues like drug misuse and overconsumption, particularly of antibiotics, which contribute to antimicrobial resistance. A holistic approach is essential to mitigate both environmental and public health risks.

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.

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.

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.

Ecopharmacology: Knowledge, Attitude, and Medication Disposal Practice Among Pharmacy Students

Background

Ecopharmacology, as a form of drug management for the environment, focuses on the impact of drugs on the environment. Pharmacists, and by extension pharmacy students, are expected to play an important role in ecopharmacology. Therefore, this study was conducted to determine the knowledge and attitude towards ecopharmacology and the practice of disposal of leftover or expired medicines among pharmacy students.

Methods

This was a descriptive cross-sectional study among pharmacy students in Northwestern Ethiopia. The study took place from May 1 to June 15, 2023. A self-administered questionnaire was used for data collection.

Results

Four hundred and forty-five students were included in the study. Only 91 (20%) of the students were aware of the term ecopharmacology, 27% knew that excretion from the human or animal body is the major route by which pharmaceutical agents enter the environment, and 42% were aware of the risk of increased antimicrobial resistance due to antibiotic residues in the environment. In addition, only 27% of respondents reported receiving information about the disposal of pharmaceuticals. The most common method of disposing of medications was throwing them away in household trash (61.8%).

Conclusion

Our results suggest that while most pharmacy students in Ethiopia have a positive attitude toward ecopharmacology, they do not know enough about ecopharmacology and dispose of their medicines poorly. More uniform education in ecopharmacology and pharmaceutical pollution might be warranted in the pharmacy curriculum.

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.