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

Towards eco-friendly pharmaceuticals: Regulatory and policy approaches for sustainable medicines use

Objectives

The current study aimed to investigate how regulatory frameworks and policies are used to support the use of sustainable medicines within the pharmaceutical sector.

Methods

The Scopus database was searched to retrieve papers. Advanced search tool of the Scopus online database was used focused on the papers that have the search query included in their titles. Data analysis incorporated bibliometric indicators like publication counts and trends, visualized through VOSviewer software version 1.6.20.

Key findings

A total of 43 publications on Sustainable Medicines Use were found between 2000 and 2024. Leading countries in publication output on sustainable medicines use were United Kingdom, United States, India, Italy, Portugal, and Switzerland, indicating their collaborative relationships and publication volumes. A total of 92 institutions have been involved in research on Sustainable Medicines Use. Key institutions such as the Faculty of Engineering and the Laboratory for Process and Environmental Engineering, Lowell Center for Sustainable Production, Greiner Environmental Inc., and the University of Florence are prominently featured, indicating their significant contributions to research in this area. Key journals such as the "Journal of Cleaner Production," "Business Strategy and the Environment," "Chemical Engineering Transactions," "Benchmarking," and "Lecture Notes in Mechanical Engineering" are prominently featured. The retrieved articles have been cited an average count of 22.26. The overlay visualization created using VOSviewer suggest a shift towards exploring new drug categories, innovative approaches, and the commercial aspects of sustainability. Future research directions are likely to delve deeper into innovative methods and sustainable chemical practices (green chemistry), reflecting an emphasis on developing greener processes and products.

Conclusion

This study offers a thorough analysis of the legislative and governmental strategies promoting the use of sustainable medicine. It offers important insights for promoting sustainability in the pharmaceutical industry by pointing out gaps, defining useful frameworks, and suggesting doable solutions. Achieving sustainable pharmaceutical practices that support worldwide environmental and public health objectives requires sustained research, policy development, and international cooperation. The area needs to keep developing and implementing sustainable methods like green chemistry to decrease environmental harm and improve sustainability. Furthermore, collaborations among academia, industry, and international organizations are essential to progress and interchange effective strategies.

CFD modelling and simulations of atomization-based processes for production of drug particles: A review

Atomization-based techniques are widely used in pharmaceutical industry for production of fine drug particles due to their versatility and adaptability. Key performance measure of such techniques is their ability to provide control over critical quality attributes (CQAs) of produced drug particles. CQAs of drug particles produced via atomization critically depend on fluid dynamics of sprays; resulting mixing, heat and mass transfer; distribution of supersaturation and subsequent nucleation and growth of particles. It is essential to develop and use computational fluid dynamics (CFD) models for adequate understanding of multi-scale transport processes ranging from molecular scale mixing and particle scale processes, and from atomizer nozzle to overall spray chamber scale establishing relationships between CQAs and design and operating parameters of spray nozzle and chamber. In this work, we critically review past and current research efforts on CFD modelling of pharmaceutical atomization-based processes with an objective to provide clear assessment of the state of the art and to provide recommendations. An overview of the key atomization-based methods for producing drug particles with desired CQAs is presented. Key underlying physical processes and relevant concepts are then outlined. This discussion is related to the demands on CFD models; and state of the art is then discussed with respect to the process needs. Recommendations are provided towards higher fidelity and more efficient models of atomized multiphase flow dynamics and turbulence, drying modelling for the produced particles, and validation approaches. We conclude by highlighting a perceived need for numerical atomization studies with a pharmaceutical context; then, we deliver an outlook on current promising active control and machine learning strategies to augment the shift towards quality-by-design approaches in pharmaceutical manufacturing.

The evolutionary path of medical waste management research: Insights from co-citation and co-word analysis

Over the past decades, medical waste management (MWM) has evolved into a paramount global challenge, intertwining environmental sustainability and public health dimensions. This manuscript traces the paradigm shift from the foundational Basel Convention of 1989 to the significant sway of World Health Organization publications on contemporary debates. Utilizing a mixed approach strategy that blended qualitative and quantitative techniques, the research employed extensive literature review, co-citation and co-word analysis methodologies to ascertain the direction of contemporary trends in MWM. Within the scope of the research findings, current strategies reveal noticeable gaps, especially those that lack sound policy structures, comprehensive insights and effective operational frameworks. Co-citation evaluations spotlight predominant themes in academic references. Foremost among them are the socioeconomic factor, environmental significance, medical waste (MW) stabilization and sustainable society, sequenced by cluster magnitude. Co-word analysis unveils that, despite the long-standing presence of incineration plants, pyrolysis has, since 2016, prioritized environmental considerations. The recycling ethos peaked in 2014, but the sustainability paradigm burgeoned in 2020, with the 'circular economy' gaining momentum in 2021. Emerging trend analysis underscores the mounting significance of circular waste technologies and sustainability as indispensable solutions. Results demonstrate MW advancements and highlight emerging trends shaping the future of the field. The research concludes by accentuating the necessity of global collaborative efforts, integrating cutting-edge technologies and infusing sustainability and circularity tenets into societal frameworks to navigate MWM's intricate landscape. Future research trajectories, including wastewater governance, novel mobile waste disposal strategies and a cyclic waste classification paradigm, are proposed.

[Unfractionned heparin wastage at a French university hospital]

OBJECTIVES

In a context of heparin shortage, we studied the wasted quantities in three intensive care units (ICU) of a university hospital where two electric syringe pump (ESP) heparin protocols coexist (20,000UI/48mL used in the cardiology ICU and 25,000UI/50mL use in the medical and surgical ICUs).

METHOD

We performed a prospective observational study of patients treated with heparin ESP. We collected the information recorded in the prescription software connected to the ESP (dosage, start time, infusion rate, interruption times, date and time of end of treatment). We observed the ESPs, noted the time of start written on the label and the quantity remaining, and questioned nurses about the constraints that lead for changing the ESPs.

RESULTS

Between 23/03/23 and 19/05/23, 164 vials of 25,000UI/5mL were used. The wasted quantity was equivalent 42 vials: 18 vials (43%) of treatment stopped, nurses practices such as changing the ESP in advance 6 vials (14%), application of the rule "discard the ESP 24hours after preparation" 9 vials (21.5%) and 9 vials (21.5%) corresponding to the 45mL discarded for the 45 ESP prepared in the cardiology ICU.

CONCLUSION

More than a quarter of the heparin purchased is wasted. The results should lead to policy decisions concerning the medications supply chain, i.e. abandoning the 20,000UI/48mL protocol, supply of ready to use heparin syringes by industry or by the pharmacy. It is essential that these data be fed back to nurses' teams, in order to gather their suggestions before considering any changes of their practices.

Medication reuse programs: a narrative review of the literature

A proportion of returned medications may potentially meet quality standards to be reused safely. In Australia, there is no regulatory guidance available to facilitate such medication reuse. This narrative review aimed to identify and review international literature describing medication reuse programs to provide insight into their implementation and potential barriers. Using the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) -based guidelines, a literature search was conducted in Medline, Scopus, and Embase using key words such as 'medication' and 'reuse' to identify relevant articles. Two reviewers ascertained eligibility for inclusion. Inclusion criteria included English language and publication after 2010. From the articles selected, identified international medication reuse programs and relevant regulatory aspects were summarized. Details, both regulatory and operational, for the specific medication reuse programs, described in the selected articles was further explored via a grey literature search. Of the 1973 identified articles, 84 were assessed for eligibility and 17 were included in this review. Of these, 14 described scenarios where medication reuse is prohibited, 2 studies described programs allowing the reuse of medication and 1 study did not discuss whether reuse was prohibited or not. From these primary articles, secondary citations were identified, with eight from gray literature. Barriers to medication reuse included exposure to environmental extremes during storage, physical appearance, evidence of tampering, safety, and efficacy concerns for the returned medication. Programs that exist globally have overcome these barriers. Several programs that provide safe and effective reuse of medications were i© The Author(s) 2024. Published by Oxford University Press on behalf of International Society for Quality in Health Care. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site-for further information please contact journals.permissions@oup.com.dentified and described. The findings described in this review should be used to inform frameworks for legislative, regulatory, and professional practice change for medication reuse. Measures implemented in the UK's pandemic response to safely reuse medications in the nursing home and hospice settings and European medication donation programs should be further investigated. The concept of medication reuse is not novel and should be considered for the Australian setting.

Digitalization enhancement in the pharmaceutical supply network using a supply chain risk management approach

One major issue in pharmaceutical supply chain management is the supply shortage, and determining the root causes of medicine shortages necessitates an in-depth investigation. The concept of risk management is proposed in this study to identify significant risk factors in the pharmaceutical supply chain. Fuzzy failure mode and effect analysis and data envelopment analysis were used to evaluate the risks of the pharmaceutical supply chain. Based on a case study on the Malaysian pharmaceutical supply chain, it reveals that the pharmacy node is the riskiest link. The unavailability of medicine due to unexpected demand, as well as the scarcity of specialty or substitute drugs, pose the most significant risk factors. These risks could be mitigated by digital technology. We propose an appropriate digital technology platform consisting of big data analytics and blockchain technologies to undertake these challenges of supply shortage. By addressing risk factors through the implementation of a digitalized supply chain, organizations can fortify their supply networks, fostering resilience and efficiency, and thereby playing a pivotal role in advancing the Pharma 4.0 era.

A call for sustainability: Why unused drugs should be redistributed to pharmacy schools for simulated pharmacy practice learning activities

INTRODUCTION

Pharmaceutical waste from unused or expired medications and supplies has environmental, economic, and social implications. Redistribution of these items from institutions to schools of pharmacy may contribute to global sustainability efforts.

PERSPECTIVE

This commentary outlines the proposed call to action through the United Nation's five dimensions of sustainability: planet, prosperity, people, partnerships, and peace. Reuse of medications by schools of pharmacy ensures the lifespan of a product is expanded, thereby reducing the amount of waste in landfills. Forming partnerships between institutions and schools of pharmacy lends to economic prosperity due to cost-avoidance and cost-recovery. This repurposing also prioritizes people by limiting the impact on supply chains and medication shortages, while also resource sharing in times of need. These efforts lead to increased peace through waste mitigation, mutually beneficial business, social responsibility, and community outreach.

IMPLICATIONS

Collaborations between institutions and schools of pharmacy can reduce pharmaceutical waste, which in turn will enhance the economic stability of both parties, while positively impacting the environment and society in which these partnerships reside.

Pharmaceutical waste management system - Are the current techniques sustainable, eco-friendly and circular? A review

Most households and healthcare facilities usually dispose of contaminated, unused, or expired (CUE) medicines with municipal wastes, the disposal of which usually amounts to $790/ton in the USA and £450/ton in the UK. Solid (e.g., tablets, capsules, powders) and semi-solid (e.g., ointment, creams) pharmaceuticals are managed with incineration/pyrolysis, encapsulation, and engineered landfills, whereas wastewater treatment plants (WWTPs) are recommended for liquid pharmaceutical wastes (PWs). However, to date, the sustainability and eco-friendliness profile of these techniques are only subjectively ensured, leading to controversial viewpoints in many guidelines. Each technique has relative strengths and weaknesses, and their comparative weighting to maximize these profiles is sought after. The present comprehensive review aims to fulfil knowledge gaps in this regard. Four electronic databases (e.g., PubMed/MEDLINE, Scopus, and ScienceDirect) were searched for PW management (PWM)-related qualitative and quantitative articles published till December 31, 2022. Articles without details of waste disposal techniques and their health and environmental impacts were excluded. Based on the literature review, we determine that incineration can be considered a sustainable option for solid and semi-solid PWs, and WWTPs can be eco-friendly for liquid PWs, whereas encapsulation and landfilling are less sustainable. It is high time that objectively proven sustainable and eco-friendly techniques be implemented for PWM based on their dosage forms or nature of hazards. Medicine take-back, eco-pharmacovigilance, extended producer responsibility, co-payment, and life cycle analysis of pharmaceuticals focusing on reduction, reuse/re-dispensing can be integrated to make existing models sustainable, circular, and eco-friendly.

Domestic Waste and Wastewaters as Potential Sources of Pharmaceuticals in Nestling White Storks (Ciconia ciconia)

Information on the exposure of wild birds to pharmaceuticals from wastewater and urban refuse is scarce despite the enormous amount of drugs consumed and discarded by human populations. We tested for the presence of a battery of antibiotics, NSAIDs, and analgesics in the blood of white stork (Ciconia ciconia) nestlings in the vicinity of urban waste dumps and contaminated rivers in Madrid, central Spain. We also carried out a literature review on the occurrence and concentration of the tested compounds in other wild bird species to further evaluate possible shared exposure routes with white storks. The presence of two pharmaceutical drugs (the analgesic acetaminophen and the antibiotic marbofloxacin) out of fourteen analysed in the blood of nestlings was confirmed in 15% of individuals (n = 20) and in 30% of the nests (n = 10). The apparently low occurrence and concentration (acetaminophen: 9.45 ng mL−1; marbofloxacin: 7.21 ng mL−1) in nestlings from different nests suggests the uptake through food acquired in rubbish dumps rather than through contaminated flowing water provided by parents to offspring. As with other synthetic materials, different administration forms (tablets, capsules, and gels) of acetaminophen discarded in household waste could be accidentally ingested when parent storks forage on rubbish to provide meat scraps to their nestlings. The presence of the fluoroquinolone marbofloxacin, exclusively used in veterinary medicine, suggests exposure via consumption of meat residues of treated animals for human consumption found in rubbish dumps, as documented previously at higher concentrations in vultures consuming entire carcasses of large livestock. Control measures and ecopharmacovigilance frameworks are needed to minimize the release of pharmaceutical compounds from the human population into the environment.

Feasibility of an Individualized Dispensing Program for Patients Prescribed Oral Anticancer Drugs to Prevent Waste

PURPOSE

Waste of oral anticancer drugs (OACDs) causes financial and environmental burdens. This study evaluates the feasibility of an individualized dispensing program to prevent waste of OACDs.

METHODS

Adult patients were dispensed individualized quantities of niraparib, abiraterone, enzalutamide, ruxolitinib, osimertinib, or imatinib as standard care, during the first 6 months of treatment. The first 50 patients participated in an feasibility evaluation conform five domains of Bowen's Framework. (1) implementation: reach (eligible patients included) and protocol fidelity (executions following protocol) assessed from pharmacy data, (2) acceptability: rated from 1 to 10 and agreement with theoretical framework acceptability domains via a survey among patients and pharmacy technicians, (3) practicality: program's costs, (4) effect: compared with previous practice (full package supply per month), defined as difference in unused OACD unit doses and net cost-savings, and (5) demand: potential scale-up of the program by including more OACDs.

RESULTS

Participants' median age was 67 (interquartile range [IQR], 58-71) years, and 76% was male. (1) Implementation: reach and protocol fidelity were 89% and 90%, respectively. (2) Acceptability was high among patients (median, 9; IQR, 8-9) and pharmacy technicians (median, 7; IQR, 6-8). All acceptability domains were agreed on. (3) Practicality: program costs were €4,289. (4) Effect: unused OACD unit doses were reduced by 34%, causing net cost-savings of €693 per discontinued patient. (5) Demand: the program could be scaled up to seven times by including all OACDs.

CONCLUSION

Individualized dispensing for patients prescribed OACDs is feasible for preventing waste in terms of implementation, acceptability, practicality, effect, and demand.

Cost-benefit analysis of the integrated pharmaceutical supply chain information service after the establishment of the Korean Pharmaceutical Information Service

Background: The Korean Pharmaceutical Information Service (KPIS) was established in October 2007 to increase the transparency of the pharmaceutical supply chain by integrating relevant information. This study aimed to describe the KPIS program and perform a cost-benefit analysis of the KPIS.

Methods: We conducted a cost-benefit analysis based on cost savings in terms of National Health Insurance (NHI). The outcome measures were the net financial benefit and benefit-cost ratio over the 12 years since the establishment of the KPIS. The cost estimate included the costs of labor and business operations, the development of an information entry system, and office maintenance. Financial benefits were defined as savings resulting from the implementation of the program based on KPIS data. Social benefits were defined as the prevention of recalled medicines from entering the supply chain and the decrease in inventory and disposal.

Results: The KPIS clearly resulted in a net financial benefit, saving 37.2 million USD, which was 2.6 times higher than the cost of implementation. While the benefit-cost ratio was less than one during the first period, it exceeded 3.4 during the second period. After calculating and integrating social benefits, the net benefit increased to 571.6 million USD, and the benefit-cost ratio was 24.8. A sensitivity analysis of the annual benefit showed that the net benefit varied from a low of −1.5 million USD to a high of 24.7 million USD according to the program implementation year.

Conclusion: The establishment of the KPIS and a system for collecting information on the pharmaceutical supply chain showed meaningful financial and social benefits when compared to the input cost. Since no other countries have an integrated pharmaceutical information system that incorporates all information from production to administration, the example of the KPIS can provide a precedent for other countries.

Food Quality, Drug Safety, and Increasing Public Health Measures in Supply Chain Management

Over the last decade, there has been an increased interest in public health measures concerning food quality and drug safety in supply chains and logistics operations. Against this backdrop, this study systematically reviewed the extant literature to identify gaps in studying food quality and drug safety, the proposed solutions to these issues, and potential future research directions. This study utilized content analysis. The objectives of the review were to (1) identify the factors affecting food quality and possible solutions to improve results, (2) analyze the factors that affect drug safety and identify ways to mitigate them through proper management; and (3) establish integrated supply chains for food and drugs by implementing modern technologies, followed by one another to ensure a multi-layered cross-verification cascade and resource management at the different phases to ensure quality, safety, and sustainability for the benefit of public health. This review investigated and identified the most recent trends and technologies used for successfully integrated supply chains that can guarantee food quality and drug safety. Using appropriate keywords, 298 articles were identified, and 205 were shortlisted for the analysis. All analysis and conclusions are based on the available literature. The outcomes of this paper identify new research directions in public health and supply chain management.

Comparing Environmental Policies to Reduce Pharmaceutical Pollution and Address Disparities

Pharmaceutical products, including active pharmaceutical ingredients and inactive ingredients such as packaging materials, have raised significant concerns due to their persistent input and potential threats to human and environmental health. Discourse on reducing pharmaceutical waste and subsequent pollution is often limited, as information about the toxicity of pharmaceuticals in humans is yet to be fully established. Nevertheless, there is growing awareness about ecotoxicity, and efforts to curb pharmaceutical pollution in the European Union (EU), United States (US), and Canada have emerged along with waste disposal and treatment procedures, as well as growing concerns about impacts on human and animal health, such as through antimicrobial resistance. Yet, the outcomes of such endeavors are often disparate and involve multiple agencies, organizations, and departments with little evidence of cooperation, collaboration, or oversight. Environmental health disparities occur when communities exposed to a combination of poor environmental quality and social inequities experience more sickness and disease than wealthier, less polluted communities. In this paper, we discuss pharmaceutical environmental pollution in the context of health disparities and examine policies across the US, EU, and Canada in minimizing environmental pollution.

The sustainability of emerging technologies for use in pharmaceutical manufacturing

INTRODUCTION

Sustainability within the pharmaceutical industry is becoming a focal point for many companies, to improve the longevity and social perception of the industry. Both additive manufacturing (AM) and microfluidics (MFs) are continuously progressing, so are far from their optimization in terms of sustainability; hence, it is the aim of this review to highlight potential gaps alongside their beneficial features. Discussed throughout this review also will be an in-depth discussion on the environmental, legal, economic, and social particulars relating to these emerging technologies.

AREAS COVERED

Additive manufacturing (AM) and microfluidics (MFs) are discussed in depth within this review, drawing from up-to-date literature relating to sustainability and circular economies. This applies to both technologies being utilized for therapeutic and analytical purposes within the pharmaceutical industry.

EXPERT OPINION

It is the role of emerging technologies to be at the forefront of promoting a sustainable message by delivering plausible environmental standards whilst maintaining efficacy and economic viability. AM processes are highly customizable, allowing for their optimization in terms of sustainability, from reducing printing time to reducing material usage by removing supports. MFs too are supporting sustainability via reduced material wastage and providing a sustainable means for point of care analysis.

Medication Use and Storage, and Their Potential Risks in US Households

Background: Medications stored in US households may pose risks to vulnerable populations and the environment, potentially increasing societal costs. Research regarding these aspects is scant, and interventions like medication reuse may alleviate negative consequences. The purpose of this study was to describe medications stored in US households, gauge their potential risk to minors (under 18 years of age), pets, and the environment, and estimate potential costs of unused medications. Methods: A survey of 220 US Qualtrics panel members was completed regarding medications stored at home. Published literature guided data coding for risks to minors, pets, and the environment and for estimating potential costs of unused medications. Results: Of the 192 households who provided usable and complete data, 154 (80%) reported storing a medication at home. Most medications were taken daily for chronic diseases. The majority of households with residents or guests who are minors and those with pets reported storing medications with a high risk of poisoning in easily accessible areas such as counters. Regarding risk to the aquatic environment, 46% of the medications had published data regarding this risk. For those with published data, 42% presented a level of significant risk to the aquatic environment. Unused medications stored at home had an estimated potential cost of $98 million at a national level. Implications/Conclusions: Medications stored at home may pose risks to vulnerable populations and the environment. More research regarding medications stored in households and their risks is required to develop innovative interventions such as medication reuse to prevent any potential harm.

Implementation of the circular supply chain management in the pharmaceutical industry

The ever-increasing levels of pollution and waste creation have subjected industries around the world to incorporate the concept of circular economy (CE) in their supply chains. The amalgamation of the CE approach along with supply chain management is called circular supply chain management (CSCM). Among other industries, the pharmaceutical industry is also involved in damaging the ecosystem. Hence, an effective framework for the adoption of CSCM in a particular industry is very essential. Therefore, this paper aims to devise a model that will help the pharmaceutical industries to adopt CSCM in their organizations. For this purpose, the study in the first phase identifies ten barriers that are working as an impediment in the adoption of the CSCM approach. To counter those barriers, the study in the second phase identifies a set of twelve enablers. To analyse the barriers and enablers, the study uses a new hybrid methodology. For allocating weights and prioritizing the barriers, the fuzzy multi-criteria decision-making (MCDM) technique, i.e. fuzzy full consistency method (F-FUCOM) is used, whereas the total quality management tool, i.e. fuzzy quality function deployment (FQFD) is used to rank the enablers. The results from F-FUCOM suggest "lack of financial resources and funding", "market challenges", and "lack of coordination and collaboration among the entire supply chain network" to be the top-most barriers, respectively, whereas the results achieved from the FQFD suggest "industrial symbiosis", "Reverse Logistic (RL) infrastructure", and "block chain technology" to be the top-ranked enablers, respectively. The provision of a facilitating framework for the adoption of CSCM in the pharmaceutical industry and the newly developed hybrid methodology are both novelties of this study.

Material convergence issue in the pharmaceutical supply chain during a disease outbreak

Purpose

Pharmaceutical donations are a practical approach to increase medicine availability during disasters such as disease outbreaks. However, often donated pharmaceuticals are inappropriate and unsuitable. This convergence of inappropriate pharmaceuticals is a severe operational challenge and results in environmental hazards. This study explores the pharmaceutical supply chains (PSCs) during a disease outbreak to relieve the negative impact of the material convergence problem (MCP).

Design/methodology/approach

This study adopts a situation-actors-process learning-action-performance (SAP-LAP) linkage framework to understand the PSC dynamics. The problem-solving component of the SAP-LAP analysis provides the strategies catering to MCP. The findings from the SAP-LAP helped to develop the causal loop diagram (CLD). This study conducts several experiments on the proposed strategies by integrating CLD into a stock and flow diagram. Later, a disease outbreak case study accessed the pharmaceutical donations effect on PSC performance.

Findings

The study synthesises and evaluates propositions and strategies to incorporate circular economy (CE) principles in PSC. This study proposed two strategies; one to sort and supply and the other to sort, supply and resell. The reuse policy improves humanitarian organisations' finances in the simulation study. This study verified the operational improvement of PSC by reducing the transport and storage burden due to MCP.

Originality/value

This study comprehensively approaches the issue of drug donation and uniquely produced several propositions for incorporating a CE perspective in PSC. The study also proposed a unique simulation approach to model the donation arrivals in response to a disease outbreak using susceptible, exposed, infectious and recovered modelling.

The Impact of Consequences Awareness of Public Environment on Medicine Return Behavior: A Moderated Chain Mediation Model

With global aging trends and prosperity in the medicine market, the number of unused or expired household unused or expired medicines is increasing. Medicines which are discarded improperly result in serious pollution. From the perspective of behavioral science, the main contribution of this paper is the construction of a chain mediation model to analyze the influence mechanism between consequences awareness of the public environment and proper return behavior of unused or expired medicines. The model explores the moderating effect of personal health awareness with through observation of to the mediating effect of personal norms and return intention. Using a sample size of 366 residents from China, the proposed hypotheses are empirically tested. The results show: firstly, the direct effect of residents’ consequences awareness of public environmental awareness on the proper medicine return behavior is not significant; secondly, return intention plays a mediating role in the positive effect of consequences awareness of the public environment on proper return behavior; thirdly, personal norms and return intention play a chain mediating role in the positive impact of consequences awareness of the public environment on proper return behavior; and lastly, personal health awareness moderates the chain mediation path by strengthening the positive effect of return intention on proper return behavior.

Integration of personalized drug delivery systems into digital health

Personalized drug delivery systems (PDDS), implying the patient-tailored dose, dosage form, frequency of administration and drug release kinetics, and digital health platforms for diagnosis and treatment monitoring, patient adherence, and traceability of drug products, are emerging scientific areas. Both fields are advancing at a fast pace. However, despite the strong complementary nature of these disciplines, there are only a few successful examples of merging these areas. Therefore, it is important and timely to combine PDDS with an increasing number of high-end digital health solutions to create an interactive feedback loop between the actual needs of each patient and the drug products. This review provides an overview of advanced design solutions for new products such as interactive personalized treatment that would interconnect the pharmaceutical and digital worlds. Furthermore, we discuss the recent advancements in the pharmaceutical supply chain (PSC) management and related limitations of the current mass production model. We summarize the current state of the art and envision future directions and potential development areas.