Knowledge, attitude, and practice of unused and expired medication disposal among second year medical students

Background: Medications are not only used for disease treatment, but also for diagnosis and prevention of the disease. Not all the prescribed drugs are used by the patients, due to lack of adherence to therapy, there are chances of stocking up the unused or expired drugs at home. It is important to provide practical and scientific guidelines for the safe disposal of expired, unused, and leftover medications. Most developing countries lack standard guidelines for the safe disposal of expired, unused, and leftover medications. There are very few studies conducted in this region to assess the knowledge of the safe disposal of unused drugs. Aims and Objectives: The present study was undertaken to assess the knowledge, attitude, and practice of disposal of unused or expired medications. Materials and Methods: This was cross-sectional, questionnaire-based study conducted among 2nd year undergraduate medical students at a Medical College in South India. The questionnaire included three parts: Part I includes demographic details of the students and questions on knowledge of safe disposal of expire/unused drugs, Part II includes questions on attitude towards the safe disposal of expired/unused drugs, and Part III includes questions on practices toward the safe disposal of expired/unused drugs. The responses received from the participant was analyzed using Microsoft Excel (2019 version), and the results are explained in frequency and percentage. Results: A total of 118 2nd year medical undergraduate students participated in the present study. Out of 118, 62 (52.5%) were female students and 56 (47.4%) were male students. Among all the participants, 98 (83%) of students said that they are aware of medicinal waste. In the present study, 73 (61.8%) students knew about the safe disposal of unused, expired, and leftover medications. Most of the students (93.2%), agreed that unsafe disposal of unused, expired, and leftover medications would adversely affect the environmental, animal as well as human health. And 50% of the students, strongly agreed that educational activities like drug take-back programs should be introduced among the public people. When the students were asked about their practice of keeping expired, unused, or left-over drugs at home, 66.1% (78) of the students said yes and 47.2% (40) of the students said they do not keep the leftover medicine at home. Topical formulations (63.5%) were the most common group of drugs that were stored. The majority of students (73%) reported that they would throw unused/expired medications in dust bins at home. Self-discontinuation is most the common reason for storing drugs in the majority of the study participants (39%). Conclusion: In the present study, the 2nd-year medical undergraduate students had awareness regarding the harmful events associated with improper disposal of unused or expired drugs. But due to lack of information or knowledge of safer methods available, majority of the students were following inappropriate methods for disposing leftover or expired medication at home. Indian Government should provide national level guidelines and conduct awareness programs, mediated through healthcare professionals to bring significant changes about the disposal of unused or expired medications.

Reliability and Validity of the Malay Version of the Return and Disposal of Unused Medications (Redium) Questionnaire in Malaysia and the General Public’s Knowledge, Attitude and Practice on Unused Medications

@#Introduction: In understanding of the general public’s knowledge, attitude and practice (KAP) on the returning and disposal of unused medications is imperative towards the designing of better educational materials and policy development. The objectives of this study was to validate the Malay version of the Return and Disposal of Unused Medications (ReDiUM) questionnaire for use among Malaysian as well as to gain an understanding on these patterns of behaviour among Malaysians. Methods: The English version of the ReDiUM was translated into Malay language according to international guidelines. Content and face validity of the questionnaire was examined by experts. Subsequently, the questionnaire was pilot tested in 10 native speakers. Reliability was assessed using Cronbach’s alpha coefficients. The test-retest reliability was measured with Spearman’s Correlation Coefficient and Cohen’s κ coefficient. Public were recruited through convenient sampling for the study. Results: The study recruited 319 respondents. For test-retest reliability, all the correlation coefficient values were >0.5 indicating strong reliability (26 respondents). Except few items, most of the kappa coefficients were >0.61 indicating substantial to almost perfect agreement. Cronbach’s alpha of the KAP domains were 0.585, 0.770 and 0.759, respectively. The median knowledge score was only 50% with some negative attitudes and practices found. Conclusions: The translated questionnaire was valid and reliable for use in Malaysia with acceptable to strong internal consistency and most items with substantial to almost perfect agreement. The findings from the study provide supporting evidence for policy makers to develop interventions to help with reducing wastage and optimize healthcare expenditure.

Practices and attitudes concerning expiration date, unused, and expired medication disposal

Background: According to the product type, the date of expiration is set after manufacturing or after dispensing of the medication or after opening of the medication’s container. Objective: The objective of the study was to assess practices and attitudes concerning unused, disposal, and expiration date of medications among Saudi population in the Northern Border Region of Saudi Arabia. Materials and Methods: A cross-sectional study conducted during a period of 9 months from April 2019 to January 2020 on a random sample, all data were analyzed by means of descriptive analysis. Results: The total number of people answered the questionnaire during the study period were 529, nearly all the participants (99%) keep medication in their homes at the study time. Only half of the participants (53%) were aware that expiry date on the bottle differs after bottle opening. About 24% of participants do not check the expiry date while purchasing medications. The main cause mentioned for not checking the expiry dates while purchasing medicines were that pharmacist already checked (71%), about half of study participants (56%) check the expiry date of stored medicines at the time of usage. About 34% and 41% of participants reported that if they buy eye/ear drops and ointment/cream respectively, they will keep it in bedroom. About 74% of study participants throw away expired medicine in household garbage as it is. Conclusion: It is obvious that Saudi people have a sufficient level of awareness of the expiry date of medication; however, their practices are poor. In light of the study findings, there is a great need to improve public awareness toward the storage and disposal of drugs and its bad consequences.

A study on awareness and disposal practices of unused and expired medicines by consumers

Background: Hazards to the environment due to improper drug disposal practices is an issue of concern. The prescription drugs, disposed into trash /sewage, consequently enter into surface waters and contaminate even drinking water. In view of the potential hazards posed due to improper storage and disposal of medicines, evaluation of the awareness of the consumers and educating them about proper disposal methods is required. The aim of present study was to evaluate the awareness and practice of drug disposal among the population.Methods: A cross sectional, observational study was conducted at Rural Health Centre (RHTC) of Kamineni Academy of Medical Sciences and Research Centre with the patients visiting the RHTC as the study subjects. A predesigned questionnaire was used to evaluate the awareness and disposal practices of unused and expired medicines by the respondents.Results: On analysis it was observed that 80 (57%) of the respondents procure medicines from health care centre. A total of 97 (69%) respondents possess unused/leftover medicines at home, 54 (39%) of the respondents mentioned the reason to be due to self discontinuation. Among the class of drugs left unused antibiotics constituted 13%, antipyretics 6%, analgesics 6%. 49% of the respondents dispose unused medicines in domestic trash, 24% flush down toilet/sink. A majority of 121 (86%) opined that awareness must be made created.Conclusions: In present study it was observed that many of the respondents possessed leftover medicines and were unaware of the hazards of improper disposal of medicines. Thus, there is a need for proper educational and regulatory interventions.

Practice towards disposal of medicines (unused/expired drugs) among the patients visiting tertiary care teaching hospital in Haryana, India

Background: Awareness towards improper disposal of medicines and its hazardous impact on environment is one of the major issues which we are neglecting but needs to be focused. In general, expired medicines/waste medicines/ left out medicines are disposed in the garbage or, rinse in sink or flushed down toilet, which ends up in the water system and have a potential effect on ecosystem. With this background, the present study was conducted to assess the practice towards disposal of medicines (Unused/Expired Drugs) among the patients visiting tertiary care teaching hospital in Haryana.Methods: This study was a descriptive, cross-sectional study conducted through face-to-face interviews by using a validated structured Questionnaire in patients attending the OPD of PGIMS, Rohtak, Haryana. A total of 150 patients participated in this study.Results: Among the 150 Patients participated in the study, 94 were male and 56 were female. Most common class of medicines used were NSAIDS (34%). About the practice of disposal of medicines 62% of them threw into the dustbin (household garbage) 18% into the toilet/sink. About consequences of improper disposal (55%) of them answered that they were not aware. The most common reason for left out medicines in home was incompletion of the course due to getting relieved from disease (50%). Most common way of procuring medicine was purchased on prescription and surprisingly only 30% participants checked the expiry date of medicine before procuring.  Among the participants 75% said that government should be responsible to create awareness for proper disposal of unused medicines.Conclusions: The present study brought out the current status and lacuna towards the disposal of medicines. Patients do not use all the medications and there is lack of knowledge about awareness of disposal of medicines and its consequences.

A Study On Unused And Expired Drug Disposal Practices : Knowledge And Behavioural Patterns Among The Rural Population

INTRODUCTION:Unused and expired drugs in the households constitute a dominating cause of environmental contamination with drugs and other health hazards in addition to Industrial waste of the pharmaceutical companies. There are no proper disposal mechanisms being followed in India even we do not have a legislation to follow and to make health care providers accountable. METHODOLOGY:Around 650 households were surveyed to know about their current practicing methods of drug disposal and also their knowledge on impact of improper drug disposal on health and environment. RESULTS:Our study shown that nearly 85% of the participants discarded leftover medications by throwing them in the Garbage, while 7% burned in open place and few Respondents 1-2% followed returned to Pharmacy/health facility/friends etc. CONCLUSIONS :There is an urgent need for creating awareness among the people regarding proper drug disposal mechanisms

A study on awareness regarding disposal of unused medicines among consumers at a tertiary care teaching hospital of North India

Background: In the recent years, large number of human pharmaceuticals have been introduced to the environment by landfill when household medications are thrown to trash and liquid medications gain access to the environment via liquid drainage systems. There is lack of knowledge and awareness in the general public regarding the safe disposal of unused and expired medicines. The objective was to assess the awareness regarding disposal of unused medicines among consumers at a tertiary care teaching hospital of north IndiaMethods: It was a cross-sectional observational questionnaire-based study carried out on 220 consumers in medicine outpatient department (OPD) of a tertiary care teaching hospital in North India for 3 months. All the participants were provided the pre-validated self-administered questionnaire. The final questionnaire consisted of twelve questions to assess participants’ knowledge and attitude towards disposal of the medicines. The data was analyzed with the help of descriptive statistics.Results: It is quite evident from the present study that majority of participants 56.36% stated 1-5 drugs were left-over drugs at their homes. Most of the leftover medicines were analgesics in 59.1% followed by antibiotics in 51.36%. Most common dosage form of these leftover medicines were tablets in 85.9% of respondents. Majority of the respondents (55.9%) were not aware of the adverse outcomes of the pharmaceuticals in the environment. The most common method followed by majority of the participants for disposing of the solid, semi-solid and liquid dosage forms was garbage in 95%, 91.4% and 76.4% of consumers respectively. About 9.31% of the participants were in favour of initiating a program to collect unused medications from home.Conclusions: It can be concluded from the present study that the consumers had poor knowledge regarding the safe drug disposal techniques. Therefore, efforts need to be done by the health care professionals to make people educate regarding the safe drug disposal techniques.

A study of knowledge and practice for disposal of unused and expired pharmaceuticals among medical undergraduates at tertiary care teaching hospitals in Uttar Pradesh, India

Background: Increasing disease incidence and prevalence necessitate healthcare practitioners to prescribe diverse medications. Families and patients are in possession of unused or expired medications and its risks have started gaining notice across the world. Majority of them including medical students are unaware about the disposal of unused or expired medicines. Misuse and improper disposal of unused/expired medications is a major safety and environmental concern, and thus proper disposal of those medications is highly important.Methods: Questionnaire based study was conducted among medical undergraduates of third year MBBS in two tertiary care teaching hospitals of Uttar Pradesh after approval from Institutional Ethical Committees during July-August 2018.Results: There were 65% of respondent had unused drugs in their home while 30% had the expired drugs. The most common reason for the unused and expiry drugs in the home was self-discontinuation. Analgesics were the main group of drugs possessed by participants. 67% in this study responded that drug disposal method was disposing the expired drugs to garbage. Only 26% know about the area in the city where unused/expired drugs are collected. 46% think that proper education of the community is required for appropriate disposal of unused drugs.Conclusions: Intervention by education about prudent drug disposal techniques that are also environmentally safe and acceptable is the need of time to change their behavior. There is also needing to understand the practice and awareness of the public to make any such education by program a success.

A Qualitative Study: Factors Related to the Prevalence of Leftover Drugs for Senior Patients in Japan / 社会薬学

To consider what pharmacists can do to prevent patients from having leftover prescription drugs, we conducted a qualitative study about the various causes behind the unused drugs. We interviewed one male and four female home-care patients who had leftover prescription drugs that pharmacists detected via their home visiting service. The Grounded Theory Approach was used for analysis, and two types were identified as “exogenous factors that cause confusion for the patient” and “patient’s personal thoughts and feelings.” “Exogenous factors that cause confusion” involved eight factors, including unsuitable dosing schedule for lifestyle, complex timing for taking medicine, and inadequate support for enhancing patients’ compliance. These factors were divided into ［problems with prescription］ and ［difficult changes to manage］. In “patient’s personal thoughts and feelings,” 16 concepts were identified and their broader concepts comprised six categories: ［distrust of drugs］, ［taking a positive view about one’s own non-compliance］, ［psychological distance from medical staff］, and others. It was assumed that there would be a perception gap of compliance between patients and medical staff. Moreover, patients affirmed their poor compliance and they did not see the occurrence of leftover drugs as a problem. Additionally, psychological distance from medical staff prevents patients from consultation. Therefore, pharmacists should check patients’ compliance for each drug as well as any medical problems. Knowing patients’ inherent mind revealed by this study, the pharmacist can assist medication alongside patients and contribute to the early prevention of unused drugs.

Examining the Effect of Pharmacists’ Visits to Homebound Patients on the Elimination of Unused Drugs / 医薬品情報学

<b>Objective: </b>To examine the effect of pharmacists’ visits to homebound patients on the elimination of unused drugs.<br><b>Method: </b>We conducted a survey with pharmacies throughout Japan that provided home-visit service, asking them questions regarding their work with up to five patients (the survey period was from January 15 through the end of February, 2013).  Main survey questions were: (1) whether they managed unused drugs since the start of their home-visit, and (2) how they managed the unused drugs.  For (2), we conducted case studies by asking the pharmacists to choose the case that impressed them most and describe the unused drugs involved, actions taken, and the results.<br><b>Results: </b>Data on 5,447 patients were collected from 1,890 pharmacies throughout Japan (collection rate: 56.9%).  Pharmacists managed unused drugs from 2,484 patients (45.6%). 1,746 patients (3,590 cases) were qualified for analysis.  In 2,332 cases (65.0%), pharmacist intervention eliminated the incidences of unused drugs.  In 782 cases (21.8%), unused drugs were discarded, while the number of drug administration days was adjusted in 2,623 cases (73.1%).  In 21 cases (0.6%), drugs were both discarded and had the number of days adjusted.  There were others for 164 cases (4.5%).  The total price of the eliminated unused drugs was approximately 6,920,000 yen (4,000 yen/person).  Illnesses that benefited most from the elimination of unused drugs were chronic respiratory failure (16,306 yen/person), and Parkinson’s disease (4,803 yen/person).<br><b>Conclusion: </b>We confirmed the economic effect of eliminating unused drugs by pharmacists’ home visits.