Towards Medicines Reuse: A Narrative Review of the Different Therapeutic Classes and Dosage Forms of Medication Waste in Different Countries

Abstract

Background: Medicines reuse, the idea of re-dispensing returned medicines to others following quality control, is yet to be implemented in the UK. This practice is potentially a sustainable way of dealing with returned medicines, which are otherwise classed as medication waste and destroyed. To inch towards medicines reuse, it is important to know more about the different therapeutic classes and dosage forms that make up medication waste. For example, it is helpful to know if medicines being returned are mostly solid-dosage forms and thus have the potential to be reused or are from therapeutic classes that would make medicines reuse cost-effective. Little is known about the therapeutic classes and the dosage forms of wasted medicines. This study aimed to narratively review and report findings from the international literature on the different therapeutic classes and the dosage forms of medicines that are returned by patients to community pharmacies, hospitals, general practitioners’ clinics, or collected through waste campaigns. Studies based on surveys without physically returning medicines were also included where relevant. Methods: A comprehensive electronic search of databases, including PubMed and Google Scholar, was carried out over one month in 2017 and updated by 5 November 2020, using a combination of carefully created keywords. Results: Forty-five studies published in English between 2002 and 2020, comprising data from 26 countries were included and reviewed. Oral solid dosage forms (mostly tablets) were the commonly reported dosage form of all wasted medicines in 14 studies out of the 22 studies (64%) that described the dosage form, with percentages ranging from 40.6% to 95.6% of all wasted medicines. Although there was variability among the levels of medication waste reported in different countries, findings from the UK and Ethiopia were relatively consistent; in these, medicines for the cardiovascular system and anti-infective medicines, respectively, were the most common therapeutic classes for medication waste. Conclusion: This narrative review provides insights about the different therapeutic classes and dosage forms of medication waste either returned by patients, collected through waste campaigns, or indicated in survey responses. The findings could help policy makers understand the potential implications of treating most unused medicines as medication waste and whether therefore pursuing a medicines reuse scheme could be environmentally or financially logical. The quality and the safety of these returned medicines using criteria related to the storage conditions (such as heat and humidity), physical shape (such as being sealed, unopened, unused, and in blister packaging), and tampering are other important considerations for a medicines reuse scheme.

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

“…Countries with a percentage of anti-infective waste medicines similar to that found in the present study were Ethiopia, 22 Egypt, 19 and Tanzania, 35 where anti-infective drugs are among the most widely used medicines. 7 , 22 On the other hand, a possible cause of the high prevalence of antibacterials for systemic use may be inappropriate prescribing, which is still a major concern in Italy. 36 , 37 , 38 These data should encourage public policies to improve appropriate prescribing of antibiotics, including the development of practical, evidence-based prescribing guidelines, access to postgraduate training, and better availability of diagnostic tools.…”

“…all lead to household stockpiling of medicines that are eventually disposed of, and thus wasted. 7 , 8 Pharmaceutical waste may also represent an environmental risk due to improper disposal. 9 , 10 …”

Knowledge, Attitude and Practice of Disposal of Unused, Unwanted and Expired Medicines among Healthcare Professionals

“…Pharmaceutical waste is a growing problem in different parts of the world in terms of its negative impact on the environment and human health including governmental expenditures. 23 Ecopharmacovigilance emphasizes the source control of pharmaceutical waste to the environment.…”

The Validity of the Theory of Planned Behaviour for Understanding People’s Beliefs and Intentions toward Reusing Medicines

“…The behaviour of interest here is whether people will accept medicines that are returned unused to a pharmacy for their own use (i.e., take part in medicines reuse). The influencing factors for medicines reuse could include, for example, the perceived advantages and disadvantages of performing the behaviour, views about the therapeutic classes and safety [ 1 , 2 ], and storage conditions [ 3 ] of returned unused medicines, and social pressure or normative belief regarding reusing medicines. Understanding the precise nature and significance of these factors is not straightforward, but could be explored using psychological theory.…”